The Re-emergence of the Opioid Epidemic and What it Means for Veterans

Chris Meek — Thu, 25 Feb 2021 08:48:57 -0500

Out of the COVID-19 pandemic, an opioid epidemic in our country has re-emerged with a vengeance. Today, according to data from the Centers for Disease Control and Prevention, 220 Americans will lose their lives due to an opioid overdose.

To put the current number of deaths by opioid overdose into perspective, a report on substance use amid COVID-19 indicates that opioid overdoses in the U.S. increased by 42% in May 2020 when compared to May 2019. Data from the Department of Veterans Affairs also tells us that veterans continue to remain more susceptible to opioid overdoses.

The good news is that despite the seemingly overwhelming nature of the situation, COVID-19 has highlighted a number of key areas where there are viable policy options to address the opioid epidemic. However, addressing the epidemic will require targeting populations, particularly veterans, that are at a higher risk for overdose.

But what exactly can and should leadership do?
1. An effective method of preventing opioid overdose is to co-prescribe a drug known as naloxone with all opioid prescriptions. Naloxone has a 75-100% efficacy in blocking or reversing the fatal effects of an opioid overdose by reversing the respiration of individuals who experience extremely delayed breathing or have stopped breathing altogether due to ingesting a lethal amount of opioids.Veterans Affairs hospitals already provide naloxone free of charge to veterans that are enrolled in their care programs. However, veterans receiving care outside of the VA system should have increased access to the life saving drug as well.

States could look to the precedent set by those that have a mandatory co-prescription plan currently in place, or follow the lead of California and Ohio where providing the option of a co-prescription is required for those who may want or feel they need it. Providing naloxone to a greater portion of the veteran population, which has twice the number of overdoses as their civilian counterparts, is perhaps one of the most effective ways that we can prevent death by opioid overdose among veterans.

2. Medical providers can change their approach to treating veteran patients and how they prescribe opioids. Prescribing opioids and other medications should never entirely replace traditional therapy practices, including talk therapy, physical therapy and other effective therapy methods. In fact, a study on the reasons a group of veterans discontinued using opioids as a part of their treatment plan found that they were more likely to do so because their clinician stopped prescribing the opioids as opposed to discontinuing use on their own volition.

This research highlights the critical role that clinicians can play in preventing or combatting addiction through the manner in which they prescribe opioid medications. It must be ensured that clinicians receive proper training both when it comes to prescribing opioids and detecting substance misuse.

3. Ending the opioid crisis and expanding access to substance education, prevention and treatment was a platform on which President Biden ran on during his 2020 campaign. President Biden has a fairly thorough plan laid out on his website for how his administration intends to combat the opioid epidemic. Though the plan does indicate the president’s intention to target vulnerable populations, including veterans, by expanding access to treatment and training VA clinicians in safe opioid prescribing practices, more directives must be included in the plan in order for it to truly impact opioid abuse among veterans. The same can be said for initiatives carried out on the state level. For instance, making expanded access to rural broadband a priority in state legislatures, like Iowa and North Dakota are currently doing, would drastically improve the delivery of telemedicine. Ensuring that veterans have access to both virtual mental and physical healthcare has the potential to assuage opioid use, especially in rural areas of the country.

The public has demanded action for far too long and that demand has only become justifiably heightened in the midst of the pandemic. The political leadership on the state and federal level that we trust to protect and better the lives of veterans must act and use their platforms to help end the opioid epidemic once and for all. This includes providing tailored education, prevention and treatment options to our nation’s heroes.

Response by Lt Col Charlie Brown made Feb 25 at 2021 8:51 AM

Lt Col Charlie Brown — Thu, 25 Feb 2021 08:51:08 -0500

It never went away, it was overtaken by pandemic news.
Step one: call these drugs what they are: NARCOTICS

Response by SGT Lorenzo Nieto made Feb 25 at 2021 9:09 AM

SGT Lorenzo Nieto — Thu, 25 Feb 2021 09:09:18 -0500

I am infected with agent orange without these type of medications I would be in so much pain I would want to die, my va doctor educate me about the abuse of the medicine I am on I have found that most people overdose on these certain medicines because they have lost hope,loneliness, the feeling no cares, I’m lucky to have a va doctor that does care about me.

Response by MSgt Steven Holt, NRP, CCEMT-P made Feb 25 at 2021 9:28 AM

MSgt Steven Holt, NRP, CCEMT-P — Thu, 25 Feb 2021 09:28:32 -0500

As a Paramedic at a busy 911 service, I can attest the Opioid problem never went away. It just got overshadowed by all the "The COVID is coming! The COVID is coming!" reactions in the media. Die from a heart attack...COVID! Die from a traumatic injury...COVID! Die from opiate abuse... yep, you guessed it...COVID!! (not trying to downplay the Covid-related deaths but few overall were attributed solely to Covid-19).

Of all the medications I carry on the ambulance, Narcan gets used most frequently.

Response by SFC Melvin Brandenburg made Feb 25 at 2021 10:11 AM

SFC Melvin Brandenburg — Thu, 25 Feb 2021 10:11:19 -0500

As someone with chronic injuries, I'm always worried that this therapy will go away completely. When I was initially injured I was going through 90 of the weakest strength every 2 weeks. That was in 2008. Currently 60 of the same strength last me about 7 to 8 months. I don't always need them, and I have other things such as NSAIDS, lidocaine patches, and muscle relaxers that I use first and only use vicodin when I can't get relief (most of the time I get relief). I go to the gym and have worked on strengthening my core and the stabilizer muscles associated with my injuries. I've had several spinal injections as well. I don't always need them, but when I need them I need them like I need air. My claim to fame is I took a fall from a 2 story roof, did the 5 points of contact, and came up on my feet. I ended up compressing my spine and damaging three disks and tore muscles. Luckily no broken bones.

Response by MAJ Ken Landgren made Feb 25 at 2021 10:48 AM

MAJ Ken Landgren — Thu, 25 Feb 2021 10:48:59 -0500

Why are they ingesting so much at a time? Accident or Suicide, or both?

Response by SSgt Richard Kensinger made Feb 25 at 2021 11:33 AM

SSgt Richard Kensinger — Thu, 25 Feb 2021 11:33:48 -0500

Based on my clinical research I agree with Lt Col Brown that it remains a constant. However, CNS stimulant use is escalating, particularly methamphetamine which is quite wicked.
Rich

Response by SFC Casey O'Mally made Feb 25 at 2021 12:05 PM

SFC Casey O'Mally — Thu, 25 Feb 2021 12:05:51 -0500

I was recently shot (20+ years in the Army, no bullet holes. But go be a pizza delivery driver, and all of a sudden my skin is perforated!). When I got to the ER, I was almost immediately given an injection of fentanyl. I am not complaining; I thanked the nurse profusely. But... No one at the ER had asked about my pain. Yes, I was in obvious distress, and yes, the Air Evac team told them I had a GSW, so they knew it wasn't a minor issue (as if the fact that I was Air Evaced didn't already clue them in) but they jumped to fentanyl without asking. Again, I am THANKFUL they did, but it does make me wonder how "routine" it is to immediately shoot up a patient with it.

While in recovery in the hospital, they were pushing an opioid for pain (I believe it was either OxyContin or OxyCodone, but I am not sure). Twice a day, morning and evening like clockwork. Again, there wasn't even a discussion. (And again, I was thankful because I WAS in a lot of pain). But... I had to be the one to say "we can probably back off the opioids now." They were happy to keep giving them to me for my entire stay. And lo, when I was discharged, there it was: a prescription for OxyContin (which I never filled).
I was in pain, the entire time. 6 weeks later, it still hurts to cough or sneeze too hard. But I was SO scared of getting hooked, I chose to come off the "hard stuff" (I was still taking tylenol, an NSAID, and a muscle relaxer for pain, plus other stuff for infections, etc.) and deal with the pain. And you know what... I COULD. Yes, I was in more pain, but the pain was manageable. When I got home, I continued to be in pain, but the pain was manageable.

I think our medical system (and, for the most part, our patients) have become SO scared of pain that we are pushing these drugs more often and (more critically) for a longer duration than necessary. As a society, we need to go back to being OK with a certain amount of pain. No one WANTS to be in pain. And high levels of pain DO add risk to other medical problems, and CAN send people into shock, which its own issue, even when NOT complicating other medical issues. I am not saying we should IGNORE pain. But... very few people have ever died from pain. Plenty have died from opioids.

Response by Cpl Vic Burk made Feb 25 at 2021 7:52 PM

Cpl Vic Burk — Thu, 25 Feb 2021 19:52:05 -0500

I already lost one friend due to opioid addiction. That is one too many. A way to addictive drug to handing out prescriptions like candy.

Response by Cpl Vic Burk made Feb 25 at 2021 8:00 PM

Cpl Vic Burk — Thu, 25 Feb 2021 20:00:55 -0500

The only time I ever take any pain medication is when my back goes out. The muscle spasms make it difficult to even move without major pain. Anyone who has had their back go out understands this. I didn't understand what a person meant when they said their back went out until it happened to me. The V. A. remedy years ago was oxycodone. I refused this and just asked for muscle relaxers and they also gave me a steroid treatment pills the inflammation. I didn't even want to run the risk of getting hooked. I stand by the Marine Corps' saying that "Pain is weakness leaving the body!" Not saying a day will come where I might need something stronger but until then, I will endure the pain!

Response by CPT Russell Pitre made Feb 25 at 2021 8:38 PM

CPT Russell Pitre — Thu, 25 Feb 2021 20:38:33 -0500

It's sad that we are struggling with this. Back in the day the Doc's would give out Meds like candy. They really don't fix what ills you sometimes. It just numbs you.

Response by Cpl David Lear made Feb 26 at 2021 6:34 AM

Cpl David Lear — Fri, 26 Feb 2021 06:34:11 -0500

I was hooked on painkillers for a long time but one day decided I was killing myself with this self medication and by crawling and scratching and sheer willpower I finally stopped but it was a long haul

Response by CW3 Kevin Storm made Feb 26 at 2021 10:49 AM

CW3 Kevin Storm — Fri, 26 Feb 2021 10:49:51 -0500

Opioids never went away, I also think we are leaving one group of antagonists out of it that must share in the blame and the over all costs of treatments. Who are they you may ask, those folks at "metric" related companies. When I worked in Level 1 trauma center in Florida as an ER Tech, monthly we would get from Hospital leadership our scores for the month in satisfaction. It was based on reports from a very well known "metrics" company. It was based on points at first but later it would morph into smiley faces. The goal was to ensure that people felt good and did not leave in pain. Pharma sales reps would come in and leave all sort of stuff for MD's (tickets to games, golf matches and the like, this was prior to a law getting passed to prevent that) , still the goal was to get people to use the product. The rise of Pain Management Clinics started and it was, IMHO, legalized drug dealers. Granted not every doctor was in this racket, but many have a taint around there MD License. We don't hear of these metric companies getting tagged in the law suits, but they played a very important role in it. I worked in a few ER/ED's over the years, and I saw the metrics people and the pharma people working MD's where ever possible. I saw Private MD's in offices who would have signs for sales reps and ask them to leave samples and go as they were too busy (I am not opposed to free samples of non opioid meds, they can help those who can't afford medications). I blame the MD's who wrote the scripts, but I blame the hospital leadership for allowing numbers to be the lead in healthcare over quality of care. I blame the metrics people for twisting numbers, and I blame Big Pharma as well.

Response by PO3 Aileen Dodge made Feb 26 at 2021 3:07 PM

PO3 Aileen Dodge — Fri, 26 Feb 2021 15:07:14 -0500

What is taking the place of the opioid crisis out of the pandemic is the POLYSUBSTANCE ABUSE CRISIS. This crisis has hit the Northeast worse than the opioid crisis first did. The Polysubstances are opioids, benzodiazepines, amphetamines, Cocaine, Methamphetamine, MDMA, LSD, and special K just to name a few. The Job of being a first responder to a drug overdose has become an overly intense situation when the patient has to be dosed several times with Narcan and no one is really sure exactly what the patient overdosed on!!!
And this problem of Polysubstance Abuse is all over, throughout all walks of life!!! What we need to do is stop looking at who is to BLAME!!!! The BLAME GAME never solved anything.
What needs to be found are EFFECTIVE WORKABLE SOLUTIONS. NO QUICK FIXES either! Those are known as BANDAID SOLUTIONS! Very temporary and usually a waste of much-needed financial aid!

Response by MAJ Byron Oyler made Mar 2 at 2021 12:05 PM

MAJ Byron Oyler — Tue, 02 Mar 2021 12:05:39 -0500

The real crisis is the chronic pain sufferers that have been punish because of abusers. The people the medical system cannot fix and need these medications are treated like criminals. I have seen it with the patients I provide care for and my Mother everyday. She is limited on options for pain control as she has decreased renal function and opioids are safer.

Response by Wayne Soares made Mar 4 at 2021 10:27 PM

Wayne Soares — Thu, 04 Mar 2021 22:27:10 -0500

Very tough problem

Response by SMSgt Jeff Kyle made Mar 9 at 2021 3:04 PM

SMSgt Jeff Kyle — Tue, 09 Mar 2021 15:04:18 -0500

I take an opioid medicine to manage constant, sometimes brutal pain. Back pain, knee pain, neck pain, wrist and arm pain. At times, even with the meds, pain is overwhelming. I had a VA NP decide that every veteran she was treating on opioid meds was an addict and cancelled their prescriptions. It didn’t go well. I ended up going to a private clinic to manage my pain. I’m extremely limited on what pain meds I can take as I’m allergic to many of them. I understand that us vets are susceptible to incorrect medication dosing. The problem is, who out there needs these drugs to ease pain or someone who’s using the meds to cope with mental or emotional injuries.
Bottom line: before we all get painted as drugged up dopers who are losers and a burden to society, talk with us and find out what’s going on in our lives. Trust us. Sure there’s about 10% of the vets that are abusing. It’s probably the same 10% that drove us 1st Sgt’s crazy while still on active duty. The rest just need help. Getting the “yer just a druggy lookin for a fix” line is not helping anyone.

Response by PO3 Chuck Honse made Mar 20 at 2021 3:29 PM

PO3 Chuck Honse — Sat, 20 Mar 2021 15:29:05 -0400

Having been on Oxycodone for the past 15 years, prescribed by the VA for pain in my legs that just got worse and worse, but I never took more then what was prescribed. I came to the realization that I needed off these drugs and wanted to live a life free of NARCOTICS! My PCP at VA put me on Hydrocodone for 3 months lowering the dose each month and also prescribed a high blood pressure med to keep my heart rate down along with anxiety cause by withdrawal. I’m now 100% opioid free and it feels good to be human again and actually feel life! BEST decision I ever made! I also quit smoking this past month also! You can do anything you put your mind to doing....just do it! The Oxycodone was a horrible cycle of hell, if you want to quit talk to ur VA dr and ask to be tapered off. It was a month of hell, but 2 moth after that were better and now I could not be more happy. Oxycodone is a BAD DRUG that should only be used in the most severe situations w/people with pain.

Response by SGT John Baker made Apr 20 at 2021 5:58 PM

SGT John Baker — Tue, 20 Apr 2021 17:58:20 -0400

"according to data from the Centers for Disease Control and Prevention, 220 Americans will lose their lives due to an opioid overdose."

220 people from a population of 328+ million people?

Is the opioid crisis an actual threat, or is it a made-up crisis? Or is it simply busy work for our huge bureaucracies?

Doctors have been responsibly prescribing opioid medications for generations helping millions of people live better lives. Not anymore. The DEA is all over this like a cheap suit. It's the first common drug that they can actually control. They have the names of the manufacturers, the distributors, the doctors, and their patiants putting ridiculous increases in the cost of obtaining them along with unbelievable monitoring and control.

Meanwhile, just about any drug, anyone wants is readily available on any city street.

This must be what we all want, a huge over-controlling ineffective nanny state.

Response by SFC Christopher Dunlap made May 5 at 2021 12:32 AM

SFC Christopher Dunlap — Wed, 05 May 2021 00:32:09 -0400

I had a neck injury in 2009 while deployed. When I returned home my PA referred me to pain management, which at the time was off post. The pain management doctor started me on a very low dose of hydrocodone. I gradually built up a tolerance to it and he would keep upping the dosage. 5 years later I was taking a total of 180mg of extended release morphine per day. I was living in a drug enduced fog and didn’t know how bad it was until I finally quit cold turkey.

Response by SSG Mick Rolling made May 20 at 2021 8:09 PM

SSG Mick Rolling — Thu, 20 May 2021 20:09:09 -0400

Opioid Overdoses by prescription pain patients usually involve (90%) other drugs and/or Alcohol, usually benzodiazepines such as Valium and Xanax. We need to stop linking Prescription opioid overdoses and deaths with heroin/Fentanyl overdoses and deaths. They are not related. Yes some former pain management patients turned to heroin/Fentanyl , but only after being savagely removed from pain management treatment for no reason other then the CDC's misguided recommendations or minor violations of pain contracts. God forbid you have a beer on occasion or a glass of wine or two then get called in for testing a few days later. In today's environment you will get cut off and thrown out of a clinic fr anything.

In the State of Maine My doctor cannot legally prescribe over the CDC recommenced levels but Doctors can prescribe drugs for assisted suicide to purposely end my life. Please explain that to me.

The missing link in Pain Management is insurance companies who will only pay for pain management in the form of pills and shots.