Veteran and Missouri man Joshua Lee has learned the hard way how dangerous opioids can be.
Lee was deployed to Afghanistan in 2009, and today suffers from PTSD, fibromyalgia and arthritis. For the pain, he was prescribed opioids by his physicians through the Department of Veterans Affairs (VA).
But things quickly spun out of control. By August of last year, Lee said he was taking 27 pills a day.
“I didn’t think the stuff I was on was going to screw me up that badly until I made a mistake of rescheduling when they were supposed to be mailed to me, and I wound up experiencing withdrawals for the first time in my life. And I realized I’m an addict. I would have done anything to get those pills,” Lee said.
In the U.S. millions of people are addicted to opioids, and the veterans' community is no stranger to the epidemic. A recent report found the guidelines the VA had recommended to manage addiction risks when prescribing opioids had not always been followed, and though progress has been made since, some veterans think there is still a long way to go.
The Office of Special Counsel released a report earlier this month that found in 2014, less than 55 percent of VA patients prescribed long-term opioids were receiving regular urine drug tests (UDT), despite VA guidelines.
UDTs are an essential tool in managing addiction risks, according to Dr. William Becker, assistant professor at General Internal Medicine at Yale School of Medicine.
"I wouldn't want to be prescribing opioids without use of that tool," Becker said.
But the lack of testing came at a time when more veterans were becoming addicted to the pain killer. The number of veterans with opioid-use disorders rose by 55 percent between 2010 and 2015, totaling 68,000 veterans, or 13 percent of the total number of veterans prescribed opioids, according to PBS Frontline.
OSC ordered an investigation into the drug tests after a whistleblower reported patients were improperly prescribed narcotics at the community-based outpatient clinic in Dover, Delaware, part of the Wilmington VA Medical Center. As part of the claims, the whistleblower alleged that a veteran who was a patient at the clinic was prescribed opioids, but was not receiving the regular UDTs recommended by the VA guidelines, and had even gone years without a UDT.
The opioid crisis goes beyond just the veteran community. According to the Center for Disease Control, one in four people prescribed opioids long term will struggle with addiction.
And when it comes to to the number deaths due to drug overdoses related to opioids in the U.S., that number also quadrupled from 1999 to 2015, with 91 Americans dying every day due to opioid overdoses, the CDC said.
But veterans are twice as likely to die from an accidental overdose, according to the National Insitute of Health.
"To the fact that opioids are prescribed more frequently in veteran populations and so because of increased rates of exposure, there's a higher risk for developing opioid use disorder," Becker said.
But the VA has been trying to fight the epidemic for years. In 2010, the VA and the Department of Defense (DOD) had created a set of guidelines to help with the management of opioid therapy, then recommending long-term, opioid-treated patients receive UDTs before being prescribed, and have routine testing after that. An updated set of guidelines was also released in February, still including the recommendation of regular UDTs as part of addiction risk management.
The VA has shown improvement since then. The agency reduced the number of veterans on long-term opioid treatment by over 187,000 from 2012 to 2016, according to the VA, and has even improved on giving UDTs. In 2017, the number of long-term, opioid treated patients receiving a drug test within one year has jumped to 87 percent.
In a statement a VA spokesperson told Circa, "Through education and outreach efforts, VA clinicians have a better understanding of the value UDT can have in certain patients for whom they provide care and they have begun to rely on these tests to a greater degree than they have in the past.”
But despite the improvements, some veterans think there is still a long way to go. In fiscal year 2016, there were 66,000 veterans still being treated for addiction to opioids.
Dan Caldwell is the policy director for Concerned Veterans for America and is a veteran himself, serving in the Marine Corps for four years, and in 2009 was deployed to Iraq. He acknowledged that the VA has made some progress, but said they have a long way to go.
“I think the biggest is accountability. When you don’t follow the guidelines, you’re terminated or your disciplined. They have guidelines in place they put in really starting a couple years ago, but if there’s no teeth behind them, then nobody is going to follow them. And that’s with everything within the VA,” Caldwell said.
And a major step towards improving accountability in the VA, according to Caldwell, was taken on June 23 when President Donald Trump signed a bill making it easier to fire VA employees.
Caldwell also said turning toward privatization of veterans healthcare would also be a big improvement for the VA.
And Lee is also working towards change in the VA system, and in April, he started to take action. He posted a photo on his Facebook page of him holding a clear,plastic bag, filled with over 9,800 smarties, one piece of candy for every pill he has to take in one year, to raise awareness of just how many pills veterans can be prescribed.
And after a trip to Colorado for his 15th anniversary with his wife, he said he tried recreational cannabis and it changed his life forever.
“It works so much better than any medication, and it’s the only reason I’m not a zombie today. You wouldn’t recognize me on my pills, believe me,” Lee said.
Lee is now advocating for medical cannabis to be an option for veterans, and is doing so through helping to start the organization Veterans Alliance for Compassionate Access, working with experts and politicians and organizing events.
“I’m not advocating medical cannabis as a cure all that’s going to magically fix someone of their opioid addiction. It takes a combination of actual work on the person’s behalf. There is no magic cure. But by combining medical cannabis with actual therapy, it is incredibly more efficient to get people off these addictive drugs and get there lives back in order, and get control of their own lives again,” Lee said.
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