August 8, 2016
As overprescription reached its peak in 2012, veteran addiction to opiates took priority among medical issues in the military. With more than half a million veterans reported to being prescribed on opioids and 13 percent diagnosed with opioid use disorder, according to data from the US Department of Veterans Affairs (VA), the urgency to protect our troops from opiate addiction became dire.
Already in 2011, a study by the American Public Health Association had shown that both the accidental overdose and suicide rates were double the national average. This being a result of recently deployed and older veterans being twice as likely as the average American to suffer from chronic pain, and thus more susceptible to being dismissed with a bottle of pills in their hands.
Prescription rates for opioid painkillers would increase by 270 percent within a 12-year period by 2012, triggering an emergency reaction from the VA to help veteran patients in the country. And so the Opioid Safety Initiative was born, ready to slam down on opioid addiction among veterans.
The goal was to provide alternative therapies to military patients for their pain and to prevent opiate misuse by monitoring prescriptions, but what began as an effective solution quickly transformed into a complicated healthcare system that left veterans in the cold.
VA Forces Veterans to Go Cold Turkey with Opioid Safety Initiative
At first glance, when the Opioid Safety Initiative opened up in Minneapolis in 2013, the results were coming up good. By 2014, the number of high-dosage prescriptions was down 90 percent in the city; and on a national perspective, the VA had managed to reduce prescriptions by 20 percent.
This coincided with new federal rules by the Drug Enforcement Administration (DEA), which mandated that veterans had to return to their doctors for prescription renewals every 30 days instead of the previous 90-day standard. The strict rule was an attempt to monitor opioid use and prevent veterans from misusing their prescriptions.
Yet, for patients who lived far away from an appropriate VA facility, getting an appointment every month to refill a necessary prescription for chronic pain would become the bane of their existence. VA facilities all across the nation were finding themselves overburdened by the massive demand of veterans requiring appointments, causing waitlists to range from two weeks to some months-long, which meant many patients would see their medications run out before they met with a doctor.
Meanwhile, the VA promoted new alternative therapy programs for veterans to enlist in, encouraging activities like yoga and meditation, massage therapy, and aquatic therapy. These programs were met with hopeful optimism from veterans, but would run thin as spots ran out almost immediately. Waitlists for VA-approved therapy treatment centers would be even longer than appointment visits at their medical facilities, leaving veterans with very few options.
So while the VA boasted about reducing their prescription numbers by 17,000 patients, it may have had little to do with veterans learning the ways of tai chi to reduce pain, but rather just the simple fact that veterans weren’t getting prescriptions.
Sign the OPCA to Prevent Veteran Addiction or Live in Pain
So imagine one day, you’re on your regular prescription painkiller medication, and the next day, you’re told you have to stop without getting any helpful transition into what will be an excruciatingly painful opioid withdrawal.
Though it had good intentions to fight against veteran addiction, this was the stark contrast the Opioid Safety Initiative gave veterans in letter-form. Both recently deployed and older veterans were receiving letters from the VA informing them that their medications would either be drastically cut or canceled altogether. These letters would be presented without any explicit explanation or helpful healthcare alternatives, even to patients without any history of opioid abuse.
“There wasn’t a lot of discussion with the veteran, except for the provider saying, ‘We’re not going to be doing this anymore because it’s not good for you,’” said Joy Ilem, national legislative director of renown veteran service organization Disabled American Veterans, in a StarTribune article.
While some veterans were losing their prescriptions, new patients in need of opioid painkillers were given ultimatums to obtain them: sign a pain contract or no deal.
These “pain contracts” went by the name of Opioid Pain Care Agreements (OPCAs), a formal agreement by veterans to pursue VA opioid safety education programs and to submit urine samples for screenings. A fairly reasonable effort if it didn’t involve “threatening language and their potential to undermine trust,” a problem acknowledged by a VA directive in the StarTribune article.
Though the VA denies “kicking out” any veterans who failed to meet the pain contract requirements, they did acknowledge that if any pattern of medication misuse or harm was used by the patient, then it would result in prescriptions being “appropriately reduced or discontinued.”
“Suddenly, the VA treats people on pain meds like the new lepers,” said Stephanie Schroeder, wife of veteran Craig Schroeder, in an article by The Washington Post. She spoke about her husband’s challenges with the VA’s new health regulations. “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.”
Joy Ilem further agreed with this point, saying, “We’re hearing from veterans with lifelong disabilities, who never had a problem with addiction issues. They have been on these drugs for decades, and then all of a sudden it was boom, a total change in attitudes.”
Finding themselves in a messy situation, the VA’s efforts to fight against veteran addiction was creating a domino effect of terrible proportions on military patients. People with physical dependences on opioids—but not necessarily addictions—were met with limited options to get the medications they needed or were simply denied outright.
And when people who need opiates can’t get them legally anymore, what comes next?
Heroin, of course.
Read more from this series:
Part 1 – “Veteran Addiction: The Military’s Struggle in US Epidemic”
Part 2 – “Veteran Addiction: The Fight Against Opiate Addiction”
Part 3 – “Veteran Addiction: How Soldiers Lose the Mental Battle”
Part 4 – “Veteran Addiction: Hope for New Beginnings and Recovery”
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