Veterans have been disproportionately hurt by the opioid epidemic, which claimed 46,700 American lives in 2017. Earlier this year, a study found the rate of veterans dying from opioid overdoses increased by 65 percent from 2010 to 2016. Veterans are twice as likely to fatally overdose on opioids as the general population.
These tragic statistics are the result of a unique set of circumstances veterans face that make them more at risk of addiction and abuse. They are indicative of structural problems with the way we treat returning service members. They demonstrate the VA’s, and, in general, the American health care system’s, overreliance on highly addictive opioids to treat chronic pain.
The Combat Cocktail – How We Overmedicate Veterans
Veterans returning from active duty bring back a host of mental and physical wounds, complicating an already daunting reintegration into civilian life. Anxiety, depression, and post-traumatic stress disorder are all experienced at rates higher than the general population. Nearly two-thirds suffer from chronic pain as a result of injuries sustained in conflict. They are also 40 percent more likely to suffer from severe pain than non-veterans. Chronic pain makes it harder to work and exacerbates the aforementioned mental issues.
To treat this, many veterans are prescribed a medication regimen colloquially referred to as the “Combat Cocktail.” The regimen, which became common practice during Iraq and Afghanistan, includes numerous painkillers, antidepressants and anxiety drugs prescribed at the same time. Sometimes, that regimen makes the user sleepy, in which case a stimulant is prescribed to make it through the day. If the stimulant made it hard to fall asleep, a hypnotic is added to the list. 1 in 3 veterans take more than ten pills a day. It’s no wonder a Wisconsin VA was dubbed “Candy Land” for prescribing 712,000 doses of oxycodone in 2012 – a more than ninefold increase in just six years.
“I think it’s a crime that those who are veterans, who have survived our wars, are being killed off by the pharmaceutical empire.” ~Dr. Peter Breggin
The Combat Cocktail’s side effects are burdensome and well-documented. Veterans on the regimen report mood swings, irritability, decreased libido, and worsened PTSD symptoms. The sheer amount of drugs also makes many veterans feel like zombies – slow, deadened, unfeeling. What’s worse, psychiatrist Peter Breggin thinks the VA does that on purpose.
“They drug the veterans,” he told the Baltimore Sun in 2016, “hoping basically to stupefy them and make them passive so they won’t demand services.”
But the problems with the Combat Cocktail go beyond zombifying veterans, for a simple, deadly reason.
Recipe for Disaster – The Dangers of Mixing Medications
The real danger of the Combat Cocktail lies not in the content or side effects of any one ingredient, but in their mixture. The Baltimore Sun piece highlights that many of these drugs were never tested or cleared to be taken together. The safety of combining drugs depends on a number of factors, including types of pill, dosages, non-prescribed substance use and the patient’s unique health factors.
Combinations of prescription medications increase the risk of overdose in veterans. Of particular danger is the combination of opioids and benzos, or sedatives prescribed for anxiety and insomnia. Both drugs tranquilize the user and suppress breathing, which is what causes overdose deaths in the first place. Yet many veterans are prescribed both as part of their cocktails. Additionally, a study by the South Texas Veterans Health Care System linked polypharmacy (five or more drugs) to a four-fold increase in suicidal behavior. The problem with the drugs, just as it is with the veterans, is both physical and mental.
Deadly Connection – The Link Between PTSD and Overdoses
On top of the problem of overmedication, a common problem in the veteran community makes them more susceptible to opioid addiction: PTSD. Researchers at the University of Western Ontario recently discovered that “the recall of traumatic memories enhances the rewarding effects of morphine.” As it turns out, the dopamine receptors in the brain that control traumatic memory recall are, in fact, the same ones that control addiction.
Similarly, a link has been found between depression and opioid addiction. Not only are those suffering from depression more likely to become addicted, ten percent of those who are prescribed opioids actually developed depression a month later.
Opioids mess with the reward systems of the brain, aggravating the symptoms of PTSD and depression. Additionally, those suffering from either disease are less affected by the drug. That means they need more of it, placing them at greater risk of addiction.
Thus, the entire process of treating veterans with opioids is fatally flawed. It is insane that doctors would prescribe a medication to a demographic uniquely vulnerable to it. Why on Earth did this happen?
Freedom (and Profit) From Pain – The Role of Big Pharma
In 2008, Congress was debating the Veterans’ Mental Health and Other Care Improvements Act. The bill required the VA to “focus attention on pain management” for veterans. In practice, that has entailed prescribing more opioids.
It passed thanks to lobbying from the American Pain Foundation, which billed itself as a public advocacy organization for chronic pain sufferers. The foundation championed opiate painkillers as an elixir for the chronic pain so many veterans suffer from. It launched the “Freedom From Pain” media blitz, urging veterans to call their senators and support the bill.
What the foundation didn’t tell Congress, or those veterans, is that ninety percent of its funding came from the opioid companies that manufactured the drugs they were peddling. The foundation took further action on behalf of its benefactors.
Dr. Rollin Gallagher, a spokesman for the foundation, wrote the “Chronic Pain” chapter of the 2007 book The American Veterans and Servicemembers Survival Guide. It encouraged veterans with pain to ask their doctors for opioids and falsely assured them the risk of addiction was low. Discovery in a Massachusetts lawsuit revealed the chapter was essentially written by Purdue Pharma, with the goal of hooking veterans on OxyContin.
“‘Untreated pain’ is often code for ‘underused opioids.'” ~ Andrew Kolodny, President of Physicians for Responsible Opioid Pricing
And when Purdue was sued in Ohio over obscuring the risks of Oxycontin, it filed an amicus curiae brief in favor of the drugmaker. They argued the lawsuit would discourage doctors from prescribing opioids and subject Ohioans to chronic pain. The Ohio Supreme Court ultimately blocked the suit.
Facing a Senate investigation, the American Pain Foundation shuttered in 2012, but similar organizations with similar industry ties have filled the vacuum. Dr. Gallagher, this time representing the American Academy of Pain Medicine, fought against FDA attempts to regulate OxyContin in 2002. The Academy of Integrative Pain Management promoted a Tennessee law banning disciplinary action for doctors that overprescribe opioids in 2015. Several foundations are promoting bills similar to the Care Improvements Act in state legislatures across the country.
And a side note: Dr. Gallagher is now on the government task force charged with dealing with the opioid epidemic.
Conclusion – The Need for Alternative Treatment
This is an outrage. Veterans are not zombies to be exploited for corporate profits. The system by which we treat returning servicemembers must be thoroughly revamped. Several alternative treatments have shown promise – yoga, meditation, acupuncture, and a handful of substances currently classified as Schedule 1 drugs.
Cannabis, magic mushrooms, MDMA and ibogaine have all shown promise in treating chronic pain, PTSD, and opioid withdrawal. Unfortunately, their classification makes them illegal for doctors to study.
Next week, we’ll examine the potential of these substances to treat issues affecting the veterans community.
Photo credit to Cindy Shebley @ Flickr.