The VA and Opioids: Finger-pointing Begins

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SFTT has been reporting for a number of years the abuse at the Department of Veterans Affairs (“the VA”) for prescribing addictive prescription drugs to Veterans suffering from PTSD and TBI.

Despite repeated messaging by VA officials that it applies “science-based evidence” to prescribe treatment for Veterans, it would appear that the VA has been sadly duped into believing that painkilling opioids is a “science-based” solution to treat Veterans with PTSD.

The Washington Post reports tonight (Oct 15, 2017), that 60 Minutes will provide an expose on how the drug industry triumphed over the DEA.   While I have no idea how CBS will spin the narrative,  it has been evident for many years that the pharmaceutical industry “owned” Congress and government authorities who “regulated” their business practices.

Opioids for Veterans with PTSD

The fact that we have an opioid epidemic in the United States should be of no surprise to anyone who has watched this tragedy unfold.    What is a surprise, is that the same groups who enabled this tragedy are now sounding the alarm bells to curb the excesses they themselves created.

In an earlier blog, SFTT cited a few organizations that should have the decency to admit that their “science-based evidence” completely underestimated the effect that easy prescription practices would contribute to addiction.

I do not doubt that corporate greed has played a large role in this terrible prescription drug epidemic, but let’s not forget their important enablers:

More to the point, politicians of both parties deserve a large measure of culpability in providing pharmaceutical companies with the breathing space and easy access to peddle their lethal drugs to the medical profession and naive end users.

How the VA Fueled the Opioid Crisis

Just this last week, Newsweek describes in detail how the VA fueled the opioid crisis by prescribing potent prescription drugs to Veterans suffering from the effects of PTSD and TBI.

In 2011, veterans were twice as likely to die from accidental opioid overdoses as non-veterans. One reason, as an exhaustive Newsweek investigation—based on this reporter’s book, Mental Health, Inc.—found, is that for over a decade, the VA recklessly overprescribed opiates and psychiatric medications. Since mid-2012, though, it has swung dangerously in the other direction, ordering a drastic cutback of opioids for chronic pain patients, but it is bungling that program and again putting veterans at risk. (It has also left untouched one of the riskiest classes of medications, antipsychotics—prescribed overwhelmingly for uses that aren’t approved by the Food and Drug Administration (FDA), such as with post-traumatic stress disorder.)

The Newsweek article, written by Art Levine, goes into great detail how the VA let our Veterans down by prescribing prescription drugs to Veterans with PTSD with little – if any – required approvals from the FDA.

Like most other pseudo-science arguments spun by VA spokespeople, our brave Veterans did not receive proper therapy for PTSD and TBI but rather were served a concoction of addictive drugs that simply mask the symptoms rather treat the problem.

The VA then felt the need to discredit any other therapy programs for Veterans that might conflict with the limited “approved” VA treatment options.

While there does seem to be a strong effort to curb the use of prescription pain drugs, Art Levine points out that this has forced addicted Veterans to seek other alternatives:

Equally troubling, the crackdown on opiate prescribing—a swing from one dangerous extreme to another—may be contributing to an increase in heroin and illegal opiate medication use among veterans, as well as suicides from pain-wracked veterans going through poorly monitored withdrawal. (Even with new opioid guidelines, the number of veterans with opioid-use disorders increased 55 percent from 2010 to 2015.)

While recognizing the heart-wrenching impact of this epidemic is certainly an important first step, it seems ludicrous to suggest that the same cast of characters who created the problem should be the ones empowered to solve it.

Veterans, Veteran organizations and our political leaders have known for years that the VA is broken.   How many more needless Veteran deaths and suicides do we need to confirm the undeniable fact Veterans are not receiving proper care and treatment at VA facilities?

While 60 Minutes will no doubt cast a dark shadow on the pharmaceutical industry, shouldn’t their partners in crime stand up and admit their undeniable culpability?

Our Veterans deserve far better than the shady dealings between unethical drug companies and their no less reprehensible political benefactors.

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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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