Veteran’s Now Can’t Meet Treatment Demands
The U.S. Department of Veteran’s Affairs has admitted that the agency helped create the large population of veterans now battling opioid dependence. When soldiers returned from service, they were over-prescribed painkillers for conditions such as pain and post-traumatic stress disorder.
Now, addiction treatment facilities are filled to the brim, and subsequent crackdowns on prescriptions have only added fuel to the fire. Moreover, the agency adopted more conservative prescribing practices in 2013, which lead addicted veterans to buy their pills on the street.
If these became too expensive or unavailable, they would switch to heroin, a trend that was already manifesting in the general population as well. So, the VA has been working on damage control, but is currently struggling to make much of a difference.
According to expert analysts, the agency is largely hindered by budget and bureaucracy, and has so far been unable to meet the treatment demands of thousands of veterans facing opioid dependence.
Thus, many veterans are left to their own devices, battling a chronic condition that now claims thousands of lives every year in the U.S.
According to a 2015 study by Castlight Health, Inc., in Fayetteville, NC, nearly one-half of opioid prescriptions are abused. Fayetteville is home to Fort Bragg, the largest military installation in the country – and yet, the VA health system has no local residential treatment program for addiction, and no inpatient detox facility.
In fact, it has only a handful of physicians in a more than 20-county area that can write prescriptions for medications indicated to treat opioid dependence.
Also, the Fayetteville VA provides services for the fastest-growing veteran population in the country. It hosted 70,000 patients in 2015, a sharp increase from 42,000 in 2010. The VA has made strides in meeting medical demand, however. In 2014, an audit found the hospital had a wait time of nearly a month for primary care. That has since decreased to around 4 days.
Officials at the VA say they are working to expand treatment capacity across the nation, and put more focus on alternative pain treatments.
And since 2012, they have reduced the number of patients on long-term painkillers by about one-third – but given the trend of patients switching to heroin, one has to wonder – at what expense?
The painkiller epidemic is certainly not an isolated problem. According the Centers for Disease Control and Prevention, more than 52,000 people died of an overdose in 2015, the majority of which were related to prescription opioids, heroin, or heroin’s much more potent cousin, fentanyl. Since 1999, the number of deaths involving opioids and heroin have quadrupled.
The veteran’s epidemic, however, originates specifically from years of conflict in Afghanistan and Iraq. The war produced a deluge of veterans with serious mental and physical heath conditions. While medical advance dramatically increased the survival rate since the Vietnam War, veterans are still returning home with irreversible damage, such as spinal cord injuries and amputations.
And painkillers were likely prudent for many injured veterans. However, VA medical facilities tended to prescribe too many drugs in too many cases. Opioids are mostly indicated for short-term use, due to their propensity for dependence and addiction. However, they are often prescribed for chronic pain and other conditions, despite the fact that they are not indicated for these diagnoses.
A Profound Lack Of Resources
According to the agency, the VA treated more than 66,000 veterans with opioid use disorders in 2016.
Another interesting fact: VA experts say that veterans are 10 times more likely than other Americans to abuse opioids. In fact, opioid dependence may be the top cause of veteran homelessness.
But the VA system’s options for treatment are limited. For example, the VA in Fayetteville has an outpatient alcohol detox unit, but no opioid detox unit at all. Veterans are instead referred to other local facilities for detox.
Once the addict is clean and stable, they are referred to an outpatient addiction treatment program. This program has about 1,000 visits per month, and had 2,800 new patients from January-October in 2016.
Addicted veterans can also be referred to one of the VA’s more than 40 inpatient addiction treatment facilities in the country. According to a 2014 audit, in total, there were just over 900 available beds. Waits are often longer than a month, which is a deterrent for patients in need, and yet there are sometimes empty beds due to staffing issues.
The closest facility to Fayetteville is in Salisbury, nearly 3 hours away. And due to the lack of VA services for addicted veterans, patients often turn to public and private providers – who are also unable to keep up with the demand for treatment.
The trend of over-prescribing opioids in the military is not terribly different than what we’ve seen in the general population.
Yes, many patients have a legitimate need for pain control – but there are a few different problems with using opioids as a first line of defense.
One of the main problems, of course, is that when opioids become too expensive or unavailable (i.e. prescription are denied) users switch to street drugs to fuel their habit.
Another problem is that opioids are highly addictive, and the availability of long-term, effective treatment for addiction is sorely lacking – apparently for both veterans and the general population.
Finally – and I cannot stress this enough – the long-term use of opoids is known to cause a condition known as hyperalgesia. This condition is characterized by increased sensitivity to pain – and thus, an increase in pain in general. Ironically, the so-called miracle drugs developed to treat pain can gradually make it worse.
~ G. Nathalee Serrels, M.A., Psychology