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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Gun Control and Veteran Suicides: Is Research Lacking?

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Like most everyone, the gun control debate is front and center on both sides of the political spectrum.  Sadly, very few – if any – of proposed changes to existing gun control laws would have a major impact on Veteran suicides.

ptsd

I recently came across an interesting article published in the Washington Post entitled “The reasons we don’t study gun violence the same way we study infections.”    The gist of the article is that well over half (actually 62%) of gun-related deaths in the United States reported by CDC are suicides.  Sadly, very little money is allocated to the study of suicides.  Some of these reasons stem from restrictions on gun research, but a chronic lack of funding suggests that other topics receive the lion’s share of research money.

The article, written by Carolyn Johnson,  states the following:

There are a few reasons for the gun violence research disparity. First, there are legislative restrictions on gun research. For two decades, the Centers for Disease Control and Prevention has been prevented from allocating funding that could be used to advocate for or promote gun control. Although that doesn’t explicitly exclude all research on gun violence, it is said to have had a chilling effect on funding.

Aside from political pressure, there is a more philosophical one in which injuries are treated differently than disease. Injuries are a public health issue, but the debate over gun research often becomes mired in a debate over whether a person who intentionally wants to hurt himself or another person will do so, with or without a firearm. Research is also often driven by where researchers see the biggest scientific opportunity to come up with a cure or therapy, and infections or cancer may simply be easier to study than gun violence using traditional tools.

One of the complications of a study like this is that it uses broad categories to look at spending trends. For example, if the majority of gun violence is suicides, it might make more sense to study suicide, regardless of whether it involves a firearm. But suicide, too, has been chronically underfunded compared with its health burden. The number of deaths annually from breast cancer are now about the same as suicide. But breast cancer research received $699 million in NIH research funding in 2016; suicide and suicide prevention received $73 million.

While it is difficulty to draw too many conclusions from Ms. Johnson’s article, it would appear that cure or therapy-related research “may simply be easier to study than gun violence using traditional tools.”   In other words, simple evidence-based studies seem to attract more funding rather than complex studies, such as suicide prevention.

Using Ms. Johnson’s analysis, it is not surprising that the VA feels more comfortable funding marijuana studies which help Veterans cope with the symptoms of PTSD rather than treat brain injury.  In fact, over the last 15 years, the VA has done little – if anything – to treat Veterans with PTSD.

Citing a National Institute of Health 2014 study of the VA, Maj. Ben Richards points out that despite the most sophisticated therapy provided by the VA the average PCL-M score to assess Post Traumatic Stress has fallen only 5 points.  In fact, PCL-M scores for “treated” Veterans is still well above the 50 benchmark considered adequate by the military.

Ben Richard's PTSD VA Study

For more of Maj. Ben Richard’s analysis of the Department of Veteran’s Affairs costly and rather futile effort to help Veterans with PTSD, please CLICK HERE.

While the VA embarks on yet another study to combat the symptoms of PTSD, tens of thousands of needy Veterans are deprived of necessary research to help them reclaim their lives rather than simply cope with their problems.

A well-tested program, Hyperbaric Oxygen therapy (“HBOT”) has allowed Maj. Ben Richards to recover much of his cognitive function.  Yet, Dr. David Cifu and others at the VA still refuse to fund HBOT for Veterans with PTSD.

Veteran suicide rates are currently 22% than the normal population.  Doesn’t it make sense to provide workable therapy programs to Veterans rather than embark yet again on studies that treat symptoms rather than the problem?  Our Veterans deserve much more.

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Hyperbaric Oxygen: What the VA Doesn’t Want You To Know

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The gatekeepers at the Department of Veteran Affairs (the “VA”) remain intransigent in providing urgently need care to Veterans suffering from PTSD and/or TBI. Standard Operating Procedure (“SOP”) at the VA is to argue that FDA-approved clinical studies are needed to sanction treatment methods – regardless if these treatment alternatives have been used with success in many other countries for decades and, in some cases, hundreds of years.  

hyperbaric oxygen and the VA

Instead, the VA serves our Veterans a cocktail of potentially lethal prescription drugs that do carry the FDA’s “Good Housekeeping Seal of Approval.”   How is this possible when the Centers for Disease Control and Prevention (“CDC”) reports  an epidemic in addiction to prescription drugs?

Unfortunately, the VA’s SOP in prescribing these opioids to Veterans with PTSD and TBI hasn’t changed in many years.   Why?  Could it be that the benefits to Big Pharma outweigh the benefits of providing our Veterans with the treatment they merit?   I am most hesitant to ask this question, but I can think of no other explanation.

For instance, treating head injuries with Hyperbaric Oxygen Therapy (“HBOT”) has been around for decades.  It is the standard procedure provided to wounded soldiers and civilians with head injuries by the Israeli medical profession for decades.

This short video below is in Hebrew with English subtitles, but it provides a very compelling argument why our Veterans should have access NOW to HBOT while the bureaucrats and FDA twiddle their thumbs and continue to ingratiate themselves with Big Pharma lobbyists.

Gordon Brown  of Team Veteran argues that  “We need this type treatment in our VA and military hospitals instead of the DRUG therapy they are now using. Most TBI cases have been misdiagnosed as PTSD and drug treatment cause further complications for our veterans.”   Gordon’s views reflect my own and those of hundreds if not thousands of Veterans.

In fact, some hospitals in the private sector are taking radical steps to curtail the use of opioids in treating pain.  In an recent New York Times article, St. Joe’s hospital is implementing wide-ranging changes to comply with CDC recommendations:

“St. Joe’s is on the leading edge,” said Dr. Lewis S. Nelson, a professor of emergency medicine at New York University School of Medicine, who sat on a panel that recommended recent opioid guidelines for the Centers for Disease Control and Prevention. “But that involved a commitment to changing their entire culture.”

In doing so, St. Joe’s is taking on a challenge that is even more daunting than teaching new protocols to 79 doctors and 150 nurses. It must shake loose a longstanding conviction that opioids are the fastest, most surefire response to pain, an attitude held tightly not only by emergency department personnel, but by patients, too.

Is it too much for that lumbering behemoth VA to show the same sense of urgency?

I suppose we can continue to get distracted with the many other “big” issues facing our country, but providing our Veterans with proper therapy is one issue where Americans can easily unite.  Let’s not let the bottom line of Big Pharma distract us from that mission.  The brave men and women who have served our country deserve no less.

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Military News Highlights – Week of March 20, 2016

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

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

Better than a War on Drugs
Pendulums are made to swing from one side to the other. So it is for the prescribing pendulum for narcotic analgesics in the U.S. today. For decades, until the 1990s, doctors were closed fisted about prescribing pain medications, with little basis for that approach other than an American tendency to puritanical attitudes towards drugs. The result was that far too many people, including those with severe, intractable pain, suffered needlessly.   Read more . . .

Prescription Drugs Targeted by PTSD

Is the Glock Pistol the Next Military Sidearm?
The U.S. Army‘s chief of staff is searching for alternatives to the multi-year Modular Handgun System effort, to include piggy-backing on Army Special Operations Command’s current pistol contract.  Gen. Mark Milley has used recent public appearances to criticize federal acquisition guidelines that all services must follow when choosing and purchasing weapons and equipment.  Read more . . .

The Military is from Mars, Civilians are from Venus
We’ve attended many meetings where it felt like the military personnel were from Mars and the civilians were from Venus: part of the same solar system, but from planets with vastly different landscapes and languages. And we knew many of our friends and colleagues who had also shared this far-too-common experience.   Read more . .  .

LZ Grace:  A Place to Heal
Lynnette Bukowski discusses LZ Grace Warriors Retreat.  Lynnette, and many volunteers, have transformed a 38 acre farm in Virginia Beach into a place for members of the special operations community and first responders to decompress and recharge. Lynnette shares the story of her husband, a Navy SEAL, and discusses some of the unique challenges the she faces in supporting who are accustomed to serving, and often suffering, in silence.   Read more . . .


VA Programs Caregivers May Not Know About
Roughly 5.5 million people serve as caregivers for veteran family members. The Department of Veterans Affairs has a lesser known benefit for these family members. Known as Caregiver Support Services, these benefits aim to help family members who are tasked with the primary care of a disabled veteran. The services available include access to a caregiver support line, support coordinator, peer support for caregivers, adult day health care centers, and home care, among other things.  Read more . . .

A War Correspondent’s Trouble with PTSD
The war was changing me, hardening me. I felt flashes of pure rage when someone ran into me on the basketball court or cut me off on the road. I chose tables at restaurants that were as far from the front doors and windows as possible, in case a bomb went off outside. I would wake up whenever there was a sound in my bedroom and then be unable to fall back asleep. In some of my dreams, loved ones died. In some, I did. I had full-blown PTSD.   Read more . . .

Join SFTT in helping get our Veterans the support they deserve.

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