The pattern is relentless: young veteran, barely 30, over-medicated, and not only uncertain but grim about his future. He may still be married, but is likely divorced, possibly estranged from his children. His family frets over his physical and mental health, while taking careful note of his ups and his downs.
Then one day, he dies. The veteran may have taken his own life deliberately. In an increasing number of cases, however, he may have simply gone to sleep and never woken up following a fatal reaction to one of the drugs or cocktails of pills he was prescribed by military doctors.
As our nation has come to rely more heavily on pharmaceutical drugs to manage chronic pain and psychological health, the U.S. military has followed suit, doling out drugs on the battlefield and now back on the home front in a vast network of veterans (VA) hospitals and clinics. But as the rates of sudden death and suicide have spiked over the past decade, it’s become clearer to mental health and military advocates that this heavy reliance on prescription drugs may be partly to blame.
“You get a cocktail, and it’s usually a sleeping pill, anti-anxiety medication, an anti-depressant, and an anti-psychotic—and sometimes even a stimulant like Ritalin or Adderall,” noted Lt. Col. Charles Ruby, who retired from the Air Force and is now working as a clinical psychologist and advocate for veterans. “You have no idea what can happen,” tells TAC.
“Prescription drugs have become the catchall—‘take this and if it makes you feel better, we’ll increase the dosage’,” according to (Ret.) Brigadier Gen. Becky Halstead, a public proponent of alternative medicine following her own two-year stint on medications for chronic fibromyalgia.
We use prescription drugs because it is a quick fix. It started because our military was strained and it was just keeping more people propped up to do their jobs. But the long-term danger is we made people too dependent on it. It’s alarming to me.
Nationally, prescription drug overdoses have risen significantly. According to the National Center for Health Statistics, for example, the number of Americans who died from painkillers rose to 14,800 in 2008 from 4,000 in 1999—the vast majority being unintentional.
In 2008, Lt. Gen. Eric B. Schoomaker, then the Army’s Surgeon General, raised eyebrows when he mentioned that there had been “a series, a sequence of deaths” in the new warrior transition units (WTU) military-wide. The units are supposed to help wounded and sick soldiers transition back into uniform or out of the military, but they’ve been beset with drug problems and low morale for years.
“Half of the warriors are ‘stoned’ on psychotropic drugs,” said one report about the WTU at Fort Drum, NY, in 2012. Another Army report in 2011 said 25 to 35 percent of the soldiers in these units nationwide were “addicted to drugs.” Reporters obtained an internal study in 2010 that revealed 32 soldiers and Marines in the WTUs had died from accidental overdoses since 2007.
Meanwhile, the drug Seroquel has been implicated in the deaths of several veterans whose families say were using the drug when they died in their sleep. Seroquel is the brand name for Quetiapine, and although it is supposed to be prescribed for schizophrenia and bi-polar disorder, military and VA doctors have used it for years to treat stress-induced insomnia.
According to at 2010 report by the Military Times, orders for antipsychotic medications like Seroquel and Risperdal (another anti-psychotic) jumped 200 percent between 2001 and 2009, the war’s peak. In fact, before the company was successfully sued (for paying kickbacks to doctors in a scheme to promote Seroquel for uses not approved by the FDA, otherwise known as “off label”), drug-maker AstraZeneca sold $340 million worth of it to the Armed Forces. Some 54,581 prescriptions for Seroquel were written for active duty servicemembers in 2011 alone—the vast majority as a sleep aid.
While off-label prescriptions are legal and common, critics like Harvard University research psychologist Dr. Paula Caplan, say the unknowns outweigh the benefits. When some veterans could be taking upwards of 20 to 40 different pills a day, half of them psychotropic, the results can be unpredictable. “You don’t know what effect the drug may have on them.”
“I have never been one to say I’m opposed to medication—I’m just opposed to these medications, which have a side effect of causing cardiac arrest,” said Stan White, whose son, Marine Cpl. Andrew White, 23, died from a heart attack in his sleep in 2008. He blames Seroquel for his son’s unexpected death. The young White was on a variety of medications for post-traumatic stress disorder (PTSD), mainly a clonazepam (anti-anxiety) and a paroxetine (anti-depressant), along with Seroquel (for his nightmares he was given 1,600 milligrams a day, double the maximum dosage given for schizophrenia, his father said).
Seroquel was taken off the Pentagon’s regular formulary in 2012, but it can still be prescribed with a waiver.
Meanwhile, numerous reports show how pervasive the overmedication problem has become:
- According to an investigation by the American-Statesman, the military has spent at least $2.7 billion on antidepressants, and $1.6 billion in narcotic painkillers like Oxycontin over the last decade. According to the Military Times, DoD orders for anxiety medications and sedatives like Valium and Ambien increased 170 percent from 2001 to 2009. By 2009, 1 in 6 active duty service members were on some form of psychiatric drug, including 17 percent on antidepressants.
- In 2010, a significant Army report on suicide found that in 2009, 20 percent of the active duty force (106,000) had been prescribed at least one medication for pain, anxiety or depression, while prescription drugs were involved in one-third of the 160 active duty suicides that year. Of the 188 accidental/undetermined deaths from 2006 to 2009 caused by drugs and alcohol, 74 percent involved prescription medications.
- According to an Institute of Medicine report in 2012, 11 percent of service members in 2008 acknowledged they were abusing prescription pills—up from 2 percent in 2002.
- An American-Statesman investigation found that of the 277 Texan Iraq and Afghanistan vets for whom they could establish a cause of death between 2003 and 2011, one in five had died accidentally due to toxic prescription cocktails.
- According to the Center for Public Integrity, 49,000 veterans (all wars) killed themselves from 2005 to 2011—more than double the rate of the civilian population. Some wonder how much the drugs had to do with it—many of these powerful medication popular with doctors carry warnings of increased suicidal thoughts, anxiety, insomnia, and psychosis, especially with high dosages or when stopped abruptly.
Dr. Caplan, who recently published When Johnny and Jane Come Marching Home: How All of Us Can Help Veterans, is a stern critic of medication dependency. She tells TAC that pharmaceutical companies are in many ways working against raised awareness of their drugs’ risks:
[It’s been] shown through lawsuits that [drug companies] minimize and even conceal various kinds of harm from their drugs, including that they increase or can increase the risk of suicide or homicide.
DoD drug spending has ballooned from $3 billion in 2002 to $6.8 billion in 2011. Critics charge that this partly reflects a shift to the “quick fix” of drugs for treating mental health conditions and chronic pain, a mindset they say is crippling full recovery.
“It’s a very significant problem,” Tom Tarantino, a former Army Captain who served as a platoon leader in Iraq in 2006, and is now spokesman and policy associate for IAVA.
“It’s one of those things that really starts with medicine on the battlefield, and in deployment you are just trying to treat symptoms so people can keep going,” he tells TAC, describing how pills were handed out in Ziploc bags in the field. “The availability is so much easier than when you are at home. When you get home, they say ‘we’re not giving you a bag full of Oxycontin, no.”
But the medications continue. “I don’t think it’s nefarious, but I do think there is an addiction problem,” Tarantino added. The latest statistics obtained by Veterans for Common Sense indicate that over 486,000 Iraq and Afghanistan veterans have been treated for a mental health issue at the VA. Many have other injuries, too, like traumatic brain injury (TBI) and musculoskeletal injuries—all requiring a battery of prescriptions.
“I have a very close friend who I served with. He has pretty severe post-traumatic stress and pretty severe TBI, and every time he walks into the VA to get treatment he’s given drugs. He’s a very active person so this really frustrates him,” said Tarantino.
Dr. Ruby, who recently launched Operation Speak Up, said medication dulls but does not dispel the painful memories of PTSD sufferers. His campaign hopes to establish group settings for veterans to talk about their combat stress, based on the Alcoholics Anonymous model. “Our view is that psychiatric drugs do nothing but sedate people. We believe that speaking out is a much better way to treat these people and to find a way to integrate back into their communities.”
While officials stand by the positive uses for medication, some 89 percent of VA facilities now also offer some form of complementary and alternative medicine. In addition to medication, the VA provides psychotherapy, as well as cognitive and exposure therapies for PTSD, according to its website. Meanwhile, the Pentagon has been funding yoga and acupuncture and any alternative “that showed even an iota of promise.”
To address prescription drug abuse, both agencies have upgraded procedures for monitoring prescriptions and their various interactions for individual patients. There’s been some success at reducing the use of the most addictive painkillers and anti-depressants. Buy-back efforts at hospitals prove useful—but are sporadic—for collecting thousands of unwanted, unused pills.
In June, Sen. Richard Blumenthal (D-Conn.) introduced a bill that would allow permanent buy-backs system-wide. “There is substantial evidence that prescription drug use and abuse is a major contributing factor to military and veteran suicides,” he told TAC in a statement, “and this bill would address that problem head on.”
Kelley Beaucar Vlahos is a Washington, D.C.-based freelance reporter and TAC contributing editor.