Did the VA Hook Veterans on Opioids?

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Recent information suggests that 68,000 Veterans are addicted to some form of opioid (hydrocodone, oxycodone, methadone and morphine).  The VA argues that “more than 50 percent of all veterans enrolled and receiving care at the Veterans Health Administration are affected by chronic pain, which is a much higher rate than in the general population.”

Oxycontin and PTSD

According to the Center for Investigative Reporting obtained under the Freedom of Information Act,

. . . prescriptions for opioids surged by 270 percent between 2000 and 2012, leading to addictions and a fatal overdose rate that was twice the national average.

Citing a VA Office of Inspector General’s report, the Center for Ethics and the Rule of Law (CERL) said: “Between 2010 and 2015, the number of veterans addicted to opioids rose 55 percent to a total of roughly 68,000. This figure represents about 13 percent of all veterans currently prescribed opioids.”

The American Society for Addiction Medicine reports these startling facts on the opioid epidemic currently sweeping the U.S.

– Drug overdose is the leading cause of accidental death in the US, with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015.

– From 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel. The overdose death rate in 2008 was nearly four times the 1999 rate; sales of prescription pain relievers in 2010 were four times those in 1999; and the substance use disorder treatment admission rate in 2009 was six times the 1999 rate.

While evidence provided by the Center for Controlled Disease and Prevention (CDC) suggests that the use prescription opioid painkillers has fallen some 41% since its peak in 2010, some 33,000 Americans died last year from addiction to opioids.  The addiction to prescription painkillers like Vicodin (hydrocodone) and Percocet (oxycodone) are rampant in the U.S.

The VA and Prescription Drugs for PTSD

For well over 5 years, Stand for the Troops (“SFTT”) has been reporting on the Department of Veterans Affairs (“the VA”) fascination with potent prescription drugs to treat Veterans with PTSD.

Despite the VA’s dismal record in effecting any meaningful change in patient outcomes, a cocktail of prescription drugs (generally opioids) are often the last resort since the VA’s Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) treatment programs have proved largely unsuccessful.

In what continues to be standard SOP, the VA perseveres in treating the symptoms of PTSD without offering any compelling life-changing treatment alternatives.  In effect, the VA is tacitly admitting “we don’t have a clue,” while arguing that they are providing the best therapy available and to seek funding for new “clinical” studies that address symptoms and not causes (i.e. cannabis, for instance) of PTSD and TBI.

In our research (mostly anecdotal but with those “in the know”), SFTT discovered that many Veterans treated with prescription opioids for PTSD would become violent and often suicidal.  In fact, they would often either discard these potent drugs (“flush them down the toilet”) or sell them on the black market to civilians.

One former Veteran explained that his colleagues would often grind up oxycontin pills into a powder and sell it on the black market for approximately $500 a month.  So prevalent was this behavior, that the government forced a large pharmaceutical company to produce oxycontin only in gel.  The result:  sales at the pharmaceutical company dropped 60% once the black market disappeared.

Personally, I think the FDA and the pharmaceutical industry effectively colluded into turning many Veterans and a large percentage of our population into junkies.

The Rationale?:  The level of addiction in the U.S. and easy access by the public to potent prescription drugs is simply unprecedented if compared to other countries.

How to Fix the VA’s Opioid Credibility Problem

It is sad to read the daily stories of spouses and loved ones deal with ravages of PTSD.  A few days of reading the Facebook page of “Wives of PTSD Vets and Military” will give you some idea of the ravages of the silent wounds of war.

Sure, we can continue to medicate these Veterans and military personnel with prescription drugs to deal with the symptoms, but I would far rather see an attempt to reverse the causes of debilitating brain injury rather than mask the symptoms.

There are several noninvasive solutions used by other countries.  First and foremost is hyperbaric oxygen therapy or HBOT that is widely used by the IDF.  For reasons that seem incomprehensible, the DoD claims that there is no scientific evidence to suggest that HBOT is effective.

Gosh, there doesn’t seem to be much evidence that suggests that prescription opioids, Prolonged Exposure (PE), and Cognitive Processing Therapy (CPT) are effective either.  Yet, the VA continues to push it’s stale and misleading agenda that it is providing our Veterans with the best available treatment programs.

Surely, we can do better than “talk the talk.”  Let’s look for real solutions.  If it can’t be found in the VA, let’s give the private sector an opportunity to help our brave Veterans.

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SFTT News: Week Ending Jun 3, 2017

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Found below are a few military news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT.

North Korea Threatens Nuclear Option Unless U.S. Steps Down
North Korea told the U.S. Thursday to withdraw its military assets from the region, warning via state-run media that a military showdown would end in nuclear destruction. North Korea’s official Korean Central News Agency released an article titled “U.S. Urged Not to Adventure Military Actions,” in which an official tasked with inter-Korean relations criticized the U.S.’s military moves in the region. Japan, an ally of Washington and rival of Pyongyang, began major naval and air force exercises Thursday with the U.S.’s Carl Vinson and Ronald Reagan aircraft carriers, Reuters reported.  Read more  . . .

Marijuana PTSD

Department of Veterans Affairs Will Look at Medicinal Marijuana
Department of Veterans Affairs officials will review research that medical marijuana could provide health benefits to veterans undergoing treatment at the VA, Secretary David Shulkin told reporters Wednesday at the White House. “There may be some evidence that this is beginning to be helpful, and we’re interested in looking at that,” Shulkin said of medical marijuana.  Read more . . .

Veterans Treatment Court Success Reported in Michigan
Of the 446 veterans that entered one of Michigan’s VTC from October 2014 to September 2016, 66 percent successfully completed it, according to the state’s Problem Solving Courts 2016 annual report. The program is also credited with reducing unemployment among VTC grads by two-thirds. Since it was founded in 2013, the 51st District Court’s VTC has graduated 34 participants. District Judge Richard Kuhn said those who complete the course “demonstrate strength, dedication and perseverance.” Currently, 18 others are working their way through the program.  Read more . . .

Computer Based Program to Treat PTSD?
On Wednesday, Creighton, the University of Nebraska Medical Center and a local nonprofit called At Ease USA announced a $1.2 million grant to pay for a new clinical trial of the cutting-edge PTSD treatment. The trial will also include PTSD-affected domestic violence victims as well as children suffering from post-traumatic stress.  If it goes as hoped, the study will replicate two initial trials — one performed in Omaha, one in Israel — that showed that the computer-based treatment significantly reduces symptoms and even normalizes the brain activity of Iraq and Afghan War veterans suffering from PTSD.  Read more . . .

Six PTSD Resources You Should Know About
Veterans have a variety of resources to turn to when they have concerns about post-traumatic stress disorder, or PTSD. Symptoms of the disorder don’t necessarily indicate PTSD and some reactions to stress and trauma are normal conditions. The best way to find out if you suffer from PTSD is through a medical professional, who can then advise treatment options. Doctors and online resources may identify the problem and help with the necessary treatment available.  Read more . . .

Veterans Training Service Dogs – Not Available from the VA
Dr. David Shulkin, appointed to his role in February announced he will launch a new initiative this summer ‘Getting to Zero’ to help end Veteran suicides as his top clinical priority.  Here in the Bay area, one local non-profit is trying to bring hope to veterans by ending the war on suicides and fighting PTSD by teaching veterans how to train their own service dogs.  Founder of K9 Partners for Patriots found a unique way to help veterans control their road to recovery by teaching them how to train a canine through commands and how to deal with interactions in public.  Read more . . .

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

Feel you should do more to help our brave men and women who wear the uniform or our Veterans? Consider donating to Stand For The Troops

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Genetics to Cannabis: Implications for Treating PTSD

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Severe depression and a heightened sense on anxiety tend to be symptoms of PTSD in returning Veterans from our wars in Iraq and Afghanistan.   Nevertheless, these symptoms and how veterans cope with these issues in their everyday life vary significantly.    In fact, many returning veterans (see video below) can be oblivious to the problem until friends and family point out that their reactions to everyday frustrations seem well out of proportion to the circumstances.

While many Veterans are receiving treatment for PTSD, recent studies by the GAO suggest that the Department of Veteran Affairs (“VA”) is failing our Veterans and their loved one. A recent GAO report points out that “10% of vets treated by VA have major depressive disorder and 94% of those are prescribed anti-depressants.” Sadly, VA protocols have not changed much over the past several years as anti-depressant medication seems to deal with the symptoms of PTSD rather than provide any meaningful therapy for those Veterans at risk.

Do Genes Play a Role in Depression?

While the VA has been glacially slow to accept new treatment protocols, a number of scientific studies suggest that the genetic makeup of human beings could play a factor in recurring depression. For instance, Healthline reports that a British Research team:

” . . . recently isolated a gene that appears to be prevalent in multiple family members with depression. The chromosome 3p25-26 was found in more than 800 families with recurrent depression. Scientists believe as much as 40 percent of those with depression can trace it to a genetic link. Environmental and other factors make up the other 60 percent.

Research has also shown that people with parents or siblings who have depression are up to three times more likely to have the condition. This can be due to heredity or environmental factors that have a strong influence.”

Scientists at Stanford recently concluded that “This could mean that in most cases of depression, around 50% of the cause is genetic, and around 50% is unrelated to genes (psychological or physical factors). Or it could mean that in some cases, the tendency to become depressed is almost completely genetic, and in other cases it is not really genetic at all. We don’t know the answer yet.

While it is still far to early to draw any conclusions from these initial studies, the treatment of PTSD could become far more targeted and hopefully, effective, if it is determined that our genetic makeup plays a major factor in one’s propensity for depression.

Citing this and other studies, Dr. Richard Friedman, a professor of clinical psychiatry at Weill Cornell Medical College, concluded in an Op-Ed piece for the New York Times:

Recent neuroscience research explains why, in part, this may be the case. For the first time, scientists have demonstrated that a genetic variation in the brain makes some people inherently less anxious, and more able to forget fearful and unpleasant experiences. This lucky genetic mutation produces higher levels of anandamide — the so-called bliss molecule and our own natural marijuana — in our brains.

In short, some people are prone to be less anxious simply because they won the genetic sweepstakes and randomly got a genetic mutation that has nothing at all to do with strength of character. About 20 percent of adult Americans have this mutation.

Dr. Friedman then goes on to make a compelling case why marijuana or cannabis might be useful in treating PTSD.   As SFTT has argued many times, there is a vast difference between “treating the symptoms” of PTSD and “treating PTSD.”   As the most recent GAO Report suggests most Veterans diagnosed with PTSD are served a cocktail of prescription anti-depressants drugs which in some cases may have led to suicide.    While “prescription” cannabis in a controlled environment may reduce anxiety disorders, it is impossible to predict how well those symptoms may be masked if ingested with other anti-depressants.

SFTT’s own findings have suggested that well over 80% of Veterans suffering from PTSD suffer from substance abuse.    As such, clinical studies focused on one variable should be rigorously questioned before reaching any conclusions.  Nevertheless, found below is some recent research into using cannabis to treat PTSD.

Cannabis for Treating PTSD?

Citing research published in the Journal Neuropsychoparmacology, the Huffington Post reports the following:

” . . . administering of synthetic cannabinoids to rats after a traumatic event can prevent behavioral and physiological symptoms of PTSD by triggering changes in brain centers associated with the formation and holding of traumatic memories.

 ‘While cannabinoids occur naturally in the cannabis plant, this research was done with WIN 55,212-2, a synthetic cannabinoid that produces a similar, effect to that of THC, marijuana’s main psychoactive compound. The researchers specifically looked at the effect of this synthetic cannabinoid on exposure to trauma reminders. Among individuals who suffer from trauma, it is common for non-traumatic events (for instance, sirens going off) to evoke the memory of the traumatic event, thus amplifying the negative effects of the trauma.

“The findings of our study suggest that the connectivity within the brain’s fear circuit changes following trauma, and the administration of cannabinoids prevents this change from happening,” the researchers concluded. “This study can lead to future trials in humans regarding possible ways to prevent the development of PTSD and anxiety disorders in response to a traumatic event.”

Dr. Friedman, quote previously in his New York Times article titled “The Feel Good Gene,” goes on to comment on the use of cannabis in treating anxiety disorders:

“The endocannabinoid system, so named because the active drug in cannabis, THC, is closely related to the brain’s own anandamide, is the target of marijuana and has long been implicated in anxiety . . .  We all have anandamide, but those who have won the lucky gene have more of it because they have less of an enzyme called FAAH, which deactivates anandamide. It is a mutation in the FAAH gene that leads to more of the bliss molecule anandamide bathing the brain.

“People with the variant FAAH gene are less anxious and are thus less inclined to like marijuana. They actually experience a decrease in happiness when smoking marijuana, compared with those with the normal FAAH gene, who find it pleasurable. If you naturally have more of the real thing you understandably have little use for marijuana.

“Studies show that those without the variant gene suffer more severe withdrawal when they stop using cannabis. Here, at last, is an example of a mutation that confers an advantage: lower anxiety and protection against cannabis dependence — and possibly to addiction to some other drugs, too.”

Sadly, Dr. Friedman engages is some wishful posturing to help those that “are genetically disadvantaged” due to “a random and totally unfair assortment of genetic variants.”

The fact is that we are all walking around with a random and totally unfair assortment of genetic variants that make us more or less content, anxious, depressed or prone to use drugs . . . But psychotropic medications, therapy and relaxation techniques don’t help everyone, so what’s wrong with using marijuana to treat anxiety? . . . The problem is that cannabis swamps and overpowers the brain’s cannabinoid system, and there is evidence that chronic use may not just relieve anxiety but interfere with learning and memory. What we really need is a drug that can boost anandamide — our bliss molecule — for those who are genetically disadvantaged.

It is prophetic talk like this to prescribe “bliss” medications  that create the expectation that there is some “silver bullet” that will help Veterans with PTSD reclaim their lives.  Test and test some more, but don’t promote “bliss” pie-in-the-sky without fully addressing the potential harmful side-effects caused by cannabis, particularly when used in combination with other prescription drugs.

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