Veterans Administration Accused Of Over-Medicating War Veterans; Many Now Battling Addiction Along With Pain

Accused of overmedicating soldiers returning from war, the U.S. Veterans Administration (VA) has been directed by Congress to reassess how doctors prescribe dangerously addictive painkillers.

Congressmen on the U.S. House Veterans’ Affairs Subcommittee on Health held a hearing on Sunday to query administration officials, and hear testimony from a pair of VA doctors who said they’d been pressured by superiors to prescribe more painkillers.

“The stakes are too high for VA to continue to get it wrong,” Chairman Dan Benishek, a Republican of Missouri, told fellow congressmen. As a former VA doctor himself, Benishek challenged officials to develop more effective protocols for managing pain in veterans, saying the present model depended too much on primary care rather than specialists.

That model of care has brought an increasingly greater reliance by government doctors on treating returning war veterans with prescription painkillers, according to a report released in late September by the Center for Investigative Reporting, which obtained data from the administration via the Freedom of Information Act. During the past dozen years since 9/11, the prescription rate at VA for hydrocodone, oxycodone, methadone, and morphine rose by 270 percent.

Some of those veterans needlessly received prescriptions for dangerous opioids, veterans and others say. Thirty-five-year-old Scott McDonald, of Belpre, Ohio, served in the U.S. Army for 15 years, working as a Blackhawk helicopter mechanic and crew chief for a medical evacuation unit before retiring last year. After seeking treatment following service in Afghanistan, McDonald died last September of an accidental overdose of medication prescribed to him by a VA doctor, according to testimony from his widow, Heather Renae.

VA doctors had prescribed McDonald a motley assortment of drugs during the course of his treatment, Heather testified. Initially complaining of pain, the retired soldier was diagnosed with post-traumatic stress disorder, for which additional medication was prescribed. In 18 months of treatment until his death, McDonald’s doctors changed medications, dosages, and prescribed off-label regimens of treatment.

“We researched the drugs online and saw that there were many dangerous interactions involved with the medications he was on,” Heather testified, adding that her husband’s training as a soldier had conditioned him to accept orders without question, including from a government doctor. “With every appointment, the medication changed, the side effects changed, and Scott himself was changing.”

On Sept. 13 of last year, McDonald’s wife found him “cold and unresponsive” on the family couch, less than 24 hours after receiving yet another prescription, a change from Vicdin to Percocet. “This opiate drug was much different than the vicodine that he had previously been taking.”

Essentially, McDonald had survived tours to overseas warzones including Afghanistan, only to be killed by a prescription medication overdose treating the lingering physical and psychological symptoms of that war.

fazio The Department of Veterans Affairs has supplied Tim Fazio with nearly 4,000 oxycodone pills since he returned home after tours in Iraq and Afghanistan in 2008. Fazio says he was never in acute physical pain but used the pills to blot out feelings of guilt for surviving when many of his friends did not. Adithya Sambamurthy, The Center for Investigative Reporting

Other sad stories, dredged by the Center for Investigative Reporting, include the guilt of retired Marine Tim Fazio, of Newport, N.H., for committing a cardinal sin for any Marine: abandoning his brother. Fazio told investigators he’d left his roommate Eric Demetrion, a fellow Marine he’d met in treatment at the VA Central Western Massachusetts Healthcare System in Northampton, to move in with his girlfriend. Subsequently, the 33-year-old veteran died of a prescription drug overdose — this one caused not by VA doctors but by addiction to prescription opioids, and the mixing of illicit substances.

However, Fazio himself has received more than 4,000 oxycodone pills and more than a dozen bottles of tramadol, another type of opioid, from VA doctors since he began treatment in 2008, two years after leaving the service. Remarkably, Fazio claims he never complained to doctors of pain, but used the prescribed drugs to self-medicate for survivor’s guilt stemming from overseas service, exacerbated now by another friend’s stateside death.

Aside from failing to safeguard against a quick death from overdose, Heather told congressmen on Sunday that VA doctors had failed to protect her husband’s longer-term health by testing liver function, to confirm that no damage had been done by the large number of medications prescribed to him.

“When I asked VA why more tests were not performed to make sure he was healthy enough, they responded that it was not routine to evaluate our soldiers’ pain medication distribution,” she testified.

A doctor who testified on Capitol Hill Sunday told congressmen she’d been fired from her job at the VA Medical Center in Hampton, Va., in 2010 after objecting to reckless prescribing of painkillers to veterans, particularly given the well-documented addiction rate: one in five users of prescription opioids become addicted.

“During my two-year period, I was coerced to writing drug [prescriptions] that I knew in my medical experience were wrong. When I would object, I was simply told to do it or else,” Pamela Gray testified.

Aside from the alleged coercion, the former VA doctor says her superiors inflated her credentials as a primary care physician, essentially billing her as a “specialist.” Moreover, many of the clinical notes she recorded in the electronic health system, she said, were later altered by others.

Robert L. Jesse, the VA’s principal deputy under secretary for health, told congressmen problems with opioid abuse extended far beyond the department’s purview as a societal problem. In response to opioid addiction among veterans, the administration has implemented a two-part plan, he said, adding the department would take advantage of their relatively new electronic health system to improve safety.

The second aspect of the administration’s plan involves greater leverage of state prescription drug monitoring plans, by which many states monitor prescription drug distribution pharmacy by pharmacy. “These programs, featuring appropriate health privacy protections, allow for the interaction between VA and state databases, so that providers in either can view electronic information about opioid prescriptions and be able to identify potentially vulnerable at-risk individuals,” he said in the statement.

Still, Congressmen appeared unsatisfied with explanations from the administration, requesting further study.

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