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Monday, February 21, 2011

Overprescribing prescription drugs to Veterans - Huffington Post

Good article in Huffington Post about the problem of overprescribing drugs to our veterans by Leila Levinson, author of Gated Grief: The Daughter of a Concentration Camp Liberator Discovers a Legacy of Trauma:

The figures have become familiar: the number of veterans and troops in the wars in Iraq and Afghanistan who suffer from post-traumatic stress disorder are at record levels: 300,000 men and women. What isn't so well known is what most of these people experience when they turn to the military for help. They get prescriptions for serious drugs. Multiple prescriptions.
Prozac, Effexor, Elavil or Trazodone for depression. Paxil for depression, obsessive-compulsive disorder or anxiety. Zoloft for depression, obsessive-compulsive disorder, anxiety. Wellbutrin for depression, anxiety, attention deficit disorder. Celexa for anxiety, panic attacks, ADHD. Valium for anxiety and insomnia. Klonopin, Ativan, or Xanax for anxiety and panic attacks. Topamax for migraines. Percocet, Lyrica, or OxyContin for pain. Adderall or Ritalin for ADD, or ADHD. Haldol, Risperdal or Seroquel for psychosis. Ambien, Lunesta, or Restoril for insomnia.

A group of veterans I had the honor and privilege of meeting with recently shared how this pharmaceutical approach to their physical and emotional pain and inability to sleep -- which I discovered is a universally disabling consequence of combat -- quickly alienates them, producing cynicism towards the VA. "They just push pills," one man told me. "They act as if there's a quick fix: just pop these pills."

The veterans know on a gut level that the remedy to their intolerable memories and nightmares -- both waking and asleep -- will not come through a pill. So they find themselves in the all but laughable situation of finding a way to get rid of the pills they are obligated to get -- once they sign on for help from the VA.
"You can't just flush them down the toilet, because then you're putting this crap in the water system." One veteran throws his in the trash, after spray painting all identifying information on the bottle. When another tried dumping the contents into a plastic baggie, the contents heated up and melted the bag. "So what the hell is that stuff doing to my insides?"

It is difficult enough for pharmaceutical companies to know the long term consequences of taking any one of the many drugs listed above, but what about when they are taken in combination? What are the synergistic effects of these powerful brain altering chemicals?

I have personally observed how psychiatrists cannot say with any certainty whether a drug will mitigate certain behavior or moods. Prescribing drugs is a crap shoot. And that only becomes more the case when multiple drugs are prescribed. The absurdity increases when we recognize that psychiatrists often prescribe drugs to address side effects of another drug. Adderall can make people insomniacs or create tics, and so drugs are given to induce sleep or stop the tics. Or stimulants are given when a drug is overly sedative.

Just getting a prescription filled can make a veteran wish they hadn't ever sought help. Many vets report that when they pick up their prescriptions, the pharmacists give them weird looks, as if to say, "What's your story, that you need all these drugs?" This only adds to the stigma our veterans and troops already feel.

Last week two excellent articles reported the military's reliance on pharmaceuticals to address the burgeoning mental health care crisis in our troops. The Feb. 14th issue of New York Magazine carried an article "The Prozac, Paxil, Zoloft, Wellbutrin, Celexa, Effexor, Valium, Klonopin, Ativan, Restoril, Xanax, Adderall, Ritalin, Haldol, Risperdal, Seroquel, Ambien, Lunesta, Elavil, Trazodone War" that describes in detail how the mental health crisis within the Army and how medications are central to its response. "Nearly one-third of all active duty Army suicides in 2009 involved prescription drugs."

James Dao of the New York Times reported on Feb. 12 in "For some Troops, Powerful Drug Cocktails Have Deadly Results" that the military is using psychiatric drugs more than it ever has before, while at the same time experiencing a remarkable increase in drug dependency, suicide and fatal accidents, many the result of a fatal combination of drugs.

The Department of Defense is paying attention, demanding increased monitoring of prescription drugs, restricting their use, offering more treatments like acupuncture, yoga, and exposure therapy, but "shortages of mental health professionals have hampered those efforts." The article goes on to say, "Given the depth of medical problems facing combat veterans, as well as the medical system's heavy reliance on drugs, few experts expect the widespread use of multiple medications to decline significantly anytime soon."
Why is the Department of Defense not issuing a public call of action to all mental health therapists to help in this crisis? Why are the mainstream media and the Department of Defense ignoring efficacious and inexpensive approaches such as those offered by Soldier's Heart and Operation Warrior Wellness? The veterans of Iraq and Afghanistan whom I met at a Soldier's Heart retreat last month began the retreat exhausted, strung out, anxious, hopeless. Four days later they had had the first nights of sleep that they could remember; their bodies showed looseness and energy; light had entered their eyes, and they expressed hope and confidence in their ability to reassemble their lives and those of their families.

The irony of the military's predicament is that the solution is the cheapest: connect our veterans to the love and caring so many of us civilians want to give them. Let's create networks of communities for them, their families. What is essential to this is to acknowledge that combat trauma is a wound to the soul, not some neurological aberration that pills can fix.

Saturday, February 19, 2011

Prescriptions drugs overused for PTSD

Drugs used to treat war veterans’ pain, depression can turn deadly
Iraq, Afghan war vets get painkillers, psychiatric drugs that don’t mix well
Sunday, February 13, 2011 02:59 AM
By James Dao

THE NEW YORK TIMES
After a decade of treating wounded troops, the military’s medical system is awash in prescription drugs — and the results have been deadly sometimes.

By some estimates, more than 300,000 troops have returned from Iraq or Afghanistan with PTSD, depression, traumatic brain injury or some combination of those. The Pentagon has looked to pharmacology to treat those complex problems. As a result, psychiatric drugs have been used more widely across the military than during any other war.

But those medications, along with narcotic painkillers, increasingly are being linked to a rising tide of other problems, among them drug dependency, suicide and fatal accidents. An Army report on suicide released last year documented the problem, saying one-third of the force was on at least one prescription medication.

“Prescription-drug use is on the rise,” the report said, noting that medications were involved in one-third of the record 162 suicides by active-duty soldiers in 2009. An additional 101 soldiers died accidentally from the toxic mixing of prescription drugs from 2006 to 2009.

“I’m not a doctor, but there is something inside that tells me the fewer of these things we prescribe, the better off we’ll be,” said Gen. Peter W. Chiarelli, vice chief of staff of the Army, who has led efforts to prevent suicide.

The New York Times reviewed the cases of service members who died from what coroners said were toxic interactions of prescription drugs. All were classified as accidents, not suicides.

Given the complexity of drug interactions, it’s difficult to know what killed the men, and the Pentagon declined to discuss their cases, citing confidentiality. But there were important similarities in their stories.

All the men had been deployed multiple times and eventually received diagnoses of PTSD. All had five or more medications in their systems when they died, including opiate painkillers and mood-altering psychiatric drugs, but not alcohol. All had switched drugs repeatedly, hoping for better results that never arrived.

All died in their sleep.

Psychiatry and warfare
The military medical system has struggled to meet the demand caused by two wars, and it reports shortages of therapists, psychologists and psychiatrists. But medications always have been readily available.

Across all branches, spending on psychiatric drugs has more than doubled since 2001, to $280 million in 2010, according to statistics obtained from the Defense Logistics Agency by a Cornell University psychiatrist, Richard A. Friedman.

Paradoxically, the military came under criticism a decade ago for not prescribing enough medications, particularly for pain.

Thousands of troops struggle with insomnia, anxiety and chronic pain, and that combination is particularly risky to treat with medications. Pairing a pain medication such as oxycodone, a narcotic, with an anti-anxiety drug such as Xanax, a so-called benzodiazepine, amplifies the tranquilizing effects of both, doctors say.

Similarly, antidepressants such as Prozac or Celexa block liver enzymes that help break down narcotics and anxiety drugs, extending their effects.

In the case of Marine Gunnery Sgt. Christopher Bachus, it is far from clear that he received the least amount of medication possible.

He saw combat in Iraq, said his brother, Jerry Bachus of Westerville, and he struggled with alcoholism, anxiety, flashbacks, irritability and survivor’s guilt once home.

“He could make himself the life of the party,” Jerry Bachus recalled of his brother’s behavior before serving in Iraq. “But he came back a shell, like a ghost.”

Christopher Bachus received a diagnosis of PTSD, and in 2005, doctors put him on a regimen that included Celexa for depression, Klonopin for anxiety and Risperdal, an anti-psychotic drug. In 2006, after he had a period of stability, a military doctor discontinued his medications. But six months later, Bachus asked to be put on them again.

According to an autopsy report, his depression and anxiety worsened in late 2006. Yet for unexplained reasons, he was allowed to deploy to Iraq for a second time in early 2007.

But when his commanders discovered that he was on psychiatric medications, he was sent home after a few months, records show.

Frustrated and ashamed that he could not be in a front-line unit and unwilling to work behind a desk, he applied in late 2007 for a medical retirement.

In March 2008, a military doctor began giving him an opiate painkiller for his back. A few days later, Bachus, 38, called his wife, who was living in Ohio. He sounded delusional, she told investigators later, but not suicidal.

“You know, babe, I am really tired, and I don’t think I’ll have any problems falling asleep tonight,” he told her. He was found dead in his quarters in North Carolina nearly three days later.

According to the autopsy report, Bachus had in his system two antidepressants, the opiates oxymorphone and oxycodone, and Ativan for anxiety. The delirium he experienced in his final days was “most likely due to the interaction of his medications,” the report said.

Nearly 30 prescription bottles were found at the scene, the report said.

Jerry Bachus pressed the Marine Corps and the Navy for more information about his brother’s death, but he received no further explanations. “There was nothing accidental about it,” he said. “It was inevitable.”


Trying to numb the pain

In his last months, Air Force Senior Airman Anthony Mena rarely left home without a backpack filled with medications.

He had deployed to Iraq in 2005 but saw little action. He got the chance to return in 2006, when sectarian violence was hitting a peak.

After coming home, he spoke often of feeling guilty about missing patrols in which a sergeant was killed and several platoon mates were seriously wounded.

He returned from his second deployment complaining of back pain, insomnia, anxiety and nightmares. Doctors diagnosed PTSD and prescribed cocktails of psychiatric drugs and narcotics.

Yet his pain and depression only deepened. “I have almost given up hope,” he told a doctor in 2008, medical records show. “I should have died in Iraq.”

By the summer of 2008, he was on half a dozen medications. His back and neck pain worsened, but Air Force doctors could not pinpoint a cause.

In February 2009, he received an honorable discharge and was given a

100 percent disability rating by the Department of Veterans Affairs, meaning he was considered unable to work. Yet for all his troubles, he seemed hopeful when his mother, Pat Mena, visited him in early July 2009.

The night after his mother left, he put on a new Fentanyl patch, a powerful narcotic often used by cancer patients. With his increasingly bad memory, he often forgot what pills he was taking, his mother said. That night, July 21, 2009, he forgot to remove the old patch. He died early the next day. He was 23.

A toxicologist found eight prescription medications in his blood.

“The manner of death,” the autopsy report concluded, “is accident.”