Opioid Crisis: Contributors to the Current Crisis

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The opioid crisis is real.  It is hard to believe that people dying from drug overdoses each year now exceed the total number of brave warriors who lost their lives in Vietnam.

Homeless Veteran

Regardless of one’s political affiliation, this drug epidemic must be faced with determination to eradicate this awful plague.  Yet, in looking at The President’s Final Report on Fighting Drug Addiction and Opioid Abuse, I find myself wondering how we got to this sad state of affairs in the first place.

Despite having only 5% of the world population, the US consumes 80% of the world’s global opioid supply.  More to the point, these are not disreputable drug barons south of the border peddling addictive drugs, but licensed members of the medical profession encouraging the use of lethal and addictive prescription drugs.

There have been pharmaceutical companies like the Sackler’s firm of Purdue Pharma that used their considerable marketing skills to hype the benefits and hide the risks of opioids, but the most obvious revelation is that the very institutions that should have protected our backs may have been complicit in enabling them:  the Healthcare System.

Specifically, the President’s Final Report (pages 20 – 23 with just a few summarized below) argues “that the modern opioid crisis originated within the healthcare system and have been influenced by several factors:”

Unsubstantiated claims: High quality evidence demonstrating that opioids can be used safely for chronic non-terminal pain did not exist at that time. These reports eroded the historical evidence of iatrogenic addiction and aversion to opioids, with the poor-quality evidence that was unfortunately accepted by federal agencies and other oversight organizations.

Pain patient advocacy: Advocacy for pain management and/or the use of opioids by pain patients was promoted, not only by patients, but also by some physicians. One notable physician stated: “make pain ‘visible’… ensure patients a place in the communications loop… assess patient satisfaction; and work with narcotics control authorities to encourage therapeutic opiate use… therapeutic use of opiate analgesics rarely results in addiction.

The opioid pharmaceutical manufacturing and supply chain industry:   To this day, the opioid pharmaceutical industry influences the nation’s response to the crisis. For example, during the comment phase of the guideline developed by the Centers for Disease Control and Prevention (CDC) for pain management, opposition to the guideline was more common among organizations with funding from opioid manufacturers than those without funding from the life sciences industry.

Rogue pharmacies and unethical physician prescribing: The key contributors of the large number of diverted opioids were unrestrained distributors, rogue pharmacies, unethical physicians, and patients whose opioid medications were diverted, or other patients who sold and profited from legitimately prescribed opioids.

Inadequate oversight by the Food and Drug Administration (FDA):  The FDA provided inadequate regulatory oversight. Even when overdose deaths mounted and when evidence for safe use in chronic care was substantially lacking, prior to 2001, the FDA accepted claims that newly formulated opioids were not addictive, did not impose clinical trials of sufficient duration to detect addiction, or rigorous post-approval surveillance of adverse events, such as addiction. 

Reimbursement for prescription opioids by health care insurers: Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014, largely paid for by insurance carriers. It is estimated that 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings.

Lack of foresight of unintended consequences: As prescription drugs came under tighter scrutiny and access became more limited (via abuse-deterrent formulations and more cautious prescribing), market forces responded by providing less expensive and more accessible illicit opioids.

Public demand evolves into reimbursement and physician quality ratings pegged to patient satisfaction scores:  Prior to this year, poor patient satisfaction with pain care could lead to reduced hospital reimbursement by Medicare through Value-Based Purchasing (VBP). There are often higher costs or no specific reimbursements for alternative pain management strategies, alternative pain intervention strategies, or spending time to educate patients about the risks of opioids.

Given the scope of the problem, there is no question that urgent action needs to be taken to address this epidemic.  Nevertheless, one must question why we should entrust leadership  of that initiative to the same institutions that enabled the epidemic in the first place.

As reported earlier by SFTT in Opioids:  Bipartisan Incompetence in DC and vividly documented in the joint Washington Post and 60 Minutes Report, there are entrenched political and business interests at play.    I find it highly unlikely that they will release their grip on the brass ring with so much money at stake.

To date, there is no price tag on resolving the drug overdose crisis.  Isn’t it ironic that the same cast of characters that profited from addicting our nation, now get a chance to monetize the painful withdrawal process?  In the corporate world, we refer to this as “double-dipping,” but in politics it is simply “business as usual.”

If you honestly believe that “big government” will get us out of the drug addiction and opioid abuse crisis the government and healthcare system colluded to create, P. T. Barnum has a bridge to sell you.

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Veterans with PTSD: The VA Way or the Highway

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It is easy to find fault with the Department of Veterans Affairs (“the VA”), particularly when it comes to Veterans with PTSD.

Department of Veterans Affairs

Secretary of Defense, Robert McNamara, tried to employ body count statistics to assess our progress in the war in Vietnam.  Similarly, the VA has erected a statistical house-of-cards to deceive Veterans and their loved that the VA has the answers for Veterans coping with PTSD and TBI.

Like McNamara, the VA “knows what is best for Veterans” and has erected insurmountable statistical barriers to prop up their failed strategies.  In effect, the VA is telling Veterans:  “It is my way or the highway!

Paraphrasing a joke: “The VA uses statistics as a drunk uses a lamppost — For support rather than illumination.”

Sadly, it is no laughing matter when we consider the thousands of combat Veterans suffering from PTSD and TBI.  More importantly, reflect on the often tragic consequences for their families and loved ones.

While Congress and the public continue to be seduced by the steady stream of assurances that the VA provides the best possible care to Veterans with PTSD and TBI, the FACTS tell a far different story.

FAKE NEWS from the VA on Veterans with PTSD

Found below is a video of Dr. David Cifu, Senior TBI Specialist at the VA, testifying before a Congressional Committee:

The VA continues to push a stale and failed agenda that states that the only two effective treatment therapies offered by the VA are:

– Cognitive Behavioral Therapy (“CBT”)and,

– Prolonged Exposure Therapy (“PET”).

As these “therapy” programs have failed miserably according to independent studies (see below), the VA has “coped” with the problem by prescribing a lethal concoction of prescription drugs which treat the symptoms of PTSD rather than deal with the underlying problem.

And we wonder why we have an opioid epidemic in this country?

REALITY CHECK at the VA

While Dr. David Cifu continues to entertain a Congressional Committee on the efficacy of the VA’s protocols, experience for yourself one woman’s harrowing experience with the VA which eventually led to husband’s suicide:

The story of Kimi Bivins is not the exception to the type of treatment Veterans with PTSD receive at the VA. Based on many similar stories, the VA is failing our Veterans and their loved ones.

I encourage readers to read Kimi’s harrowing description of what actually takes place at a VA facility.

While the folks at the VA casually dismiss anecdotal stories, VA claims that Veterans receive the best therapy possible is simply not supported by the evidence.

No less of an authority that the National Academies of Sciences (Medical Division) reported in a 2014 study entitled “Treatment for POSTTRAUMATIC STRESS DISORDER in Military and Veteran Populations,” that CBT and PET barely made a statistical dent in providing Veterans with PTSD any lasting improvement in their condition.

Consider Maj. Ben Richards‘ compelling evidence documenting the failed experiments at the VA in helping Veterans with PTSD.

Standing behind a well-entrenched bureaucracy of statistical inaccuracies and dogma, the VA goes out of its way to discredit other treatment alternatives. Consider this bitter “scientific” debate between Dr. Cifu and Dr. Paul Harch on the efficacy of hyperbaric oxygen therapy or HBOT in treating PTSD and TBI.

Finding a Middle Ground for Veterans with PTSD?

With so little known about the brain and how to treat trauma, it seems absurd for the VA to insist that they have all the answers.  The evidence clearly suggests that the VA doesn’t have a clue.

Nevertheless, the VA argues that “alternative therapies” that do not pass scientific scrutiny and FDA approval will not be endorsed by the VA.  As we have seen countless times – from body armor testing to hyperbaric oxygen studies – the DoD uses test protocols that deviate from accepted standards.

If the tests are flawed, one is likely to draw the wrong conclusions!

For the vast majority of Veterans with limited economic means, the VA is effectively making life and death decisions based on flawed testing and a reluctance to embrace other treatment alternatives.

This is probably done with the intent of protecting Veterans from charlatans and snake oil peddlers, but doesn’t it also block Veterans from receiving promising therapies from legitimate sources?

When dogma or “approved” therapies become the LAW, then it seems unlikely that much progress will be made to help our brave Veterans recover their lives.  The VA would do well to encourage Veterans to seek alternative therapies and provide an interactive sounding board for Veterans to voice their opinions on these programs.

Honesty and transparency and a willingness to accept mistakes is the sign of a responsive institution.   Today, the VA hides behind a dogma based on self-delusion and falsehood.

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Veterans Treatment Courts: Smart Justice

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Several years ago, I had the honor to meet Judge John Schwartz, one of the early pioneers in promoting the benefits of  Veteran Treatment Courts.

Drug Treatment Courts

Drug Courts began to emerge in the nineties to deal more effectively with a growing drug problem in the United States.  As I wrote earlier,

Since the mid-1990, the US judicial system has recognized the need to deal with drug-related criminal activity and have established some 2,600 Drug Treatment Courts in the United States.  Drug treatment courts are specialized community courts designed to help stop the abuse of drugs, alcohol, and related criminal activity. Non-violent offenders who have been charged with simple possession of drugs are given the option to receive treatment instead of a jail sentence.   These programs have proven to be remarkably successful for reducing the level of recidivism in our prison system.

Capitalizing on the infrastructure and success of the Drug Treatment Courts, some 50 or so Veteran Courts have sprung up across the United States to deal with veterans who have committed a crime while suffering from substance abuse.  In many cases, these troubled vets have the support of other Vets (often from the Vietnam era) who “mentor” their military colleagues through the rehabilitation process.

Since then, Veteran Treatment Courts exist in every state in the United States.  These Courts provide Veterans with PTSD and substance abuse issues with an alternative to serving time in a federal or state penitentiary.

As the video from Justice for Vets explains below, Vet Courts provide Veterans with a second chance to recover their lives with the support of wise counsel from fellow Veterans, judicial system and law enforcement officers.

Aside from the fact that this appears to be a most sensible way to provide brave Veterans with the steady supportive counsel of a fellow Veteran, the Vet Court system has also reduced our prison population and cut recidivism by almost two-thirds.

While the Veteran Court system was largely the inspiration of community judges, law enforcement officers and a supportive community, the Department of Veterans Affairs (“the VA”) has been playing an active role in supporting these local and State programs since 2008.

Currently, there are approximately 220 Veteran Treatment Courts functioning in the United States with many other communities seeking to establish similar programs of their own. In fact, Justice for Vets recently provides a great deal of direct support and information for communities seeking to establish their own Veteran Treatment Court.

While 2017 applications for Justice for Vets support are currently closed, communities interested in this initiative would do well to contact Justice for Vets for more information on the Veteran Treatment Court Application Process.

Now, there are some – perhaps, many – who are opposed to any “special treatment” provided to people who break the law.  Nevertheless, the “cost” of incarcerating individuals who break drug laws and their exposure to hardened criminals seem to outweigh any potential long-term benefit to society.

For years, the VA has been serving up a cocktail of drugs to Veterans suffering from PTSD.  Only now have we come to the realization that this may not have been the proper way to deal with this serious problem.  In fact, opioid abuse is now an epidemic across the U.S.   One could argue that our Veteran population was well aware of this problem long before it hit mainstream America.

Should Veterans be subjected to incarceration, because the VA support system erred so badly?  I think not!

In May, we celebrate Drug Court Professionals across the United States who have contributed both their time, money and expertise to combat drug abuse in the United States.  If your community is currently planning – or thinking about – establishing a proactive response to drug abuse then you may well want to register for the NADCP Training conference that will be held this year in Washington, D.C. from July 9 – 12.

Justice for Veterans is a co-sponsor of this training conference and SFTT salutes those professionals who are giving their time and energy to fight drug abuse in America.

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