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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What do NFL and Military Helmets Have In Common?: Not Much!

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Like many, I am moved by the tributes paid to military Veterans and active service members at NFL games.  Nevertheless, both the NFL and the military have come under sharp criticism regarding the number brain injuries suffered on both the playing field and battlefield.

chronic_traumatic_encephalopathy

Both the NFL and military have stonewalled the problem for many years, but it now appears that the NFL is taking action to introduce a “safer” helmet in the hope that they can reduce concussions and permanent brain injuries for professional athletes. Hopefully, better protective gear will work its way through college and high school football programs.

The Vicis Zero1 helmet has now been purchased by 25 NFL teams and will be introduced during the 2017 season. According to initial press releases:

In testing against 33 other helmets to measure which best reduces the severity of impact to the head, the Vicis ZERO1 finished first. Included in the study were helmets from Schutt and Riddell, which currently account for approximately 90 percent of helmet sales.

Vicis was founded by neurosurgeon Sam Browd and Dave Marver, former CEO of the Cardiac Science Corporation, with the goal of reducing the high rate of concussions in football. While it would take years of play and further studies to conclusively prove that they’ve been successful, the studies show that they’re on their way to making an impact.

Found below is a video explaining how this helmet helps provide additional protection to football professionals:

While the safety requirements for battlefield and football helmets differ significantly, it does appear that the NFL has acted a lot quicker than the military to protect its professionals.

Reducing brain injuries at their point of origin is far preferable to treating neurological damage to sensitive brain cells in the aftermath.

The US Army – and other DoD components – have long been aware that current helmets offer battlefield personnel little protection against IED devices typically found in Afghanistan and in the Middle East.  Indeed, SFTT has been reporting on various studies by the military embedding sensors into military helmets.

According to my calculation, the US Army has over 10 years of sensor data to draw on.  Surely, this is sufficient to draw some conclusions and develop a better-designed helmet capable of providing additional protection against concussive brain injury.

While the military continues to “study” the issue, it is encouraging to see the NFL to take action.  Frankly, I don’t buy the NFL sales pitch that the league rushed in to protect the health and safety of its players.  If true, they would have done so long ago when the NFL first started studying brain injuries.

As the New York Times reported earlier, the NFL leadership buried extensive “concussion” evidence collected between 1996 and 2001 to deflect potential claims by former NFL players who had suffered brain damage.

As we have seen in the case of body armor,  DoD leadership and the NFL have much in common:  a strong propensity to hide the facts from their employees and the public at large.

While one can find many faults in the way the NFL leadership has acted “to protect the safety of its players” and the integrity of their franchise, NFL teams are now treating brain injuries far more seriously than the DoD.

In addition to helmets, several NFL teams are now treating players with suspected brain injury with hyperbaric oxygen therapy (HBOT).    Sadly, the Department of Veterans Affairs continues to block the use of HBOT in treating Veterans with PTSD and TBI.

Could it be that DoD personnel charged with evaluating HBOT therapy failed to employ the proper protocols in 2010 clinical testing procedures?  If so, why?

SFTT remains hopeful that both the VA and the DoD will act quickly to introduce helmets that afford more protection to battlefield personnel and approve HBOT as an acceptable treatment procedure for PTSD and TBI.

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Hyperbaric Oxygen Therapy (HBOT) by Grady Birdsong

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Hyperbaric Oxygen Therapy HBOT Grady BirdsongGrady Birdsong, a USMC Veteran from Vietnam, has co-authored a book with Col. Robert Fisher (USMC – Ret) that deals with hyperbaric oxygen therapy (“HBOT”) entitled “The Miracle Workers of South Boulder Road:  Healing the Signature Wounds of War.”

The book is a 2016 Best Book Awards finalist and details how HBOT helps reverse the damage of traumatic brain injury.   In a must-hear interview, Grady Birdsong explains his experience with HBOT (and now his advocacy)  to Jerry Fabyanic on his “Rabbithole” program at KYGT in the Idaho Springs/Denver area.

Grady Birdsong spikes up interest in hyperbaric oxygen therapy with a down-to-earth radio interview with KYGT Radio with the following introduction:

In our advocacy campaign to make this clinic and treatment known, I had the good fortune of being interviewed on KYGT Radio over the weekend by Jerry Fabyanic on his “Rabbithole” program in a mountain town close to Denver. He has so graciously provided me with a link to that interview about our book. We most gratefully appreciate his voice and his audience at KYGT in the Idaho Springs/Denver area. Likewise my close friend and veteran Marine, David T. “Red Dog” Roberts, 1st Bn, 4th Marines, Delta Company in Vietnam and his Doc, Corpsman, Kenneth R. Walker produced two songs that are complementary to this advocacy of healing the signature wounds of war. You will hear them in the interview.

CLICK HERE for the entire and very educational 50+ minute podcast.

SFTT has long recommended the use of hyperbaric oxygen therapy or HBOT to treat Veterans with the symptoms of PTSD and TBI.  There are many studies that prove conclusively that the supervised application of HBOT helps improve brain function and restores cognitive abilities.

While Mr. Birdsong points out the many restorative benefits of HBOT, follow-up supervision is recommended to help deal with some of the symptoms of PTSD.

Sadly, in many online forums dealing with the ravages of PTSD, most military families are unaware of the benefits of regular supervised “dives” in HBOT chambers.  I would argue that the Department of Veterans Affairs has purposely discredited the use of HBOT in treating PTSD and TBI to promote their own failed agenda and the prevalent use of addictive prescription drugs.

One only needs to listen to the likes of Dr. David Cifu, Senior TBI Advisor to the Department of Veterans Affairs, to see the cynicism and blatant disregard for clinical evidence adopted by the VA against HBOT.   One can only speculate why, but HBOT seems to offer Veterans a far better solution than the cocktail of drugs served up by the VA.

Found below is a very moving and instructional video by Grady Birdsong of a young woman who “recovered her life” from the “signature wounds of war” with the use of HBOT:

Thanks to the effort of Grady and many other dedicated Veterans, we can all join together and help Veterans reclaim their lives. It is simply the right thing to do!

Nevertheless, the benefits of HBOT will not be widespread until the restrictive and self-serving barriers to this treatment are adopted and encouraged by the VA. Secretary Shulkin of the VA wants change to occur at the VA.  What better way to demonstrate his commitment to reducing Veteran suicides than by embracing HBOT to treat PTSD?

If you want to learn more about how HBOT can be used in treating PTSD and TBI, I suggest that you purchase The Miracle Workers of South Boulder Road:  Healing the Signature Wounds of War.  Share it with family and friends to encourage them not to give up hope on our brave Veterans.

For those tired of watching the lives of loved one end in pain, depression and hopelessness; write Dr. Shulkin and members of Congress and ask for action.  Don’t allow naysayers and self-serving bureaucrats like Dr. Cifu block Veteran access to HBOT.

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Hyperbaric Oxygen Therapy (HBOT) to Treat Veterans with PTSD

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Veterans and casual observers continue to be mystified why the Department of Veterans Affairs (the “VA”) continues to insist on failed therapy programs to treat Veterans with PTSD.

Dr. David Cifu, the senior TBI specialist in the Department of Veterans Affairs’ Veterans Health Administration, argues that Veterans treated with Cognitive Behavioral Therapy and Prolonged Exposure Therapy are receiving the best therapy possible to treat PTSD.   There is no reliable third-party verification to support Dr. Cifu’s bold assertion.

More to the point, Dr. Cifu dismisses  other treatment alternatives arguing that there is no scientific basis to support them.  In particular, Hyperbaric Oxygen Therapy (HBOT) has been singled out for particular disdain by Dr. Cifu.

Specifically, the VA concluded their trial “study” with the following observations:

“To date, there have been nine peer-reviewed publications describing this research,” Dr. David Cifu, VA’s national director for physical medicine and rehabilitation recently told the Oklahoman. “All the research consistently supports that there is no evidence that hyperbaric oxygen has any therapeutic benefit for symptoms resulting from either mild TBI or PTSD.”

Frankly,  there is voluminous scientific evidence that HBOT is both a viable and recommended treatment alternative for Veterans suffering from PTSD and TBI.

Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric Oxygen Therapy or HBOT is available at many privately-owned hospitals in the United States and around the world.  There is compelling scientific evidence that HBOT reverses brain damage.

In fact, HBOT is the preferred therapy of  the Israeli Defense Forces (“IDF”) for service members with head injuries.  Frankly, this assertion alone trumps any argument to the contrary by Dr. Cifu.

In its most simple form, HBOT is a series of “dives” in a decompression chamber (normally 40) where concentrated oxygen is administered under controlled conditions by trained physicians.  There is clear and conclusive evidence that brain function improves through the controlled application of oxygen.  In effect, it stimulates and may, in fact, regenerate brain cells at the molecular level.

HBOT Brain Functionality Over Time

In addition, HBOT is far cheaper to administer than currently approved programs at the VA.   Maj. Ben Richards argues that all Veterans with PTSD and TBI could be treated with HBOT for less than 10% of the VA budget allocated for pharmaceuticals.

More to the point, the annual VA treatment costs for Veterans with PTSD and TBI are roughly $15,000. For this annual expense, many Veterans could receive HBOT.

Dr. Figueroa asks, What are we Waiting For?

Almost 3 years ago, Dr. Xavier A. Figueroa, Ph.D., in an article entitled “What the <#$*&!> Is Wrong with the DoD/VA HBOT Studies?!!” clearly sets forth a compelling scientific argument why Veterans with TBI and PTSD should be treated with HBOT.

Found below is a summary of Dr. Figueroa’s conclusions (footnotes removed):

A large fraction of the current epidemic of military suicides (22+ service members a day take their lives) are more than likely due to misdiagnosed TBI and PTSD. Although the DoD and VA have spent billions (actually, $ 9.2 billion since 2010) trying to diagnose and treat the problem, the epidemic of suicide and mental illness are larger than ever. Drug interventions are woefully inadequate, as more and more studies continue to find that pharmacological interventions are not effective in treating the varied symptoms of TBI or PTSD. In many cases suicide of veterans have been linked through prescribed overmedication.

HBOT is a safe and effective treatment with low-to-no side effects (after all, even the DOD accepted the safety of HBOT back in 2008). Access to HBOT is available within most major metropolitan centers, but the major sticking point is money. Who pays for the treatment?  Those that are willing to pay for it out-of-pocket and state taxpayers picking up the tab for brain-injured service members forced back into society without sufficient care (or forced out on a Chapter 10, when it should have been treated as a medical condition).

The continued reports of studies like the DoD/VA sponsored trials allow denial of coverage and provide adequate cover for public officials to claim that more study needs to be done. As we have seen, the conclusions of the authors of the DoD/VA sponsored studies downplay the results of effectiveness. There are sufficient studies (and growing) showing a strong positive effect of HBOT in TBI. More will be forthcoming.

The cardinal rule of medicine is “First, Do No Harm”. With HBOT, this rule is satisfied. Now, by denying or blocking a treatment that has proven restorative and healing effects, countless physicians and organizations, from the VA to DoD, Congress and the White House, could be accused of causing harm. Never mind how many experiments “fail” to show results (even when they actually show success). Failure to replicate a result is just that…a failure to replicate, not a negation of a treatment or other positive results. You can’t prove a negative and there are many clinical trials that do show the efficacy of HBOT.

The practice of medicine and the use of HBOT should not be dependent on the collective unease of a medical profession and the dilatory nature of risk adverse politicians, but on the evidence-based results that we are seeing. Within the VA, there are hard working physicians that are trying to change the culture of inertia and implement effective treatments for TBI and PTSD, using evidence based medicine. Unfortunately, evidence-based medicine only works when we accept the evidence presented to us and not on mischaracterized conclusions of a single study (or any other study). Our veterans, our citizens and our communities deserve better than what we are currently giving them: bad conclusions, institutions too scared to act in the interests of the people it serves and too many physicians unwilling to look at the accumulated evidence.

Indeed, it is time to for Dr. Shulkin to rid the VA of Dr. Cifu and embrace cost-effective treatment therapies which provide some hope for Veterans with PTSD and TBI.

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PTSD and the Super Bowl

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As we all settle in to watch the Super Bowl tomorrow, let us reflect on the large number of brave Veterans who have suffered from PTSD and traumatic brain injury (TBI). Indeed, there are enough wounded Veterans from our wars in Iraq and Afghanistan to fill several Super Bowl stadiums.

PTSD and CTE

Nevertheless, I suspect that sports’ pundits will be more focused on CTE – chronic traumatic encephalopathy – found on the brain of former pro quarterback, Kenny Stabler caused by “repeated blows to the head.” Indeed, there is now a list on Wikipedia that lists the number of deceased pro football players that were diagnosed with CTE.

Veterans with post traumatic stress disorder and/or TBI now exceed some 200,000 and they are simply not receiving the treatment they require to reclaim their lives.  The Veterans Administration’s preferred solution is to mask the symptoms of brain trauma with an often lethal cocktail of pharmaceuticals. At the same time the VA blocks other far more inexpensive technologies, like Hyperbaric Oxygen Therapy,  used around the world.  Why?

PTSD by the Numbers

Less we forget, please find below a video from the late Navy S.E.A.L, Chris Kyle who explains how difficult it is for some Veterans to adjust after they come home from war.  We now believe that some 20% of Veterans are affected by some form of brain trauma, although many experts believe that the number is far higher.  Listen to Chris Kyle:


via: PTSD by the Numbers: Battling Post Traumatic Stress Video

As we watch the Super Bowl, let us reflect on the conditions of our brave Veterans and the personal demons they face each day.

UK Troops Suffering from PTSD and Depression

Traumatic brain injury is not only prevalent in the US, but the British Armed Forces are also coping with serious problem.  Based on the statistics below, they are probably underestimating the scope of the problem, but it is clear that they see clear evidence of “alcohol-related” behavioral disorders and Veterans try to “self-medicate.”  Substance abuse is rampant among Veterans in the US, particularly with those who suffer from PTSD.   One health specialist suggested it could be as high as 90%.

See what the British say about traumatic stress among their own troops:

Of those, 1,235 have been awarded compensation and discharged with post-traumatic stress disorder. The figures, obtained under a Freedom of Information request, show 718 were discharged for depression, while 130 were suffering from alcohol-related behavioral disorders.

Speaking yesterday Patrick Rea, of the charity PTSD Resolution, said: “Assuming that most of these cases involve the Army, it brings us to a ratio nearing one in 10. Previous figures suggest that around two per cent of troops across all branches are suffering from PTSD. Of course, the problem is that there is a latency about PTSD that may not show up in official figures.Then, five years after they leave, it results in breakdown of their marriage, loss of employment and even criminality.”
via: Rising toll of stressed out troops suffering from PTSD and depression

Mental Health Week: PTSD and Suicide

Jenny Hale, a Public Relations graduate student at the Newhouse School of Public Communications, discusses below the relationship between PTSD and suicide.   While Jenny is right to suggest contacting the CRISIS LINE at 1-800-273-8255 for help, the Veterans Administration has not done a good job in helping Veterans with PTSD.  I would take the advice provided below with a grain of salt.

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Post-Traumatic Stress Disorder (PTSD) is a mental health problem that can occur after someone goes through a traumatic event like war, assault, an accident or disaster. Symptoms can start immediately after an event or can develop years later. These symptoms usually include flashbacks or memories, sleep problems or nervousness. Indicators lasting longer than a month may be related to PTSD.

Since 2002, 128,496 service members have been diagnosed with PTSD after being deployed in post-9/11 wars. The highest numbers reported were in the year 2012, with over 20,000 total cases between deployed and non-deployed soldiers.

If you or someone you know is suffering from PTSD, there are several outlets for both civilians and military to find help.

  • VA Center—All VA hospitals have care for PTSD. Contact your nearest VA Medical Center for an appointment.
  • Consult a therapist—The International Society for Traumatic Stress Studies can help locate a clinic near you. Find a list here.
  • Call the Veterans Crisis Line—Family and friends, as well as veterans, can speak to VA workers 24/7 online or by phone for confidential support. 1-800-273-8255 or chat with a professional here.

Suicide is another serious mental health issue among veterans. A veteran commits suicide every hour, while a service member commits suicide every day. 8,000 veterans commit suicide every year.

24 percent of suicides include veterans with PTSD symptoms and 66 percent of those have been deployed. Over 50 percent of veterans had no sign of behavioral health disorders prior to their death.

Suicide is preventable. If you or someone you know is showing feelings of guilt, saying that life isn’t worth living or expressing failure, seek help through the Suicide Prevention Line at 1-800-273-8255.
via: Mental Health Week: PTSD and Suicide

While I too will be sitting around the television watching this great American tradition of the Super Bowl, I will think of our many Veterans suffering from PTSD who don’t have access to the latest therapies available to help them reclaim their lives.  CTE has surfaced as a “big issue” within the NFL.  I only wish Veterans with PTSD and/or TBI would receive the same level of national attention.

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