Chronic pain is a serious problem for veterans. Research shows that half of all veterans have some kind of chronic pain problem after returning from combat and managing that pain can be challenging. But those challenges are compounded when the VA lacks many of the options available in a civilian environment -- or fails to offer them to patients -- and are left with NSAIDs and narcotics. Because of this, they are creating a new problem: drug addiction.
The VA has previously acknowledged the problem of drug addiction within the veteran community, and stated that it contributes to veteran homelessness as well as exacerbates problems such as PTSD and TBI (Traumatic Brain Injury). Because the VA is aware of the problem, the obvious question must be asked: why would the VA contribute to the problem of drug addiction on the front end, only to dump millions of dollars into dealing with its effects on the back end?
"Giving a prescription, which they know how to do and are trained to do, is almost a default," retired brigadier general Dr. Stephen Xenakis, a psychiatrist who served as commanding general of the Southeast Regional Medical Command for the U.S. Army, told the Center for Investigative Reporting (CIR).
Xenakis said that opiates will often cause more harm than good.
According to the CIR, the VA is making a sizable contribution to the prescription drug abuse problem among veterans. Data shows that "prescriptions for four opiates -- hydrocodone, oxycodone, methadone and morphine -- have surged by 270 percent in the past 12 years."The data also shows that the rise in the number of prescriptions has dramatically exceeded the growth of patients. In 2012 alone, the VA wrote 6.5 million prescriptions for opioid pain medication.
The number of patients who die as a result of addiction to pain killers is twice as high within the VA system as in the civilian world.
Addiction to pain killers among veterans can also be tentatively linked to the recent "wait times" scandal that has the VA in a quagmire. Data shows that the clinics with the highest number of pain killer addicts also had extremely long wait times to see doctors, sometimes three months or more, which makes finding and treating the root cause of pain difficult at best.
The report from the CIR highlights some of the most heartbreaking and shocking cases of opioid over-prescription, which directly contradict the VA's pain management guidelines. The CIR's report shows that the VA is severely overmedicating patients as they struggle to deal with complex cases and an overloaded system.
However, the problem is not consistent across the country. There are some clinics that adhere to the rules, and some that do not.
The VA has been aware of the opioid problem for at least the last 5 years -- likely earlier. In 2009, new regulations required medical staff to put more focus on treating the causes of chronic pain rather than just using narcotics to cover up the symptoms.
VA officials have said in previous statements that the health agency is taking steps to address the problem, but did not respond to requests for further comment.
The VA recently rolled out the Opioid Safety Initiative (OSI), a program that is designed to reduce dependency on prescription pain killers. The department says that in just four months, it reduced dependency by 50 percent at its pilot locations in Minnesota.
However, when considering what this initiative entails -- some training materials for staff, patients, and their families, and a smart phone app to track chronic pain -- it's hard to believe that this is an accurate figure.One component of this program that could be helpful, however, is the expanded use of complementary and alternative medicine (CAM). CAM includes everything from acupuncture to yoga -- treatment that isn't used in mainstream medicine. Most veterans who are addicted to pain killers say that despite the VA's treatment guidelines, they were never offered any other options for coping with their pain before being given the pills or injections.
Often these treatments come at a much lower cost than the opioids do.
For example, Transcutaneous Electrical Nerve Stimulation (TENS) has been widely used in chiropractic and physical therapy offices for decades, but until recently was prohibitively expensive for most as the large machines can cost thousands of dollars and weren't conducive to personal use. However, good TENS units are now FDA approved, non-invasive, non-habit forming, and available without a prescription for less than $100.
The units work by blocking the nerve pathways that send pain signals to the brain. Unfortunately, CAM treatments for chronic pain are not available at every VA location.
While the VA says that 9 out of 10 of their sites have some type of CAM program, the vast majority don't deal with chronic pain, but rather with PTSD and other mental health concerns. CAM treatments may not be effective in all cases, but research has shown several methods to be helpful in treating pain when used with more traditional practices, such as physical therapy, and non-narcotic medication.