Veterans returning from Afghan and Iraqi combat zones following the 9/11 terror attacks felt the brunt of the opioid epidemic as they acclimatized to civilian life, according to a new study from health economists.
Researchers from the University of Connecticut, University of Georgia, and San Diego State University reported in a study distributed by the National Bureau of Economic Research that combat veterans deployed as part of the global war on terror have an opioid abuse rate about seven times higher than civilians.
In other words, the opioid crisis that has immiserated parts of the United States in recent years, costing 47,000 lives in 2017 alone, is far more acute still for veterans of the war on terror. About 46 Americans die every day of an opioid overdose, and patients in the Veterans Health Administration are almost twice as likely to die of opioid-related overdoses.
The grim numbers are attributable in part to treating chronic pain due to injuries in combat with opiates. Injuries sustained in combat range from shrapnel wounds and broken bones to spinal cord injuries, more often than not requiring painkillers as part of treatment and recovery.
The authors of the study agree that “lax monitoring of opioid prescriptions by Veterans Health Administration (VHA) providers” placed veterans at “substantial risk” for opioid abuse and fatal overdoses. They added that “next to nothing” is known for sure about how U.S. policies in the global war on terrorism directly affected veterans’ susceptibility to opioid addiction.
“When somebody reports he has pain, it’s very hard to get around it,” said one of the authors, Dr. Resul Cesur, associate professor of healthcare economics at the University of Connecticut. “Regarding opioids, all of these prescription drug monitoring programs and related interventions which have been taken at national or state levels … these have been implemented in a relaxed fashion.”
The study places heavy emphasis on the effects of enduring trauma, which can sometimes lead to using drugs and alcohol as coping mechanisms. That phenomenon is not new, according to veterans of Operation Enduring Freedom and Operation Iraqi Freedom.
The study’s authors write that post-traumatic stress disorder, which affects nearly one-fifth of active-duty service members, creates an increased risk of veterans abusing prescription painkillers, heroin, and synthetic opioids, including fentanyl, as part of their efforts to cope with psychological pain.
“So you get into a firefight, and you may get injured. That could contribute to opioid use through physical or psychological channels,” Cesur said. “Or, you get into an enemy firefight, and you see people dying, we know very well that it might have very strong psychological effects on people, and this could be based on any type of death you observe, whether an enemy or an ally.”
Charles, a veteran of Operation Enduring Freedom in Afghanistan who was deployed in 2004, 2008, and 2013 and asked not to have his real name used for privacy reasons, told the Washington Examiner that anyone in a combat zone could undergo trauma, “whether he is an infantryman or a mechanic.”
Veterans Affairs medical care centers, Charles said, are not doing what they should be doing to care for those who have undergone such trauma and who have since begun abusing drugs and alcohol. “They send you from one department to the next, and it’s too easy [for a veteran] to fall through the cracks,” he said.
The VA has long faced scrutiny for patient backlogs and veterans dying without receiving care.
The veterans’ claims backlog fell drastically between March 2013 and September 2015, from about 600,000 claims to about 71,000. Since that decline, backlogged claims have been relatively steady at more or less 70,000 claims monthly — still much too high, according to veterans.
The VA Office of Inspector General has already conducted 37 healthcare inspections of VA care centers across the country since January 2019, many of which turned up troubling details of such deficiencies as inferior training methods for care providers and lack of medication oversight.
For example, the OIG found in July 2019 that leadership at the VA Northern Indiana Health Care System in Fort Wayne, Indiana, had thwarted primary care providers’ plans to taper patients off opioids gradually and safely. According to the report, the chief of staff told primary care providers on several occasions to approve opioid medication fills. Even though the inspector general found that patients did not have identifiable adverse health outcomes, “the continuation of patients’ opioids may have prolonged dependence on opioids.”
The VA has cut opioid prescriptions by over 40% since 2012, mostly by requiring more frequent visits to a VA care provider to get those prescriptions, which costs patients more money. The authors of the report added that more and more providers are reluctant to fill prescriptions for opiates knowing the potential for abuse.
A reduction in opioid prescriptions sounds like good news, but the authors conclude that doing so may drive more veterans to seek a cheaper alternative to regulated pills from a pharmacy, such as illicit heroin or fentanyl purchased on the street.
