Veterans: A Battle with Pain (Part I)
MILITARISM, 11 Apr 2016
Mark Brunswick and Brian Peterson - Star Tribune
VA doctors freely handed out pain medications to veterans for years. Then they stopped. The results have sometimes turned tragic.
WORST-CASE: Iraq veterans Zach Williams and Ryan Trunzo overdosed after battling chronic pain and withdrawls from pain medication.
Zach Williams came home to Minnesota with two Purple Hearts for his military service in Iraq. He also carried other lasting war wounds.
Back pain made it hard for him to stand. A brain injury from the explosions he endured made his moods erratic.
Williams eased the chronic pain with the help of narcotics prescribed for years by the Minneapolis Veterans Medical Center. Then the VA made a stark and sudden shift: Instead of doling out pills to thousands of veterans like him — a policy facing mounting criticism — they began cutting dosages or canceling prescriptions, and, instead, began referring many vets to alternative therapies such as acupuncture and yoga.
At first, the change seemed to work: Worrisome signs of prescription drug addiction among a generation of vets appeared to ebb. But the well-intentioned change in prescription policy has come with a heavy cost. Vets cut off from their meds say they feel abandoned, left to endure crippling pain on their own, or to seek other sources of relief.
Or worse.
On Sept. 20, 2013, police were called to Williams’ Apple Valley home, donated to him by a veterans group grateful for his sacrifice. Williams, 35, lay dead in an upstairs bedroom. He had overdosed on a cocktail of pills obtained from a variety of doctors.
Authorities ruled his death an accident, officially “mixed drug toxicity.” Advocates for veterans and some treatment counselors angrily call it something else: the tragic result of the VA’s failure to provide support and services for vets in the wake of the national move away from prescription pain pills.
At the VA’s Medical Center in Minneapolis, for instance, there is one chiropractor on staff for the more than 90,000 patients it sees a year.
“The VA has been doing an awful job on this issue,” said Dr. Andrew Kolodny, chief medical officer for Phoenix House, a drug and alcohol rehabilitation organization that runs more than 130 treatment programs in nine states, including programs for veterans.
Before alternative therapies can work, Kolodny said, the VA needs to better tend to the addicts it has created.
Hugh Quinn, a veterans advocate for Itasca County, is even more blunt: “The VA let them get wound up on all these drugs and now they cut them off completely,” he said. “These guys are coming into my office and they are a goddamn mess and the VA is just blowing them off.”
VA leaders strongly defend the work they’ve done to wean thousands of vets off highly addictive pain pills and to direct them toward other ways to treat their chronic pain.
“VA has been at the forefront in dealing with pain management, and we will continue to do so to better serve the needs of veterans,” Carolyn Clancy, the interim VA undersecretary for health, told the Senate Veterans’ Affairs Committee earlier this year.
In May, four members of Congress asked the U.S. Government Accountability Office why vets are having trouble accessing alternative treatments and why some vets are no longer getting the medications they need.
Generation of addicts
Almost 60 percent of veterans returning from the last decade of war list chronic pain as their most common medical problem.
The VA’s initial solution: a powerful but potentially addictive class of drugs known as opioids.
During an 11-year period ending in 2013, the number of prescriptions from the VA for pain meds like oxycodone and morphine surged 259 percent nationally.
At VA hospitals in Minneapolis, St. Cloud, and Fargo, prescriptions for morphine and oxycodone more than doubled for every 100 patients from 2001 to 2014.
Methadone prescriptions almost tripled, according to data obtained by the Star Tribune through the federal Freedom of Information Act.
Lawmakers and some veterans groups, concerned about overdoses, drug suicides and reports that medications were being sold on the street, pushed the VA to adopt more effective pain management protocols.
Cutting back at three VA hospitals
A 2012 DEA rule change led to a steep decline in prescriptions for addictive painkillers at VA hospitals and clinics, while the number of veterans seeking treatment for chronic pain has steadily increased since the start of the wars in Afghanistan and Iraq. The charts below show pain prescription data for the three regional VA hospitals in Minneapolis, St. Cloud and Fargo since 2001.
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