The ever-growing list of veterans waiting for medical treatment has led to over-prescribed opioid pain medication. It is clear this is a problem that can only be fixed when everyone in the Veterans Affairs’ medical community is on the same page. Veteran Pete Savo offers a compelling look at this critical issue facing our country today.
By Dr. Pietro Savo
We return from the battle to find ourselves chasing our tail through life. Veterans are accustomed to taking on a mission bigger than life itself — we get banged up, sent home alive if we are lucky, and then the real battle begins. Our injuries at times are less severe than our treatments. We trust in the system, we trust in the military, and we trust in our nation to do what’s right to return us back to the completeness we began with. The reputation of the Department of Veterans Affairs’ (VA) medical system is crippled with standards that are different than those for the U.S. health system. Perhaps what we are witnessing is the symptom of a fragmented government project that has failed beyond hope. The ever-growing list of veterans waiting for medical treatment has led to over-prescribed opioid pain medication. Ryan Honl, veteran and VA whistleblower on opioids, points to the reality that the VA does not have the means to heal veterans, so it prescribes drugs that mask the pain, which has created new victims in the opioid crisis in the United States. By no means does this writer believe that creating opioid addiction was the VA’s intent. This is simply a textbook example of an unprepared, mismanaged and overburdened government department, clearly ill-equipped to support the modern war veteran.
Worse than the injury
A study conducted for the Journal of Rehabilitation Research & Development identified the frequency and severity of pain and psychiatric comorbidities among military personnel who had been deployed during Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF) and Operation New Dawn (OND). Study results indicated pain was the most common complaint, with a debilitating occurrence of pain among veteran personnel returning from military deployment (Phillips, 2016).
Overwhelming numbers of veterans returning from battle placed the VA into a temporary-fix mindset that turned out to be worse than the injury — a form of government-sanctioned drug dealing. The VA’s opioid-prescribing mindset not only destroyed veterans, but it impacted their families who were not prepared to handle a wounded veteran with an opioid addiction. Studies conducted by the Department of Defense (DOD) identified another failure mode. The prescribed (and later the abuse of) opioid pain medication became a concern of the DOD as well because of its bearing on military readiness. Countless veterans are no longer ready or able to perform their duties, while the rate of healing wounded veterans diminished. Among veterans, opioid addiction is associated with post-traumatic stress disorder and other mental health and substance abuse diagnoses. The growing rate of opioids prescribed to younger veterans has also been documented (Diana, 2014).
One-third of opioid medication prescribed is for pain conditions, and there appears to be little effort to eliminate the source of pain, only to mask it. Chronic pain is a common reason for emergency department visits. Civilian providers were more likely to prescribe an opioid than military providers (58 percent versus 42 percent); however, this is significant, as opioid practices for both medical practitioners and opioid drug dealers benefited from the pain mitigation strategy (Ganem, 2016).
Pressure to act
The American Medical Association recently adopted new policies at its annual convention to address what it agrees is an opioid epidemic. A priority included: 1) promoting access to other treatments for pain instead of simply masking pain with opioid-type drugs, and 2) supporting efforts for pain treatment to encourage doctors to co-prescribe naloxone with opioids to patients at risk of an overdose, as naloxone blocks or reverses the effects of opioids (Aleshire, 2016).
U.S. lawmakers have felt pressure to act. Title IX of the Comprehensive Addiction and Recovery Act (CARA) was introduced in the Senate by Sen. Tammy Baldwin, D-Wis., as the Jason Simcakoski Act, named in honor of U.S. Marine Veteran Jason Simcakoski, who died of an overdose after being prescribed 13 different medications, including opioids. The emphasis is on improving the VA response and countermeasure to military veteran opioid addiction.
The Jason Simcakoski Act would require the VA director to expand the VA’s Overdose Education and Naloxone Distribution (OEND) program, a strategy aimed at training health care providers to be prepared to mitigate and help veterans recover from opioid addiction by also making naloxone available to veterans at risk for opioid overdose (Creech, 2016).
Hope exists when state VA hospitals work independently. For example, two or three years before veteran opioid addiction became a crisis in New Hampshire, the New Hampshire VA hospital staff developed a better pain management program by hiring pain management experts from private practice. Practice experts identified a significant over-prescription problem and recommended a countermeasure strategy. The New Hampshire VA implemented programs that focused on hiring new pain management staff from the private sector and providing educational lectures to clinical staff on pain management issues. Rapid improvements turned this issue around locally, yet these initiatives were not embraced and adopted nationwide. We failed to learn from VA community lessons learned.
No magic bullet
There is no one magic bullet to solve the military veteran opioid addiction problem. Recommendations will have to come in different forms. First, we as a nation must admit that the problem exists. Second, we must reach out to every U.S. VA hospital to share over-medication reduction strategies that work. Finally, we must ask that U.S. VA hospitals share their own over-medication reduction strategy success stories.
It is clear this is a problem that can be fixed when everyone in the VA medical community is on the same page. This writer is confident that U.S. VA hospitals have developed creative solutions to reducing over-medication; it’s now time to share them with the entire medical community!
Dr. Pietro Savo served in the United States Navy. He is a respected lecturer and published author. If you’d like to contact Dr. Savo, you can reach him at firstname.lastname@example.org or 603.321.6224
Aleshire, I. (2016, Jul 12). Opioids are winning. The Register —Guard Retrieved from https://search.proquest.com/docview/180 3250950?accountid=28844.
Creech, C. T. (2016). Increasing Access to Naloxone: Administrative Solutions to the Opioid Overdose Crisis. Administrative Law Review, 68(3), 517-550.
Diana, D., Jeffrey, D. D., May, L., Luckey, B., Balison, B. M., & Klette, K. L. (2014). Use and Abuse of Prescribed Opioids, Central Nervous System Depressants, and Stimulants Among U.S. Active Duty Military Personnel in FY 2010. Military Medicine, 179(10), 1141-1148.
Ganem, V. J., Mora, A. G., Nnamani, N., & Bebarta, V. S. (2016). A 3-Year Comparison of Overdoses Treated in a Military Emergency Department — Complications, Admission Rates, and Health Care Resources Consumed. Military Medicine, 181(10), 1281-1286.
Honl, R. (2016, May 19). Ryan Honl: Here are the facts about the Tomah VA scandal. University Wire Retrieved from: https://search.proquest.com/docview/1789786612?accountid=28844.
Phillips, K. M., Clark, M. E., Gironda, R. J., McGarity, S., Kerns, R. W., Elnitsky, C. A., & Collins, R. C. (2016). Pain and psychiatric comorbidities among two groups of Iraq- and Afghanistan-era veterans. Journal of Rehabilitation Research & Development, 53(4), 413-432. doi:10.1682/JRRD.2014.05.0126.