When ret. Sgt. Ben King came home from Iraq he was “high on his service,” but like many other veterans coming home from active duty at the time, the adrenaline eventually wore off and the pain settled in.
Suddenly, King, who served on an Army tactical psychological operations team (PSYOPS), was feeling less like a “warrior” and more like an old man. He had serious joint aches and couldn’t sleep well at night. He started self-medicating with alcohol and sleeping pills. He was becoming an emotional wreck.
“When I got back,” he explained to TAC, “I came back high on my service and proud of my service and very much the warrior. But little by little, things started wearing me down.”
King, now 34, is among a significant percentage of recent combat veterans suffering from chronic pain (44 percent) and/or symptoms of Post Traumatic Stress Disorder (20 percent or more). They range from people like King who suffered emotional stress and muscle strain from the rigors of everyday combat life, to the thousands of men and women who survived the kinds of head and limb injuries that would have left them dead in wars just a generation ago.
Veterans along this scale have, up to now, turned to pills for pain, anxiety, depression, and insomnia—mostly because they relied on them before they got out of the military. When they got home, VA doctors found prescription meds an effective way to plow through the glut of patients flooding into hospitals in unanticipated numbers across the country.
But unfortunately, as has been reported here at TAC and in many other outlets, overmedication has led to the rampant misuse and abuse of pills, dependency, and even death. As Aaron Glantz wrote in a piece about the VA for the Center for Investigative Reporting in 2013, “Since the 9/11 terrorist attacks, the agency charged with helping veterans recover from war instead masks their pain with potent drugs, feeding addictions and contributing to a fatal overdose rate among VA patients that is nearly double the national average.”
Because of reporting like Glantz’s, and numerous studies both inside and outside the military and VA health system, things are beginning to change. Whether that ends up being good or bad for veterans, will depend on whether there are other options for the injured and disabled.
According to a Washington Post report in February, new federal Drug Enforcement Agency rules instituted last summer have restricted access to the number of opiates like Oxycontin and Vicodin that anyone, including veterans, can get per month. In other words, doctors cannot fill more than a 30-day supply of painkillers to anyone, anymore. This does not apply to drugs for depression, anxiety or insomnia. The changes came not only in response to veterans’ issues, but nationwide addiction and overdose statistics, what Centers for Disease Control has called a “growing, deadly epidemic,” backed up with data indicating that it is “the worst drug epidemic U.S. history.”
For some vets who welcome alternative pain management and who believe pill popping has taken over their lives, this is a welcome development. But for many others, the Post points out, it is a troubling one. Vets tied to the VA system often drive great distances to get to a government pharmacy, and the wait times for appointments at some facilities can be weeks, even months.
“Suddenly, the VA treats people on pain meds like the new lepers,” said Stephanie Schroeder, the wife of veteran Craig Schroeder. She told the Post her husband was injured in a makeshift-bomb explosion while serving in Iraq. He suffers from traumatic brain injury, hearing loss, a herniatic disc, and pain from a broken foot. He has been on a “steady regimen” of opioids ever since. Now, he’s had to wait five months for an appointment with the VA and his prescriptions have simply run out.
“It feels like they told us for years to take these drugs, didn’t offer us any other ideas, and now we’re suddenly demonized, second-class citizens,” she said.
Dr. Charles Ruby, who retired from the Air Force and is now working as a clinical psychologist and veterans advocate in the greater Washington, D.C., area, is a proponent of therapy vs. medication for PTSD sufferers. He acknowledges, too, that pain meds, especially in combination with psychotropic drugs, can be lethal. However, he is skeptical of what he says are the federal government’s arbitrary constraints on painkillers.
“It’s probably a good idea to manage the doling out of [opioids], but who does the managing, in my view, should be the prescribers, the doctors,” he told TAC, “not the DEA stepping in. The government is going with this brutish shotgun approach without judging the consequences.”
Veterans’ blogs have been lighting up with responses to the new rules, which many are calling onerous and resulting in withdrawal symptoms among users. Among the complaints, that vets are all being labeled addicts no matter the circumstances.
“Best I can tell, VA could have handled the change better and treated veterans affected with more compassion while they suffered through withdrawals,” writes disabled veteran and advocate Benjamin Krause, who runs DisabledVeterans.org. “A big problem with the change was that VA failed to warn and did not explain exactly why the change was going on. Veterans that pushed for the painkillers they previously received were labeled as ‘drug seeking.’”
Many of Krause’s commenters said they would like to try medical marijuana as an alternative, but did not trust that even if they did so in a pot-friendly state such as Colorado, their federal benefits wouldn’t be at risk.
The VA did not respond for calls for comment. A Center for Investigative Journalism report in 2014 found that for years, the VA did not follow its own rules regarding the distribution of highly addictive painkillers—including morphine. All the while, VA prescriptions of narcotics jumped 270 percent between 2001 and 2012.
Ben King said he recognizes the struggle and is now a strong proponent of alternative treatments. After he was introduced to yoga at a D.C.-area VA, he became convinced he could lose the pills and booze. He now runs “Armor Down,” which supports “mindful meditation” as a healing approach for veterans.
“It was really rough for me to start thinking about pulling away from these things that I was using, which I felt were very valuable, very helpful,” he told TAC. But they were just blunting his symptoms, and only for short periods of time. King now believes meditation and other holistic remedies can work to help veterans transition to civilian life and even manage pain.
The VA has come to this realization, too, and in recent years has poured money into alternatives, including a $21.7 million initiative late last year that would study the effectiveness of such therapies—including the use of morning light to treat back-pain and PTSD, as well as hypnotherapy, chiropractors, and meditation to reduce chronic pain.
According to a December article in Medical Care, authors A. Rani Elwy and Stephanie Taylor presented 14 new studies on CAM (complementary and alternative medicine) therapies, saying the research showed “promising steps to improve the health of veterans and active military personnel.” They also cited statistics showing that CAM programs were offered in some form at 90 percent of VA medical facilities at the time.
King said the greatest obstacle has always been the stigma of such programs for the military culture. “What (the DEA rules) represent for the VA is a kind of pulling off of the Band-Aid,” he said. “If they VA can find a way to articulate the means of these (alternative) practices, they can have the opportunity to frame the changes as beneficial to everyone. But it’s going to take some guts.”
Several members of Congress have been pushing for funding for alternatives, too. Rep. Julia Brownley, D-Calif., recently re-introduced her Expanding Care for Veterans Act, which would broaden research and access to CAM.
“(Complementary and alternative medicine) can help veterans manage chronic pain and reduce overuse of prescription drugs, which, as we now know, can lead to very serious health problems caused by addiction,” Brownley said in a statement to TAC.
However, in response to the new DEA restrictions, she warned, “The VA and DEA must also ensure that regulations aimed at preventing prescription drug abuse do so without compromising pain management.”
The reality is, not all sufferers can be expected to get through the day with Yoga or acupuncture. Their injuries are too serious. For vets who need to cut through the VA wait times or get to a pharmacy closer to home, the Veterans’ Affairs Choice Card program would allow them access private clinics. But so far, according to a recent VA report, only 27,000 out of the nine million eligible vets have bothered to use it.
One issue, according to the Washington Post, is that veterans have to wait months to be reimbursed by the VA for private care. Again, bureaucracy gets in the way.
Meanwhile, veterans feel labeled and abused, as though they are paying for others’ mistakes. “Their policies regarding the prescription of opiate pain relievers are not only an atrocity against the disabled but are criminal in their application and enforcement,” raged one DisabledVets.org commenter.
“As usual, no one cares, and veterans who are suffering in agony remain voiceless and trapped in a government made nightmare.”
Kelley Beaucar Vlahos is a Washington, D.C.-based freelance reporter and TAC contributing editor. Follow her on Twitter.