A report published by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that one in 15 veterans of the United States Armed Services struggles with a substance use disorder; this represents about 1.5 million veterans, ages 17 and older, or about 6.6 percent of the population. Although this is lower than the national average of about one in 11 people, ages 12 and older, veterans struggle with specific issues, like PTSD, chronic pain, depression, and suicidal ideation, which puts them at risk for abusing specific substances, such as opioid narcotics.
Opioid Abuse on the Rise among Veterans
According to the Centers for Disease Control and Prevention (CDC), over 630,000 people died from drug overdoses between 1999 and 2016, and 66 percent of those deaths involved at least one opioid drug. On average, 115 people die every day from an opioid overdose. While most of those overdose deaths involve heroin or illicit fentanyl, about 80 percent of people who now struggle with heroin or illicit opioid addiction began abusing opioids after receiving a prescription to treat pain.
Opioid treatment is reportedly an important component of battlefield medicine. Abuse of these drugs may begin outside of combat or deployment. In fact, access to opioid drugs is found through nonmedical as well as physician sources in the military, like family members, non-military friends, and fellow soldiers. The VA and other reports acknowledge that physicians need better training to manage opioid treatment for veterans. Between 2001 and 2009, for example, the percentage of veterans receiving pain management with prescription narcotics increased from 17 percent to 24 percent. The number of opioid prescriptions written by military physicians more than quadrupled during that time.
Pain management is extremely important for veterans because they are at much higher risk of injury – not just from experiencing combat, but due to carrying heavy equipment or using ill-fitting gear or machines. The National Center for Complementary and Integrative Health (NCCIH) reports that 9.1 percent of veterans, compared to 6.4 percent of civilians, experience severe pain. Of these, chronic pain is one of the most common complaints.
- Over 20% of veterans experience back pain.
- About 16% experience joint pain.
- Over 25% experience migraine pain.
- About 27% experience neck pain.
- Approximately 34% experience both back pain and sciatica.
- About 37% experience jaw pain.
Female veterans, like female civilians, are more likely to experience chronic pain than their male counterparts, but all veterans experience higher rates of severe pain compared to non-veterans. As veterans and non-veterans age, they are more likely to experience severe pain, with those 50-59 years old and those 60-69 years old experiencing the highest levels of severe pain among both veteran and civilian groups.
VA patients are often prescribed two or more opioid drugs to treat chronic pain problems, and one veteran may have as many as three different prescribers. The drugs most prescribed through the VA include:
- Oxycodone: 46.9%
- Hydrocodone: 39.5%
- Codeine: 6.8%
Although most veterans suffering from chronic pain are older, young veterans make up one of the most vulnerable demographics, with opioid abuse rising among veterans under the age of 35. Between 2003 and 2007, for example, rates of opioid abuse reported among young veterans rose from 3 percent to 4.5 percent.
Among recently returning veterans of the Iraq and Afghanistan conflicts, pain medications are widely prescribed. A 2008 survey of 762 veterans of these combat scenarios found that 64 percent were prescribed at least one opioid drug in the year following their return; 59 percent were prescribed opioids for short-term treatment, and 41 percent received long-term prescriptions to treat chronic pain. Among those, 51 percent of long-term opioid users had been prescribed short-acting opioid drugs, and one-third had received a concurrent prescription for a sedative-hypnotic drug.
Co-Occurring Disorders Increase Opioid Addiction Risks in Veterans
Among veterans, diagnoses of post-traumatic stress disorder (PTSD) are high. Receiving a diagnosis of PTSD increases the risk of substance abuse, including opioid addiction. However, suffering from PTSD or another mental health condition increases a veteran’s chances of receiving a prescription opioid, likely because these mental conditions exacerbate chronic pain. One report found that 17.8 percent of veterans with PTSD, and 11.7 percent with another mental health problem, received opioid prescriptions.
These groups are also more likely to receive prescriptions for sedative-hypnotics due to insomnia. Veterans with co-occurring mental health and substance use disorders who experience chronic pain and sleep issues triggered by underlying mental illness are more likely to receive opioids and sedatives together than to receive comprehensive mental health treatment.
Not only are veterans with mental health and chronic pain problems more likely to receive drugs, the combination of opioids and sedatives puts them at increased risk of accidental overdose. Additionally, opioid abuse has been tied to an increased risk of suicide. Substance abuse in general increases veterans’ risk of attempting and completing suicide, but opioids are, according to a new report, particularly risky. Male veterans who abuse prescription sedatives quadruple their risk of death from suicide while female veterans are 11 times more likely to die if they abuse sedative drugs. Opioids were tied to an eight times higher risk of death among female veterans. While two-thirds of veteran suicide deaths in the study involved firearms, the remaining third involved intentional poisoning.
It may not be a coincidence that 2012 was the height of the VA’s prescribing of opioid painkillers, and it had the highest rate of veteran suicide the US has seen. Since then, the VA reduced opioid prescriptions by 20 percent and has cut the opioid doses given to other veterans. The focus has shifted to therapy for PTSD, depression, and substance abuse struggles.
Unfortunately, opioid addiction among veterans remains high. Between 2010 and 2015, opioid abuse and addiction among veterans rose another 55 percent with about 68,000 veterans, or 13 percent of that population, abusing the drugs.
Treatment and Ongoing Support for Veterans to Overcome Opioid Abuse
Among veterans seeking substance abuse treatment, a 2015 report found that 10.7 percent needed treatment specifically for heroin addiction, and 5.3 percent needed help ending addiction to other opioids like oxycodone, hydrocodone, methadone, morphine, and fentanyl. Among the general population, rates of opioid treatment sought are slightly higher, but veterans’ statistics reflect the ongoing problem of prescription narcotics and misuse of those drugs leading to more severe opioid addictions.
As the VA shifts treatment focus to underlying mental health conditions affecting substance abuse disorders, Cognitive Behavioral Therapy, trauma-centered therapy for PTSD, and mindfulness meditation are all approaches to mental health treatment that have worked well for both veteran and civilian populations. Both antidepressants and CBT work well to address PTSD, and treating these conditions reduces stress and thereby reduces the experience of severe pain.
The Military Officers Association of America (MOAA) notes that service members and veterans are more likely to talk about their struggles with opioid abuse with their friends, close family, or coworkers. It is important for military officers to make their work environment comfortable enough for colleagues, concerned friends, or worried family members to come forward and discuss treatment options and social support that the military can offer. This kind of supportive environment can also reduce the risk of death from suicide, as behavioral changes are less penalized or stigmatized, and genuine offers of help are put forward.
The VA should screen all incoming veterans seeking help for opioid addiction, chronic pain, or mental health struggles for any co-occurring disorders, as these are common in this population. Referring the veteran to treatment for co-occurring disorders, preferably through the same clinician for all issues, will help keep the veteran safe and focused on recovery.