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Why Are Military Veterans More Prone to Opioid Abuse?

Active duty members of our armed forces are more likely to encounter dangerous situations that can lead to injury. From time in combat to carrying heavy equipment or using ill-fitting gear, these soldiers can literally be in for a world of hurt.

Opioids are administered on the battlefield, or as other injuries occur and are treated after the fact. Unfortunately, the user can abuse opioids, potentially leading service members, and eventually veterans, down a path of addiction.

Veterans also struggle with specific issues, like PTSD, chronic pain, depression, and suicidal ideation, which puts them further at risk for abusing specific substances, such as opioid narcotics.1

You can find more information about veteran opioid abuse, how it can co-occur with mental disorders, and treatment options for an opioid use disorder below.

General Addiction & Opioid Use Information

In the general population of the United States, over 630,000 people died from drug overdoses between 1999 and 2016, and 66% of those deaths involved at least one opioid drug. On average, 115 people die every day from an opioid overdose.2

While most of those overdose deaths involve heroin or illicit fentanyl, about 80% of people who now struggle with heroin or illicit opioid addiction began abusing opioids after receiving a prescription to treat pain.2

One in 15 veterans of the United States Armed Services struggles with a substance use disorder.1

Chronic Pain Can Lead to Opioid Abuse Among Veterans

injured serviceman leaning against window and using crutchAbuse of opioids 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.3

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.

Between 2001 and 2009, for example, the percentage of veterans receiving pain management with prescription narcotics increased from 17% to 24%. The number of opioid prescriptions written by military physicians more than quadrupled during that time.4

The National Center for Complementary and Integrative Health (NCCIH) reports that 9.1% of veterans, compared to 6.4% of civilians, experience severe pain. Of these, chronic pain is one of the most common complaints.5 In fact:6

  • 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.6

As veterans and non-veterans age, they are more likely to experience severe pain, with those 50 to 69 years old experiencing the highest levels of severe pain among both veteran and civilian groups.6

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:4

  • 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% to 4.5%.4

Pain medications are widely prescribed to recently returning veterans of the Iraq and Afghanistan conflicts. A 2008 survey of 762 veterans of these combat scenarios found that:7

  • 64% were prescribed at least one opioid drug in the year following their return.
  • 59% were prescribed opioids for short-term treatment.
  • 41% received long-term prescriptions to treat chronic pain.
  • 51% of long-term opioid users had been prescribed short-acting opioid drugs.
  • One-third had received a concurrent prescription for a sedative-hypnotic drug.

Opioid treatment is reportedly also an important component of battlefield medicine. But the VA acknowledges that physicians need better training to manage opioid treatment for veterans.

Co-Occurring Disorders & Opioid Addiction Risks in Veterans

Among veterans, diagnoses of post-traumatic stress disorder (PTSD) are high.8 Having PTSD increases the risk of substance abuse, including opioid addiction.9

However, suffering from PTSD or another mental health condition may increase a veteran’s chances of receiving a prescription opioid, likely because these mental conditions exacerbate chronic pain: One report found that 17.8% of veterans with PTSD, and 11.7% with another mental health problem, received opioid prescriptions.4

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.10

service man recieving therapyNot 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.10 Additionally, opioid abuse has been tied to an increased risk of suicide.11

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.12

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.12

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% and has cut the opioid doses given to other veterans. The focus has shifted to therapy for PTSD, depression, and substance abuse struggles.13

Unfortunately, opioid addiction among veterans remains high. Between 2010 and 2015, opioid abuse and addiction among veterans rose another 55% with about 68,000 veterans, or 13% of that population, abusing the drugs.13

Treatment & Ongoing Support for Veterans with Opioid Use Disorder

Among veterans seeking substance abuse treatment, a 2015 report found that 10.7% needed treatment specifically for heroin addiction, and 5.3% needed help ending addiction to other opioids like oxycodone, hydrocodone, methadone, morphine, and fentanyl.14

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, they are utilizing approaches to mental health treatment that have worked well in the past, including:15

Both antidepressants and CBT work well to address PTSD, and treating these conditions reduces stress and thereby reduces the experience of severe pain.15

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.16

It’s 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 screens many incoming veterans seeking help for opioid addiction, chronic pain, or mental health struggles for co-occurring disorders. 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.

 

References:

  1. Substance Abuse and Mental Health Services Administration. (2015). 1 in 15 veterans had a substance use disorder in the past year.
  2. Centers for Disease Control and Prevention. (2018). Understanding the Epidemic.
  3. Committee on Prevention, Diagnosis, Treatment, and Management of Substance Use Disorders in the U.S. Armed Forces; Board on the Health of Select Populations; Institute of Medicine. (2012). Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press.
  4. Teeters, J.B., Lancaster, C.L., Brown, D.G, &Back, S.E. (2017). Substance use disorders in military veterans: prevalence and treatment challenges. Substance Abuse and Rehabilitation, 8, 69-77.
  5. National Center for Complementary and Integrative Health. (2019). Pain: U.S. military and veterans.
  6. Nahin, R.L. (2017). Severe pain in veterans: the impact of age and sex, and comparisons to the general population. The Journal of Pain, 18(3), 247-254.
  7. Macey, T.A., Morasco, B.J., Duckart, J.P., & Dobscha, S.K. (2011). Patterns and correlates of prescription opioid use in OEF/OIF veterans with chronic noncancer pain. Pain Medicine, 12(10), 1502-1509.
  8. S. Department of Veterans Affairs. (2018). How common is PTSD in Veterans?
  9. S. Department of Veterans Affairs. (2019). PTSD and substance abuse in veterans.
  10. Carlson, K.F., Gilbert, T.A., Morasco, B.J., Wright, D., Otterloo, J.V., Herrndorf, A., & Cook, L.J. (2018). Linkage of VA and stage prescription drug monitoring program data to examine concurrent opioid and sedative-hypnotic prescriptions among veterans. Health Services Research, 53(suppl 3). 5285-5308.
  11. Rapaport, L. (2017). Opioid abuse tied to higher suicide risk in veterans.
  12. Institute for Healthcare Policy & Innovation, University of Michigan. (2017). Drug and alcohol problems linked to increased veteran suicide risk, especially in women, long-term study finds.
  13. Childress, S. (2016). Veterans face greater risks amid opioid crisis.
  14. Substance Abuse and Mental Health Services Administration. (2015). Veterans’ primary substance of abuse is alcohol in treatment admissions.
  15. National Center for PTSD. (2015). Effective treatments for PTSD: consider cognitive behavioral therapy (CBT) as first line treatment.
  16. Military Officers Association of America. (2017). Veterans and opioid addiction.