Posted on Feb 25, 2021
The Re-emergence of the Opioid Epidemic and What it Means for Veterans
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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.
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.
Posted in these groups: Addiction Counseling
Substance Use
Department of Veterans Affairs (VA)
Resources
Medical
Substance Use Department of Veterans Affairs (VA) Resources Medical
Posted 5 y ago
Responses: 19
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It never went away, it was overtaken by pandemic news.
Step one: call these drugs what they are: NARCOTICS
Step one: call these drugs what they are: NARCOTICS
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SPC Terry Page
Rx narcotics play an important role in pain management and most of us know their inherent danger. I think the best we can do is treat them like a loaded gun and apply appropriate caution. Loaded guns are useful, we just have to be aiming at the enemy. I totally agree that the problem never went away, just drowned out by pandemic noise.
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SSG Mick Rolling
Narcotics or managed drugs used to assist with a patient with chronic pain that helps raise their quality of life. WE ARE NOT JUNKIES.
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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.
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MSgt T Clark
Great point. So many veterans and the general population reach a emotional depth of disparity that the narcotics become their escape. I mean look the circumstances in which we must combat the pandemic like social distancing away from the people we love and comrade with friends has elevated the opioid crisis.
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PO2 Edward Gilbert
The focus to reduce addictions and take away narcotics where needed has definitely hurt those that need them to manage pain. Doctors who understand that and can treat accordingly along with monitoring the use, education as you mentioned, needs to be part of the treatment process. Not just remove them from the equation for those of us who can't live without them. It is then that the patient starts looking to the street, and the drugs coming over from China and distributed on the streets now are not always what they appear to be, and what is contributing to many overdoses.
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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.
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.
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PO2 Edward Gilbert
I had similar experience, the NP assigned as my PCP didn't like tramadol, so immediately reduced my prescription. I requested an MD for my PCP and was reassigned. With him I was able to relate my situation, he understood and at least works with me on it. This new VA hospital I transferred to also takes a piss test regularly for vets prescribed narcotics to keep an eye on potential abuse. This along with State Police records review to be sure the vet is not doctor shopping and going to other pharmacies. I'm okay with that, just provide me what I need to manage my daily pain.
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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
Rich
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SFC Melvin Brandenburg
I have an ex brother in law who is in prison because he was a heavy ice user. He used to be a pretty decent guy, but now he isn't even the same person.
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SSgt Richard Kensinger
SFC Melvin Brandenburg - Sadly, he will never be the same. Ice causes permanent neuromodulation of a number of neural networks.
Rich
Rich
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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.
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SFC Marc W.
I'm with you here. Before I found my current treatment miracle, I only wanted enoug narcotics to give me relief from the pain for a bit. Honestly being in constant pain can wear anyone out, so having something a little stronger as a back up is a nice way to make sure I don't just sit on the couch pissy.
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PO2 Robert Cuminale
I'e dealt with opioids for nearly 20 years. I have spinal stenosis which has crushed various vertebra and both sciatic nerves. Pain runs from my back to my feet. In addition to the pain there are periods of throbbing which are more painful than the continuous pain. I have shrunk in height from 6 feet to 5 feet 9 inches. I've had three laminectomies which involves removing the protective coat from my spine to make room for the discs and nerves.
My pain killers have changed often through the years. The health insurance changes what i can have based on cost. I'm now on 30 Mg of Morphine ER TID. The pain management operation now has a policy of no more than 90 Mg per day because DEA has put the fear in them. For that we can thank the Florida pill mills and the 30 K or so of people ODing every year. Steroid shots are ineffective.
Four to five hours sleep is a good night. I doze at my desk while reading the newspaper. I stay busy doing house repairs and yard work. I'm slow but I get it done. I take care of my 15 bird feeders and put out a few pounds of corn for the dozen and a half deer that visit. The last land here is gone and they've nowhere to go. They're two of the few pleasures I have.
I'd like have an increase in my medication but no go. It's been years since the last one. Pain management is a joke. Instead of my doctors faceless bureaucrats in Washington now advise us as to how much pain I can bear.
My pain killers have changed often through the years. The health insurance changes what i can have based on cost. I'm now on 30 Mg of Morphine ER TID. The pain management operation now has a policy of no more than 90 Mg per day because DEA has put the fear in them. For that we can thank the Florida pill mills and the 30 K or so of people ODing every year. Steroid shots are ineffective.
Four to five hours sleep is a good night. I doze at my desk while reading the newspaper. I stay busy doing house repairs and yard work. I'm slow but I get it done. I take care of my 15 bird feeders and put out a few pounds of corn for the dozen and a half deer that visit. The last land here is gone and they've nowhere to go. They're two of the few pleasures I have.
I'd like have an increase in my medication but no go. It's been years since the last one. Pain management is a joke. Instead of my doctors faceless bureaucrats in Washington now advise us as to how much pain I can bear.
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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.
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PO2 Edward Gilbert
Exactly right, in spite of potential abuse, there are those that need the meds for pain management. There is a place for them if the patient can be managed and reviewed appropriately to allow dispensation where needed.
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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.
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PO2 Robert Cuminale
More often than not health problems are not repairable. In those cases much more effort should be expended to relieve the pain from chronic maladies. Instead adequate pain relief has been cast away because of those who can't control the their desire to withdraw from the world, sometimes permanently. If some are desiring more relief it is mostly because they wish to be a part of the world as in holding a job and enjoying the company of others. Continuous unrelenting pain causes withdrawal from acquaintances and enjoyable past times. One never gets rid of all the pain. To do that with narcotics would leave you in a condition similar to that of the drug abuser but with a difference. One group desires separation and the other wants to be in the group. Because of the first group the other one has to suffer.
Did anyone really believe the government when it said chronic pain patients wouldn't be subjected to more pain because of the drug addicts?
Did anyone really believe the government when it said chronic pain patients wouldn't be subjected to more pain because of the drug addicts?
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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!
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