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.”