America’s opiate crisis has reached epic proportions. Reuters has recently reported that more Americans have been killed by opiate drug abuse than have been killed in the Vietnam, Iraq, and Afghanistan wars combined. It extends far beyond those typically afflicted by drug abuse, digging deep into middle class America. In fact, it has become so widespread that it has even forced the Department of Transportation to update DOT drug testing regulations for 2018. New Department of Transportation regulations now require DOT drug testing for an additional four semi-synthetic opioids that are often abused, including oxymorphone, oxycodone, hydromorphone, and hydrocodone.

Unfortunately this crisis disproportionately impacts the veterans’ community, with federal data showing that veterans are twice as likely to die from an accidental overdose of opiates than non-veterans are. Why is this group so disproportionately impacted by the opiate crisis? It’s a combination of chronic pain and the high prevalence of post traumatic stress disorder (PTSD) among veterans.

Veterans and chronic pain

Chronic pain is a problem that affects around 30% of Americans today, but among veterans data shows that a shocking 50% of older veterans and 60% of veterans who have recently deployed in the Middle East deal with chronic pain. Failure to treat chronic pain among veterans increases the risk of suicide. However, opiate regiments that are poorly managed have the potential to become fatal, too.

Until recently the Veterans Administration (VA) has treated chronic pain in veterans primarily with opiate painkillers. In fact CBS and other news sources have reported that for more than a decade that the VA was recklessly over-prescribing both psychiatric and opiate medications. Many veterans who have been prescribed narcotics long-term were also taking benzodiazepines, and when the two drugs are mixed it dramatically increases the risk of a fatal overdose. Most VA patients were not seen by a pain clinic, resulting in the poor management of their medications.

Veterans and PTSD

Substance Use disorder (SUD) often goes hand and hand with PTSD. Studies show a strong link between the two, with over 20% of veterans suffering with PTSD also dealing with SUD. A report released by the VA found that between 2001 and 2014, substance abuse disorders and mental health disorders increased drastically, increasing from 27% to 40%. Among veterans who are already being prescribed opiates and other medications the potential risk for abuse of these medications is very high.

The effects of the opiate crisis on veterans

Unfortunately, the opiate crisis is taking a heavy toll on veterans. Reports show that 21% of veterans who are being treated for substance abuse are homeless. Substance abuse disorders and mental disorders are the largest cause of hospitalizations among veterans and military families. Not only is accidental death from opiate overdoses a risk, VA patients with mental and substance abuse disorders have a high risk of suicide. Even though the VA is taking measures to drastically cut back on opiates for veterans with chronic pain, this drastic cutback puts veterans at risk as well if their pain is not otherwise managed successfully.

One measure taken by the VA to curb the over-prescription and abuse of opiate is the Opioid Safety Initiative, which was launched in 2013 to track opiate use among veterans. Veterans must now sign consent forms and submit to having regular urine tests if they take opiates, and the VA is connecting with drug monitoring programs run by states to prevent patients from receiving multiple prescriptions for opiates from multiple doctors.

Although the VA system is working to address the opiate crisis among veterans, treating thousands of veterans for opiate addiction, there’s still a lot of work to be done. Some VA centers are beginning to test alternative treatments for chronic pain such as yoga, physical therapy and acupuncture. These programs can help veterans better manage chronic pain. However, while a few centers are introducing these programs, many still have not, leaving veterans without options to treat chronic pain.

The opiate crisis continues to be a nationwide problem that still disproportionately affects veterans, and there’s a lot more work to do. It’s not enough to simply call this crisis a national emergency. The federal government needs to take measures to fight this crisis while ensuring veterans are getting the care they need after serving their country.  But more than that, it’s up to every one of us to look after our fellow brothers and sisters in arms.