By Jake Altinger reporter
For roughly the last two decades, the Department of Defense (DOD) of Department of Veterans Affairs (VA) have been pumping fuel into the wildfire of opioid addictions and overdoses blazing across the country, and as a recent combat veteran, I have personal experience with the variety of hoses through which that fuel flows.
I served in the US Army from June 2009 to April 2013 and deployed three times to Afghanistan as an airborne infantryman with the 75th Ranger Regiment. I have a herniated spinal disc in the base of my neck, another in my lower back, chronic pain in my left knee, and I have been diagnosed with PTSD.
I was first introduced to opioids when I was still in the army. After getting PRK (a laser eye surgery similar to LASIK), I was prescribed 24 pills of oxycodone to cope with the pain over the next six days. I got the surgery done on Monday, and, taking them as prescribed, the pills lasted through Sunday night. When I went to work the next Monday, the pain in my eyes was gone, but I felt ill. I was nauseous – ready to vomit at any moment. I had a pounding headache, no appetite, and could not focus mentally.
I was going through opiate withdrawals.
I knew a Ranger buddy of mine still had a large stash of Percocet he was prescribed a few months prior after breaking his hand in a bar fight. He gave me the rest of the bottle, and over the next three weeks I slowly reduced my dosage until I weened myself off the pills.
The possibility of opiate dependency or withdrawals was never taken into consideration in my treatment plan. I was expected to take these powerful painkillers I had never been exposed to before for a week and then stop, cold turkey, and go back to work.
None of my leadership knew I had developed a dependency on them or that I was still taking them illegally. If I had been caught, I could have been kicked out of the Ranger Regiment, even out of the army.
In fact, when I was out-processing from the army, I bumped into a Ranger I knew from another company in the Judge Advocate General’s (JAG, i.e. military lawyers) office getting kicked out for just that. He had injured his back after falling off a ladder in Afghanistan and was prescribed a large amount of oxycodone to cope with the pain.
By the time the pills ran out, he was addicted. Like myself, he first got his fix from friends who had stashed away extra painkillers. Unlike myself, he couldn’t ween off. When his friends ran out of pills, he turned to the streets, and before he knew it, he was shooting heroin.
The absurd thing is, this Ranger was never caught – never failed a drug test. He came forward to his command, admitted his addiction, and told them he needed help. His command, in turn, tried to kick him out of the army for substance abuse and drug trafficking, citing his personal confession – his cry for help – as the only evidence against him.
The army lawyers told him that was illegal – that they couldn’t kick him out for confessing he had a problem – but his reputation had already been ruined among his Ranger buddies, so he settled for an honorable discharge.
I still have no idea if he ever got treatment for his addiction. For all I know, he could have ended up like Robert Deatherage – an army veteran I read about last year in the Wall Street Journal.
Like that Ranger I met in the JAG office, Deatherage battled opioid addiction after suffering multiple injuries in Afghanistan, turned to the streets for pills, and eventually got hooked on the needle.
Deatherage hit rock bottom the in 2015, holed up in an empty church in Fayetteville, NC, where he tried to commit suicide twice in the same night. He first attempted to shoot himself, and when the gun misfired, he injected himself with all the drugs he had but failed to overdose.
The impression I got from my time in 2nd Ranger Battalion is that the military and veteran communities are swimming in opioids. Anytime a soldier had pain too strong for an 800mg ibuprofen to handle, they came back from the doctor with a big bottle full of hydros, oxys, or morphine.
And multiple NGOs, investigative reporters, and the VA itself have validated my impression.
The Center for Investigative Reporting (CIR) found that from 2000 to 2012 VA prescriptions for four powerful opiates – morphine, methadone, oxycodone, and hydrocodone – rose by 270 percent. In 2014 alone, the VA wrote 1.7 million opioid prescriptions for just 443,000 veterans.
The Center for Ethics and the Rule of Law (CERL) revealed that the number of veterans suffering from opioid addiction rose by 55 percent between 2010 and 2015 to a total of 68,000 veterans, citing a report from the VA Office of Inspector General.
A Newsweek investigation found that the VA has been overprescribing opioids and psychiatric medications to veterans since at least 2000.
The VA’s behavior was not only reckless and irresponsible but downright corrupt.
Newsweek also uncovered corporate documents from Purdue Pharma, the manufacturer of OxyContin convicted of deceiving doctors and patients about its dangerous and addictive attributes, revealing how Purdue paid a VA pain management team $200,000 to push their fallacious advertising campaign and develop VA/DOD guidelines claiming that opioids “rarely” cause addiction.
Former VA Secretary Robert McDonald said veterans are 10 times more likely to abuse opioids than the average American and such abuse often leads to joblessness, homelessness, and suicide.
Tackling the opioid epidemic among service members and veterans is a tricky task.
One the one hand, many veterans legitimately need opioids. Roughly 60 percent of recent veterans deployed to the Middle East and 50 percent of veterans who served in prior conflicts suffer from chronic pain, according to VA statistics as of March 2015.
At the same time, many of those veterans also suffer from psychiatric conditions such as Post-Traumatic Stress Disorder (PTSD), depression, anxiety, and traumatic brain injury (TBI).
The combination leads to a vicious, and often deadly, cycle. Physical pain from military wounds and injuries lead to opioid prescriptions. The opioids then become a coping mechanism to numb their emotional and psychological pain, leading to addiction. Opioids disrupt the veterans’ normal sleep cycles and appetites, and makes them feel more socially isolated, worsening their psychological symptoms, which leads to more coping, more opioid abuse.
According to the CERL, both veterans and non-veterans with PTSD are three to four times more likely to develop a substance abuse disorder.
After reporters, patients, and NGOs began sounding the alarm on the VA’s practices, the VA swung the pendulum dramatically in the opposite direction. In 2012, the VA and Drug Enforcement Agency (DEA) imposed new policies to dramatically reduce the number of opioids prescribed. From 2012 to 2015, the number of veterans receiving opioids dropped by 115,575 individuals, according to the VA’s claims.
However, these policies have had their own unintended, detrimental consequences.
For instance, veterans must now make a face-to-face appointment with a doctor to renew prescriptions for opioids, whereas they previously did not. This increases the patient load at VA clinics, which are already underfunded, understaffed, and overloaded. Consequently, many veterans are not able to get the pain medication they need when they need it.
I encountered this very problem in September, when my neck and back injuries became severely aggravated. I ran out of the tramadol (a milder opioid painkiller and muscle relaxer) the VA had prescribed to treat my injuries. To get the prescription renewed, I would have to see a doctor face-to-face, so I called the Lindstrom VA Clinic in Colorado Springs to make an appointment. The soonest available appointment was over six weeks out, on Nov. 3.
The Washington Post told the story of Craig Schroeder, a Marine Corps vet who found himself in a similar, yet much worse, situation. Schroeder was wounded by a roadside bomb in Baghdad, Iraq, and suffers from chronic pain from a previous foot and ankle fracture, a herniated disc in his back, and TBI. After the new regulations were put in place, Schroeder was cut off from his pain medication for over five months, until he could get an appointment with a VA doctor in North Carolina.
In addition, the new negative stigma associated with opioids has caused VA doctors to be excessively cautious and apprehensive to prescribe them, even to veterans who actually need them and do not abuse them.
One such veteran is Robert Rose, a Marine Corps veteran whom Newsweek interviewed as part of their investigation. Rose was cut off from opioids by his VA doctor even though he was not abusing them. The doctor even encouraged Rose to keep smoking cigarettes and drinking Mountain Dew to cope with his pain, rather than prescribe the painkillers he needed. Without his pain medication, Rose is now confined to a wheelchair, whereas he used to spend his days on his feet doing woodwork and playing with his grandchildren.
“We do not have another silver bullet that we can say, ‘Instead of opioids, try this,’” Dr. Carolyn Clancy, the VA’s deputy under-secretary for health, told FRONTLINE Enterprise Journalism Group last year.
Cutting off veterans who legitimately need opioids, like Schroeder and Rose, will inevitably backfire and increase the demand for opioids on the streets.