Over-Medicated Veterans: Military Abuse and Public Tolerance

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Thomas Catan’s article in the Wall Street Journal entitled “For Veterans with PTSD, A New Demon: Their Meds” is not news. The over-use of drugs as routine part of battlefield medicine has been noted since the first days of our military deployments to Iraq in the spring of 2003.

Over-reliance on the miracles of modern pharmaceuticals has became just Standard Operating Procedure in the US military.

And, likewise with the Dept. of Veterans Affairs medical system.

Even the casual observer will note substantial evidence that over-medication is endemic to all areas of our nation’s current healthcare systems — military and civilian.

But, in the military and VA, there are even more incentives to “push” pills.

As one example, it’s no coincidence that the senior Pfizer official for “government relations” from 2005 -2010 was a former Director of Veteran Affairs (twice) and long-time inside-the-Beltway power player.   See here »

Pfizer was the firm involved in the Chantix debacle with Iraq war veteran James Elliott and the involuntary testing of this smoking cessation drug — with known significant psychotropic side effects — on a group of “psychologically damaged” vets at the Washington DC Vets Center.

The nature of business in the heavily regulated pharmaceutical industry — and the huge sums spent by the federal government on drugs — means that all major pharmaceuticals have similarly well-connected Potomac Patriots in key lobbying roles.

It’s  also safe to say that these huge firms, thanks to their “K” Street lobbyists and the lack of meaningful oversight by Congress, “own” this part of the federal budget — military and civilian.

Given the complexities and uncertainties of healing damaged minds, whether visible or invisible wounds, and the intensive, expensive work required for the most effective therapies, it’s no surprise the VA finds it much easier to dope ’em up, and send them out the door.

And, in the sad case of the former Marine highlighted in this WSJ article, I’m not sure any amount of effort and other therapies would make a difference.

(Personal admission: dealing with alcohol and drug abusers was the least enjoyable aspect my time as a front-line troop leader, so my hat is off to all those who are truly trying to make a difference in this area where success is so damn difficult to come by, and failures make tragic headlines too damned often.)

The one certainty is that the drug companies make their profits, whether this former Marine takes the meds or flushes them down his toilet.

My bottom line: this is part of the price for an ill-conceived war, a price to be paid for decades to come as too many of our Vets struggle with the twin demons of TBI and PTSD, and Washington remains focused on short-term profits, not long-term solutions.

Roger Charles

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F.D.A. on Prescription Drugs

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People complain that the F.D.A. takes far too long in approving “new” drugs, but they seem to be equally obtuse in pointing out the dangers of using drugs they have already approved.  According to a new article appearing in the New York Times, the F.D.A seeks tighter control on prescriptions for class of painkillers.     I suppose we should be grateful that the guys and gals in the white robes in D.C. have finally come to their senses and realize that we now have a nation of addicts: addicted to prescription and generic pain killers all approved by the F.D.A.   How sweet!

The “debate” is not without its polemics as this lengthy excerpt from the New York Times article suggests:

 

“In 2011, about 131 million prescriptions for hydrocodone-containing medications were written for some 47 million patients, according to government estimates. That volume of prescriptions amounts to about five billion pills.

Technically, the change involves the reclassification of hydrocodone-containing painkillers as “Schedule II” medications from their current classification as “Schedule III” drugs. The scheduling system, which is overseen by the D.E.A., classifies drugs based on their medical use and their potential for abuse and addiction.

Schedule II drugs are those drugs with the highest potential for abuse that can be legally prescribed. The group includes painkillers like oxycodone, the active ingredient in OxyContin, methadone and fentanyl as well as medications like Adderall and Ritalin, which are prescribed for attention-deficit hyperactivity disorder, or ADHD.

In recent years, the question of whether to tighten prescribing controls over hydrocodone-containing drugs has been the subject of intense lobbying.

Last year, for example, lobbyists for druggists and chain pharmacies mobilized to derail a measure passed in the Senate that would mandate the types of restrictions that the F.D.A. is now recommending.

At the time, the lobbying arm of the American Cancer Society also said that making patients see doctors more often to get prescriptions would impose added burdens and costs on them.

Senator Joe Manchin III, Democrat of West Virginia, expressed dismay when the proposal died in the House of Representatives.

“They got their victory – but not at my expense,” said Mr. Manchin, whose state has been hard hit by prescription drug abuse. “The people who will pay the price are the young boys and girls in communities across this nation.”

As SFTT has been reporting for many months,  prescription drug abuse with terrible side-effects is chronic among the many brave warriors returning from combat in Iraq and Afghanistan.   Sadly, treating the symptoms with OxyContin and other toxic pain-relievers has been the panacea prescribed by the VA.  Despite clear and irrefutable evidence that this was causing more harm than good for warriors suffering from PTS and TBI, the lobbyists and their political pundits in government were reluctant to pull the plug on what is little more than government-sponsored drug addiction.

Finally, we may get an opening to help these brave young men and women rebuild their lives without the terrible consequences of addiction.

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Obama’s Dictator is Better than Bush’s Dictator

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The Obama administration is once again immersed in a political tragedy in Egypt largely of its own making.  How it will play out is largely anyone’s guess, but President Obama seems destined to make the same silly mistakes in international diplomacy that have plagued previous administrations.  Mind you, his motives may be well-intended, but trying to be on the “right side of history” often leads to the blood of others to be shed.

Other than politicians who have no sense of irony, I find it ironic that the Obama administration and the accompanying media who seemed so enamored of the Twitter-fueled revolution that brought down President Mubarak  should now be seeking shelter in the embrace of yet another Egyptian military dictatorship.    Of course, we don’t want to call it a dictatorship and curtail aid, but it seems that this military dictatorship is preferable to the Obama administration than the Bush administration’s dictator.   Um….

While I don’t have a clue what is going on in Egypt – certainly anymore so than Tweety-bird Wolf Blitzer of CNN – I am quite familiar with dictatorships.   They aren’t fun.   Deciding on which dictator is better than another is a fool’s errand and best left to historians after the dust settles.   Didn’t we choose the better dictator  in Vietnam?

Clearly, the events in Egypt are a tragedy, but self-serving comments by the Obama administration that has stood-by while 100,000 people have died in Syria is sophomoric in its cynicism and hypocrisy.

Sure, let’s keep our troops at home.   But please!:   Let’s curb our penchant for meddling is situations we don’t understand and, most certainly, can’t influence.

Save the “tough talk” for the 200,000 or so veterans suffering from PTS who have fought wars in Iraq and Afghanistan.    These brave and often troubled young men and women certainly deserve our compassion.   More importantly, they happen to be living in the United States.

Richard W. May

STFF

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President Obama and VA Claims

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With great fanfare, President Obama “told a crowd of disabled veterans on Saturday that his administration has made headway with efforts to battle a longstanding backlog of disability claims.”

As reported in the Washingon Post, “’Today, I can report that we are not where we need to be, but we’re making progress,’” Obama said during a speech at a Disabled American Veterans’ convention in Orlando. “’In the last five months alone, it’s down nearly 20 percent.  We’re turning the tide.’”

If true, this is very good news indeed, but one needs to be rather skeptical if only recently the VA reversed course on Agent Orange disability claims from the Vietnam War.   Editor’s Note: That’s a hell of a VA backlog for a war that ended over 40 years ago.

Our research suggests that many of the 200,000 plus veterans suffering from Post Traumatic Stress have been misdiagnosed by the VA, received inadequate treatment, prescribed a cocktail of dangerous drugs or simply been ignored.

While I have no problem with the President taking credit for a statistical drop in the backlog of veterans seeking VA support, who is accountable to the tens of thousands of veterans from Iraq and Afghanistan who are jobless, often homeless and addicted to drugs and alcohol while they cope with the disabling consequences of PTS?

Personally, I would like the President to address the chronic problems faced by the many brave men and women who have served in harm’s way and not received the promised support they merit.   Brave leaders address the troops directly rather than stand behind a pulpit for a staged political event.

Sharing in the suffering of our brave warriors is now even more important the lauding their success.

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SFTT and PTS

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For several months SFTT, its medical task force and its Board have been thoroughly analyzing the battlefield of brave warriors suffering from Post Traumatic Stress and examining the resources and procedures currently available to treat this crippling disability. We have purposely dropped the “D” from PTSD since most scientific research indicates that PTS is far more serious than simply a “disorder”.

There are countless stories of brave young men and women suffering from PTS, some of which have been chronicled in SFTT. The social consequences of this growing problem are enormous and, sadly, there is no magic bullet on the horizon to deal with this problem in the numbers required to stem its insidious growth. Substance and alcohol abuse, joblessness, homelessness, alienation, low self-esteem and even suicide are just a few of the manifestations of PTS faced by returning veterans and their loved ones.

Sadly, the VA has been unable to stem the near epidemic growth of veterans suffering from the conditions of PTS and TBI (“traumatic brain injury”). Fortunately, a number of public and private institutions have emerged which are beginning to address some of the necessary conditions that must be in place to provide a lifeline to our veterans and promote a path to “wellness.”

Over the next couple of weeks, SFTT will be sharing some of these “new” treatment procedures and existing programs where our brave Veterans can receive the treatment they merit. Our ultimate objective to share these resources with Veterans and their loved-ones by re-positioning SFTT to become the go-to resource for those afflicted by PTS.

There is much information on PTS available to Veterans, but it is hard to identify actionable resources that have proven to be reliable to Veterans. SFTT – with the support of its medical task force – intends to become that “do-to” resource by partnering with other organizations that have the same goal: Help our brave Veterans reclaim their lives.

Join SFTT by becoming a Member and help provide our brave Veterans the Lifeline they deserve.

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Dr. Yuval Nuria on the Boston Marathon Massacre

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Many Americans are both deeply saddened and outraged over the horrific carnage at the Boston Marathon massacre. Unfortunately, there is a tendency to rush to judgement based on very limited and conflicting information on who the perpetrator(s) is and their motivation. In some respects, this “rush to judgement” is fueled by poorly researched media reporting, but judging from the Tweets received by Josh Zepps of Huffington Post, reactions to tragic events are often shaped by ideology or mental preconceptions that seem to be totally illogical and poorly considered.

Found below is a rather lengthy interview (26 minutes) by Josh Zepps of Huffington Post with four panelists, including SFTT’s Medical Advisor, Dr. Yuval Nuria, discussing how people react to traumatic situations. Dr. Nuria is Professor of Clinical Psychology at Columbia University. Dr. Nuria begins speaking at minute 3 in the video:

This tragic terrorist event brings home the incomprehensible grief and trauma faced daily by our brave young men and women in uniform who serve in harm’s way. SFTT is indeed fortunate to have someone as experienced as Dr. Nuria to help develop effective treatment programs that address the needs of our brave warriors who suffer from PTS.

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PTSD Treatments

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As the VA struggles to deal with the overwhelming number of cases of Veterans suffering from PTS, new approaches are beginning to manifest themselves.  From Equine therapy to Transcendental Meditation, no approach is being dismissed lightly given the clear evidence that prescription drugs have not proven to be successful in providing a long term cure.

SFTT is thrilled to count on the assistance of Yuval Neria (see below) is a Special Advisor to SFTT’s Medical Task Force.    We welcome his active collaboration.

Yuval Neria

Medical Center (CUMC Director of Trauma and PTSD Program, and a Research Scientist at the New York State Psychiatric Institute (NYSPI) …

While SFTT often focuses on the men and women suffering from PTS, it is clear that their spouses, children and immediate families are not immune to the terrible side-effects.

Study: PTSD affects veterans’ spouses, too – ksl.com

PTSD generic paxil 20 mg tablet affects veterans’ spouses, tooksl.comResearchers have know for some time that PTSD places relationships at risk, but this new research raises red flags for health risks for a spouse or partner. “It’s having an effect beyond the vet …

Military May Be Turning to Meditation for PTSD – PsychCentral.com

Military May Be Turning to Meditation for PTSD.  Military May Be Turning to Meditation for PTSD With its emphasis on developing tranquility, meditation may seem an odd fit for the military. But recent studies have shown that mindfulness …

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Veteran Treatment Courts and PTSD

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It is pleasing to see that CBS decided to feature one of the 120 or so Veteran Treatment Courts in the United States on one of its most popular investigative programs: 60 Minutes. Found below is a brief summary of this very moving and disturbing report:

Two and a half million Americans have served in Iraq and Afghanistan; many of them, more than once. The VA tells us about 20 percent come home with post-traumatic stress disorder, known as PTSD. So, that comes to about 500,000. For some, returning is harder than they imagined. The suicide rate for the Army is up 15 percent over last year. For the Marines its up 28 percent. A few of our troops return to become something they never thought they could be: criminals, for the first time in their lives.

Around Houston, in Harris County, Texas, 400 veterans are locked up every month. We met a judge there who saw them coming before the bench, fresh out of the warzone and he thought a lot of them were worth saving. Judge for yourself once you meet some of our troops, coming home.

A byproduct of the 1995 Crime Bill, the Veterans Treatment Court (Vets Court for short) is a way for Veterans facing jail time to avoid incarceration. If they accept, they are assigned to a mentoring Veteran and must remain drug-free for two years, obtain a high school diploma and have a steady job at the end  of the probation period. This may seem like a good deal, but the path to recover their lives is difficult and fraught with temptation, particularly for those Veterans with PTSD.

SFTT applauds those in law enforcement and the judicial system and supporting Veterans organization for developing such an effective and common sense approach to help Veterans reintegrate into society. 60 Minutes paints a very sympathetic picture of the Veterans Administration in this rehabilitation process, but Vets that we have talked to who have participated in Vet Court programs paint a somewhat different picture.

It is evident that there is a high incidence of dependency on drugs, potent painkillers, antidepressants and alcohol among those with PTSD. One graduate of the Veterans Court Program who now is a substance abuse counselor told me that close to 90% of Vets with PTSD have substance abuse issues.

Now, the VA has very strict rules on issuing prescription medication to Veterans with documented substance abuse problems. In other words, it may be difficult for Veterans to receive proper treatment for PTSD if substance abuse and PTSD are treated as mutually exclusive problems. This clearly introduces a level of difficulty for the VA in providing the type of comprehensive rehabilitation treatment these Vets deserve. Some may call it Catch 22, but I am sure our Vets find it no laughing matter.

In any event, SFTT applauds the Veteran Treatment Courts and is committed to help them expand across the United States.

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Gun Control Legislation and Military Suicides

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The terrible tragedy in Newtown has spurred much debate about gun control legislation in the United States.   With gun-related deaths in the United States 20 times more than the average of other countries in the developed world, it is clearly a horrific problem for our nation.  What is less-well publicized is that two-thirds of the reported 32,000 gun deaths in the United States are suicides.    This has led some to suggest that any new gun control legislation may have a more pronounced effect on reducing suicides than other gun-related violence (see below).   I am not convinced given the  focus on automatic weapons and over-sized magazines.

The Center for Disease  Control and Prevention reports that there were approximately 38,000 suicides in 2010 and of those, roughly half were by firearm.   Which brings us to a very alarming statistic:  A military veteran commits suicide every 80 minutes or 22 a day!  In other words, nearly 8,000 veterans commit suicide each year.  Astonishingly, 1 in 5 suicides in the US is a military veteran  and it rarely raises a ripple among that smug crowd within the DC Beltway who appear to use gun control legislation to press some self-serving political agenda.  Some writers suggest that military suicides (includes Vets) could be closer to 1 in 4! (see below).   Shouldn’t the focus of the discussion be on those most at risk from death by firearm rather than the weapon of choice?

It would be reassuring to think that our government leaders would spend as much energy focused on helping our brave warriors reclaim their lives rather than dissipate their energies on political rhetoric which dramatizes gun violence without providing a responsible solution.   Sadly, our political leadership don’t seem up to the task of focusing on the BIG PICTURE.

As much as the Sandy Hook tragedy stirred our nation into looking for answers to deter gun violence, our Vets and their loved ones experience their own Newtown massacre each day  when on average 22 Vets commit suicide.    Isn’t it time we as a Nation wake up to the BIG PICTURE and mobilize the necessary resources to deal with this unending tragedy?   This is a time for REAL LEADERSHIP!

Gun Control and Suicide – NYTimes.com

Modest regulations are more likely to deter suicide than prevent murder, and should be judged accordingly.

What Researchers Learned About Gun Violence Before Congress

We’re not just looking at mass shootings, but also looking at the bulk of the homicides that occur every year and the suicides, which account for a majority of all gun deaths. Then the last question is how do you do it? Once you

Record Numbers of US Military and Veteran Suicides | Global

Headlines like this should shock: Suicides Outpace War Deaths. Surge in Military Suicides. Nearly Two Dozen Veterans Commit Suicide Daily. These reports and similar ones reveal imperialism’s dark side. War takes its toll.

REAL Number of Veteran Suicides in the U.S. Too High To Be

I’d thought that everyone in U.S. was aware of the mass number of veterans that we lose to suicide each day, but a recent message I received from a supportive Facebook group administrator who helps me by sharing my

Report: Veterans suicides may be underestimated – Marine Corps

Veterans make up 22.2 percent of all suicides in the U.S., and that startling figure might actually be an underestimate because of difficulty in determining veterans’ status, according to a new report.

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PTS is much better than PTSD

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As psychiatrist Dr. Jonathan Shay says below “I really don’t like the term ‘PTSD.”   SFTT doesn’t like the term either and internally we prefer “PTS” or Post Traumatic Stress.  Clearly, there is a stigma attached to the term “disorder” but it also suggests – erroneously – that this debilitating problem of great personal and social significance is simply a “disorder” that can be medicated or treated and that the individual afflicted with PTS will soon

lead a normal and healthy life.

VA studies suggest (see below) that there is no “silver bullet” and as SFTT’s Medical Advisory Board has recommended, one needs to experiment with a number of treatment modalities to determine which one(s) are best suited for a Vet’s particular situation.   Certainly, it is more than medication and may involve extended job retraining and the acquisition of other practical life-skills to help returning vets on the path to a richer life.  Just because there is no easy solution, doesn’t mean that we need to turn our backs on these brave heroes.

Public Insight Network | Beyond PTSD to “moral injury”

“I really don’t like the term ‘PTSD,’” Department of Veterans Affairs psychiatrist Dr. Jonathan Shay told PBS’ “Religion & Ethics Newsweekly” in 2010. “He says the diagnostic definition of “post-traumatic stress disorder” is a fine 

PTSD: The Futile Search for the “Quick Fix” | Guest Blog, Scientific

Short-term TFTs are regularly prescribed by the VA, and yet, VA studies indicate that the majority of veterans treated for PTSD are still in treatment four years later (see Fig. 2). The military and VA want a quick fix, but that’s not

The Truth About PTSD and America’s Military Veterans | Video

There are few people who inspire more respect and admiration than our brave servicemen and women — those willing to selflessly serve their country and at times, even face death for the sake of others. While it is always a

Families: Vets’ PTSD ‘like living in hell’ – NavyTimes.com

Families: Vets’ PTSD ‘like living in hell’NavyTimes.comUntil the day she wrestled a gun from the mouth of her drunken husband, the 37-year-old wife of a Tennessee Army National Guard sergeant thought she was holding it together. But then the flashbac …

If you want to help, please consider becoming a Member of SFTT and add your voice to a growing chorus of concerned citizens.  Our brave warriors need more than lip service.

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