Veterans Account for 20% of U.S. Suicides

Posted by:

Military suicides, particularly among Veterans, show no signs of abating.  Despite recent efforts by Secretary of Shulkin of the Department of Veterans Affairs (“the VA”), the “silent wounds of war” follow our Veterans into civilian life.

Veteran Suicides

(U.S. Army photo by Stephen Baker)

In a most informative report published by CNN, Veteran suicides account for roughly 20% of all suicides in the United States.

SFTT has reported on this disturbing trend for several years, but little has been done to curb Veteran suicides. Our analysis of this dreadful situation – covered amply in previous articles – may be summarized as follows :

1. PTSD and TBI are the Smoking Guns of Veteran Suicide

Veterans with complex PTSD or PTSD and TBI are more than 25 times more likely to commit suicide than their veteran peers, according the National Center for Biotechnology Information (“NCBI”).

2.  The VA is Currently Not Able to Effectively Treat Veterans with PTSD

Like the NFL’s denial of culpability, the VA continues to insist that Cognitive Process Therapy (“CPT”) and Prolonged Exposure Therapy (“PE”) help reverse the trends of PTSD and TBI.  This is patently untrue as described in more detail below.

The VA’s top-tier Specialized Intensive PTSD treatment Programs (“SIPPs”) failed to achieve clinically significant improvement in PTSD symptoms after an average 46-day program of treatment at an average cost of $23,578 per veteran. Average change in PCL-M scores was 5.7 points and “most program graduates met the criteria for clinically significant PTSD after discharge….” according to Institute of Medicine of the National Academies or IOM 2014 study, p.100.

“However, the outcomes from RCTs suggest that only a minority of veterans can be expected to lose their PTSD diagnosis as a result of getting CPT or PE, arguable administered in an ideal fashion…” (p.49) 2/3s retain PTSD diagnosis.

“In the RCTs conducted to date, with one exception, mean symptom scores at the end of treatment or at the latest follow-up (when available) indicated that PTSD symptoms were still substantial .” (p.49)

“Attaining high end-state functioning may be the exception rather than the rule.” (p.49)

The VA continues to treat the symptoms of PTSD and TBI with potentially lethal prescription drugs rather than use other proven therapy programs.  In fact, many current programs (i.e. cannabis) funded by the VA focus on treating symptoms rather than the underlying causes of PTSD and TBI.

3. The VA has Shown Little Inclination to Understand the Causes of PTSD

The “evidence-based” treatments currently deployed by the VA and DOD have little actual evidence supporting their efficacy in treating combat trauma and the existing evidence shows these treatments are generally ineffective.

The IOD concluded in 2014 that “[N]either department [DoD and VA] knows whether it is providing effective, appropriate, or adequate care for PTSD.

The VA insists that this is not the case, but many other studies have reached similar conclusion regarding the standard therapies used by the VA.

Specifically, in randomized controlled trials of “evidence-based” treatments in military PTSD “. . . mean post-treatment scores for CPT and prolonged exposure therapy remained at or above clinical criteria for PTSD, and approximately two-thirds of patients receiving CPT or prolonged exposure retained their diagnosis after treatment.  Symptom remission was rare.”   (Steenkamp, et. al., p. 489)

4.  SFTT has Assembled a World Class Medical Task Force to Identify and Deploy Effective Treatment for TBI and PTSD

Despite overwhelming evidence to the contrary, the VA continues to march to a drummer of its own choice insisting that Veterans are receiving the best care possible.  As SFTT will demonstrate in the next couple of weeks, support for Veterans diagnosed with PTSD (and their supportive families) is abysmal.

Veterans recognize the limitations of the VA and are seeking alternative therapy programs.  SFTT has assembled a world class Medical Task Force to identify promising new technologies and recommend proven treatment programs.

While some of these therapy programs have been around for years with proven success stories, others are more experimental in nature.  There is no “silver bullet” and each Veteran may respond differently to a specific program.  Nevertheless, it seems far better than the hype rather than substance of VA programs.

Visit the SFTT website for more information on promising new therapies to treat PTSD and TBI and do consider supporting the SFTT mission through a kind DONATION.

Veterans and those who serve our country need a helping hand.

0

What do the NFL and the VA Have in Common?

Posted by:

Like the Department of Veterans Affairs (“the VA”), the NFL has eloquently side-stepped the effects of brain trauma caused my massive or repeated concussive events.

In a most disturbing study, the Journal of the American Medical Association has concluded that “110 of 111 NFL players were found to have chronic traumatic encephalopathy, or C.T.E., the degenerative disease believed to be caused by repeated blows to the head.”

Chronic Traumatic Encephalopathy or CTE

This should come as no surprise to most anyone who has followed repeated denials by NFL officials and team owners that repeated concussive events on the field of play lead to permanent brain damage.

Why?  The liability is simply too great and public outcry might hurt the lucrative revenue stream of the NFL, which is currently exempt from antitrust laws thanks to the largesse of Congress.

Personally, I don’t believe that the risk of brain injury will deter rabid fans from attending college or NFL games anymore than residents of Rome passed up an opportunity to attend a bloody spectacle at the colosseum.

Nevertheless, there is a strong grassroots effort to cut back on football programs for young children.  A recent news report from Tampa, Florida highlights the dilemma faced by parents whose 9 and 10 year-old children want to play contact football.

NFL Players and our Military Heroes

While NFL players have the opportunity to walk away from the sport they dearly love, the brave men and women who serve in our armed forces don’t have quite the same options.

More to the point, Veterans suffering from from PTSD and TBI have few possibilities given the VA’s limited menu of therapy options: Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT).   As the VA acknowledges, neither of these therapies has produced significant improvements in the well-being of Veterans.

To mask the their failure in treating PTSD and TBI, the VA has resorted to potent prescription drugs with unsettling side-effects.   In effect, treating PTSD and TBI has largely been a “loss loss” for Veterans with equally devastating results on their families.

What the VA and the NFL have in common is a culture of arrogance and denial based on a concerted and prolonged effort to hide the truth from those it purports to serve and protect.   In effect, the VA has told Veterans that “it is the VA way or the highway.”

Sadly, far too many Veterans have opted for the highway.

Dr. David Cifu and the Culture of Doom

Nowhere is this arrogance of the VA more manifest than in the pompous and self-serving performance by Dr. David Cifu, a consultant for the VA on PTSD and TBI, at a 2016 Congressional subcommittee:

Scholars in attendance were revolted by Dr. Cifu’s anecdotal and silly justification for why the VA’s policies and procedures for treating PTSD and TBI are so far out of touch with the latest scientific research.

Sadly, Dr. Cifu’s opinions reflect entrenched attitudes at the VA and deprive tens of thousands of brave Veterans the treatment they deserve to combat this debilitating injury.

While Dr. David Shulkin is cleaning house at the VA, he would do well to look at those like Dr. Cifu to determine if they are up to the task in reestablishing the credibility of the VA.

Veterans that talk to SFTT believe that the VA is useless in helping to address their problems with PTSD and TBI.

0

Did the VA Hook Veterans on Opioids?

Posted by:

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.

0

Veterans Affairs On The Fence for Service Dogs

Posted by:

Almost every day one hears a moving story of how Veterans with PTSD and other debilitating injuries are provided comfort and support by service dogs.

Service Dogs for PTSD

Photo via Pixabay by Skeeze

Nevertheless, the Department of Veterans Affairs (“the VA”) continues to argue that there is little  scientific or clinical evidence to confirm that service dogs benefit Veterans in a meaningful way.

“I would say there are a lot of heartwarming stories that service dogs help, but scientific basis for that claim is lacking,” said Michael Fallon, the VA’s chief veterinary medical officer. “The VA is based on evidence based medicine. We want people to use therapy that has proven value.”

The argument is a brief synopsis of Dr. Fallon’s testimony to the House Subcommittee and Government Reform provided in April, 2016.

In his written testimony, Dr. Fallon goes on to state the following:

The VA/Department of Defense Clinical Practice Guideline recommends trauma-focused cognitive behavioral therapy [such as Prolonged Exposure (PE), and Cognitive Processing Therapy (CPT)], Eye Movement Desensitization and Reprocessing, stress inoculation, selective serotonin reuptake inhibitors, and venlafaxine, a serotonin norepinephrine reuptake inhibitor, as primary treatments for PTSD. PE and CPT are among the most widely studied types of trauma-focused cognitive behavioral therapy. Evidence demonstrating their effectiveness is particularly strong.

As SFTT has reported on numerous occasions, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) have been largely ineffective in reversing brain damage to Veterans suffering from PTSD and TBI.

Specifically, the VA has very little evidence to show that PE and CPT therapy programs have done much to reduce the incidence of PTSD symptoms among Veterans against the “gold-standard” standardized PCL-M tests currently used by the VA.   The chart below illustrates the point (50 is considered base level):

Veterans Affairs Fails at PTSD

Aside from being very expensive to administer, the “evidence based medicine” supporting the effectiveness of PE and CPT programs currently administered by the VA is SADLY LACKING.

It is not unusual in the scientific community that promotes the effectiveness of the VA to apply fuzzy logic to alternative treatment programs.   In fact, there is a propensity among advocates to search for pharmacological solutions rather than embrace alternative therapy programs.

As one who has watched this charade play itself out on the big stage of public opinion, it is difficult for me to accept the argument that new pharmacology alternatives outcomes will be any different than the VA’s embrace of OxyContin to deal with the symptoms of PTSD.

Whether it is dog or equine therapy or hyperbaric oxygen therapy (“HBOT”), Veterans are seeking out alternatives that are largely discredited by the VA.   In fact, one NIH researcher suggests argues that

Research also suggests further opportunities for the VA and other health care systems to develop new and innovative ways to overcome barriers to treating veterans with PTSD. With veterans and their families increasingly seeking care outside of the VA system, community providers play a key role in helping to address these challenges. It is critical they receive the education, training, and tools to improve their understanding of and skills for addressing the needs of this unique population.

It is difficult to understand that it should take 10 years to test the efficacy of using service dogs to help Veterans with PTSD.  Similarly, I recently learned that suspect test conditions used by the DoD to evaluate HBOT several years ago have prevented the VA from offering Veterans this life-changing service.

The VA continues to be its own worst enemy in helping provide Veterans with a lasting solution to their brain injuries.

0