Opioids are addictive and deadly.
The widows of two veterans on Thursday described how Veterans Affairs Department hospitals prescribed deadly cocktails of pills to treat their husbands’ pain.
Heather McDonald told a hearing of the House Veterans Affairs Committee that her husband Scott -- who served as an Army crew chief on medevac helicopters through multiple deployments to Afghanistan, Iraq and Bosnia -- died on Sept. 13, 2012 due to what she believes was an overdose of Percocet -- a combination of oxycodone, an opioid, and an analgesic -- prescribed by the Columbus, Ohio, VA hospital to treat back and shoulder pain.
Percocet was the last in a stew of drugs prescribed by VA to treat her husband’s pain, McDonald told the hearing, including gabapentin, a drug developed originally to treat epileptic seizures but used by the VA for pain treatment; meloxicam, another analgesic-type drug; and Zoloft and Valium to treat his post-traumatic stress disorder.
“Keeping our men and woman doped up to keep them quiet and happy is not treatment. It is cruelty and torture and, in too many cases, it's manslaughter,” McDonald testified.
McDonald told the hearing that it took the VA 11 months to pay her death benefits, and as a result she lost her house and car.
Kimberly Stowe Green said her Army paratrooper and military policeman husband who served in the first Iraq war died on Oct. 29, 2011, after back surgery at the Fayetteville, Ark., VA hospital. She told the hearing that the Arkansas State Crime Laboratory and the state Medical Examiner determined her husband died of “mixed drug intoxication” from the pills prescribed by VA.
Green said these drugs included two opioid painkillers, oxycodone and hydrocodone; gabapentin; tramadol, an analgesic; Ambien, a sleeping pill; along with Valium and Zoloft, even though VA clinical practice guidelines warned against such drug combinations due to the possibility of dangerous interactions. Green bluntly told the hearing her husband “survived combat. He did not survive the VA.”
Josh Green and Justin Minyard, two Army veterans, detailed the aftermath of VA’s pill-popping approach to pain treatment. Green, severely wounded by a mortar blast in Iraq, said the VA hospital in American Lake, Wash., prescribed him a mix of 13 pain killers, including Percocet, methadone and morphine, in such massive quantities that he ended up with liver damage.
Minyard, an Afghanistan and Iraq veteran, developed chronic back pain after searching the Pentagon for survivors for 72 hours after the 9/11 attack on the Pentagon, when he was serving with the 3rd Infantry Old Guard at Ft. Meyer, Va. This, he said, compounded the chronic pain he developed while in combat.
The Army and VA both prescribed him opioids, Minyard said, and he ended up on “an insane amount of opioid pain medication….my life revolved around getting my next fix.” Pain pills became the sole focus of his life, he said. “My days drifted by like this: wake up: pain pill; have lunch: pain pill; in the afternoon: pain pill; and on and on,” he told the hearing.
Green said he sought alternatives to medication -- including physical therapy from VA in an appointment that consisted of him sitting in a chair while the therapist described exercises he should do at home. A VA doctor did prescribe a non-opiate drug, Lyrica, with few side effects, but since this drug was not on the VA formulary, the hospital could not prescribe it, Green said.
Concerned about further liver damage from pain pills, Green testified he spent $12,000 on a therapeutic hot tub and another $3,000 on a massage chair, but still needs to take 5 milligrams of oxycodone a day.
Minyard also wanted to kick the pain pills and on his own found a pain specialist at Ft. Bragg, N.C., who recommended spinal cord stimulation, which uses an implantable device to block the brain from receiving pain signals. As a result, Minyard said he has not taken an opioid in two years.
Green and Minyard both told the hearing that neither VA nor the military health care system were responsive, and only veterans who aggressively manage their own care get help. Green said veterans need to “kick the doors down” in VA hospitals to get help. Minyard said he had to make his own way through a “maze of providers” to find “the one doctor who knew the secret.”
Dr. Claudia Bahorik, who has spent the past 3-1/2 years as a fill-in primary care physician at VA medical facilities around the country, said that “the provision of veterans with narcotics in a rather cavalier fashion appears to be a systemic problem.” She said VA facilities encourage prescriptions of narcotics by denying alternative forms of treatment such as chiropractic massage or acupuncture. VA’s overuse of pain pills results in what Bahorik described as a “chemical lobotomy” of veterans.
Dr. Robert Jesse, principal deputy undersecretary of health for the Veterans Health Administration, said the VA faces a real challenge in the treatment of pain as more than half of the 5.7 million veterans it treats a year are affected by pain, a figure that increases to 60 percent for Afghanistan and Iraq veterans.
Jesse said VA has established a “stepped” approach to pain management, which includes alternatives to medications, established dedicated pain clinics at 95 percent of its medical facilities, and hired dedicated pain specialists. Jesse said the VA prescribes opioids to only a small percentage of its patients.
He said that in 2012 only 7.5 percent of VA patients received prescriptions for a 90 day supply of short-acting opioids and 1.6 percent received one prescription for a long-acting opioid for a year. He said 32 percent of patients prescribed opioids also received physical therapy, and 17 percent occupational therapy.