Bet You Didn't Know Majority of VA Hospitals Use Holistic Therapies

Majority of VA hospitals offer holistic therapies, alternative to opioids, study finds

Washington Times

Laura Kelly

August 11, 2017

“In addition, some of the mind/body practices can be effective for the reduction of post-traumatic stress disorder symptoms. A patient might not want to admit they have PTSD, but they may be persuaded to take a yoga class,” she said.

This Tuesday, Feb. 19, 2013, file photo shows hydrocodone pills, also known as Vicodin, arranged for a photo at a pharmacy in Montpelier, Vt. Leftover opioids are a common dilemma for surgery patients; a study published Wednesday, Aug. 2, 2017,

Nearly 80 percent of military medical facilities are offering alternative medicines for pain management and psychological treatment instead of opioids when possible, according to a study published Thursday by the nonprofit RAND Corp.

Over 8.9 million veterans are treated at 1,233 veteran health facilities each year, according to the Department of Veteran Affairs.

The study said there were about 76,000 alternative therapy patient visits per month treated by 1,750 providers. Services include acupuncture, yoga, relaxation therapy, among others, and responding physicians said patients often express interest and openness to the treatments.

“Patient visits for [complementary and alternative medicine] make up a small but nontrivial portion of total outpatient [military treatment facilities] visits,” the authors wrote.

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Veteran Faces New Battle, Saving Her Baby From Opioid Dependency

U.S. Army veteran Jaclyn Alexander returned from Iraq to face new battle -- saving her baby girl from opioid dependency
MassLive.com
By Dan Glaun
January 08, 2017

This is first in a MassLive special report on the the impact of the opioid crisis on children in Massachusetts.

Jaclyn Alexander and her daughter Ella Donna, who has neonatal abstinence syndrome. Alexander developed an opioid addiction after being prescribed painkillers in the military; she is now clean.

When Jaclyn Alexander returned to the United States from military service in Iraq, her war was just beginning.

From an airbase nicknamed "Mortaritaville," to nerve damage in her back, to oxycodone, to morphine, to addiction. From addiction, to motherhood, to theft, to heroin, to detox and dope sickness, to recovery, to the Baystate Medical Center Neonatal Intensive Care Unit, where she sat holding her second daughter, quiet and calm but born dependent on the suboxone keeping her mother from relapse.

It has been, she said, a long road.

"I could not be in a better place. If you asked me a year ago if I would be right here right now I would absolutely have said no," Alexander said, amid the soft whooshes and mechanical chirps of the medical ward. "It's a phenomenal turnaround."

Alexander's baby, Ella Donna, is one of the growing number of children born dependent on opioids - what doctors call neonatal abstinence syndrome. It is a condition that requires special care, but is treatable, with approaches that have been refined as Massachusetts' addiction crisis has given the state one of the highest rates of NAS in the country.
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Killing Pain or Killing Veterans?

The claim made about Opioids is a valid one. The question is, why hasn't Congress done their jobs after all the years it has been reported in the past?

Not a new problem for veterans

Air Force veteran Ken Grady, 45, says the local VA prescribed him OxyContin, Percocet, Vicodin and fentanyl patches in the 2000s because of a series of surgeries for back injuries. “The VA made it so easy,” he says. “It was endless, and I abused it.”

And one more thing to point out is this.

Last month, Mr. Grady had several teeth pulled by a VA contractor, who prescribed him Vicodin for the pain. Mr. Grady says he protested, but “you don’t have to twist my arm too much.” He relapsed, bought more pills on the street and landed back in jail. He hoped to be out by Christmas but his mother says it is taking longer than expected to find treatment and a place to stay.

The VA Hooked Veterans on Opioids, Then Failed Them Again
Wall Street Journal
By Valerie Bauerlein and Arian Campo-Flores
Photographs by Travis Dove for The Wall Street Journal

Shortly after enlisting in the Army, Robert Deatherage was prescribed Percocet for a back injury. Wounds from Afghanistan meant more painkillers.

FAYETTEVILLE, N.C.—Robert Deatherage, a 30-year-old Army veteran who has battled addiction to pain pills and heroin since suffering severe injuries in Afghanistan, says he reached rock bottom a year ago when he holed up in an empty church and tried to kill himself. Twice.

“I was just so sick of being as sick as I was,” he says. He put a gun in his mouth and pulled the trigger, but it didn’t fire. He says he then used two syringes to shoot all the drugs he had, but didn’t overdose.

Mr. Deatherage took the failure as a spiritual sign and walked to the nearby Veterans Affairs Medical Center. The facility didn’t have any space and turned him away, offering only a jacket from the lost and found and a phone number for a homeless veterans coordinator. After he picked up his disability check a few days later, he checked into a hotel where he knew other addicts, including veterans.

“It gets discouraging,” Mr. Deatherage says. “It makes it easier to just say, ‘F--- it, I’ll just keep doing what I’m doing.’ ”
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But this is nothing new.

Veterans dying from overmedicationCBS News
By Jim Axelrod
September 19, 2013
(CBS News) Veterans by the tens of thousands have come home from Iraq and Afghanistan with injuries suffered on the battlefield. Many of them seek treatment at Veterans Affairs hospitals. Now a CBS News investigation has found that some veterans are dying of accidental overdoses of narcotic painkillers at a much higher rate than the general population -- and some VA doctors are speaking out.
Five tours of duty in Iraq and Afghanistan left 35-year-old Army Spc. Scott McDonald with chronic back pain.
His wife Heather said over the course of a year, VA doctors in Columbus, Ohio prescribed him eight pain and psychiatric medications."It just got out of control," said Heather. "They just started pill after pill, prescription after prescription...and he'd come home with all brand-new medications, higher milligrams."

Then a VA doctor added a ninth pill -- a narcotic called Percocet. Later that evening, Heather came home from work and found Scott disoriented on the couch.
"And I asked him," Heather recalled, "'You didn't by chance by accident take too many pills, did you?' And he's like, 'No, no. I did what they told me to take, Heather.' I popped a pillow under his head and that's how I found him the next morning, exactly like that."
McDonald wasn't breathing. The coroner's report ruled his death accidental. He had been "overmedicated" and that he died from the combined effects of five of his medications.
read more here

But that wasn't new either

Veterans with PTSD more likely to get addictive painkillers despite the risks, VA study showsBy Associated Press, Updated: Tuesday, March 6, 4:34 PM (2012)
CHICAGO — Morphine and similar powerful painkillers are sometimes prescribed to recent war veterans suffering from post-traumatic stress along with physical pain, and the consequences can be tragic, a government study suggests.
These vets are at high risk for drug and alcohol abuse, but they’re two times more likely to get prescriptions for addictive painkillers than vets with only physical pain, according to the study, billed as the first national examination of the problem. Iraq and Afghanistan vets with PTSD who already had substance abuse problems were four times more likely to get these drugs than vets without mental health problems, according to the study.
Subsequent suicides, other self-inflicted injuries, and drug and alcohol overdoses were all more common in vets with PTSD who got these drugs. These consequences were rare but still troubling, the study authors said.read more here 

But that was nothing new either. 

Rise in drug prescriptions may signal abuseBy Gregg Zoroya - USA TodayPosted : Saturday Nov 1, 2008
The sharp rise in outpatient prescriptions paid for by the government suggests doctors rely too heavily on narcotics, says Army Col. Chester “Trip” Buckenmaier III, of Walter Reed Army Medical Center in Washington.
Recently, at least 20 soldiers in an engineer company of 70 to 80 soldiers at Fort Leonard Wood, Mo., shared and abused painkillers prescribed for their injuries, according to court testimony.
“The groundwork for this toxic situation was laid out through the continual prescription of highly addictive, commonly overused drugs,” said Capt. Elizabeth Turner, the lawyer for one defendant in the case.
In response to six suicides and seven drug-related deaths among soldiers in Warrior Transition Units — created for the Army's most severely injured — aggressive efforts are underway to manage prescription drugs, says Col. Paul Cordts, chief of health policy for the Army surgeon general. These include limiting prescriptions to a seven-day supply and more closely monitoring use.

But that wasn't new either 

Autopsy: Mix of pain meds killed Irwin soldierThe Associated PressPosted : Friday Aug 22, 2008 8:08:04 EDT
SAN BERNARDINO, Calif. — An autopsy of a soldier who died while training at Fort Irwin has revealed she was killed by a combination of prescription drugs she was taking for pain.
The San Bernardino County Sheriff’s Department made the finding about the accidental death of Spc. Emily T. Ort, 24, of Willis, Texas.
“There is no evidence of suicide,” the report said. “The decedent did not have a history of chronic drug abuse.”
On May 3, Ort was discovered unresponsive in her sleeping bag and was rushed to the hospital where she was pronounced dead. An autopsy was performed a few days later, but the report was not released until this week.
Ort had acetaminophen, morphine, hydrocodone and gabapentin as well as anti-anxiety drugs Valium and oxazepam in her system, the report said.
The soldier was apparently taking Vicodin and Valium for injuries she sustained during a 2007 car accident.
The night before she died, Ort told her mother that her medication was stolen and her doctor prescribed morphine and a muscle relaxer as replacements, the report said.http://www.armytimes.com/news/2008/08/ap_irwindeath_082208/

I could keep going but I have such informed readers you get the point.

Families Prepare to Talk About Reality of "Candy Land" Deaths

Late vets' family members to have their say about VA care
USA TODAY
Donovan Slack
March 29, 2015

He checked him into Tomah for severe anxiety and a painkiller addiction last summer. But in late August, Jason texted him to say the medications were making him crazy. He asked his father for help. So Marv Simcakoski set up a meeting with his son, a patient advocate and his son's doctor, who consulted with Houlihan on adding another opiate to his son's regimen.

WASHINGTON — A construction contractor will relive the "most painful day" of his life when his veteran son died at a Wisconsin Veterans Affairs' center.

A widow will recount receiving bags of pills in the mail for a husband who hadn't been home for months.

A daughter will chronicle the final lucid hours of her veteran father as he waited hours for care, then slumped over limp and unresponsive.

And a pharmacist will raise questions about three more "unexplained" veteran deaths — all patients like the others who received treatment at the Tomah Veterans Affairs Medical Center.

All are set to testify at what promises to be an emotional congressional hearing in Tomah, Wis., Monday. It will be their first chance to publicly face VA officials overseeing the facility since news reports drew national attention to their struggles and triggered investigations by several state and federal agencies, including the VA and the Drug Enforcement Administration.

Five months after Daigh declined to release his findings, 35-year-old Marine veteran Jason Simcakoski died from an overdose as an inpatient in Tomah. It was just days after Houlihan agreed that another opiate should be added to the 14 drugs he was already prescribed.

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VA Releases Tomah Opioid Report

VETERANS AFFAIRS VA News Releases
VA Releases Key Findings of Clinical Review of Opioid Practices in Tomah
03/10/2015 04:18 PM EDT

VA Releases Key Findings of Clinical Review of Opioid Practices in Tomah
Clinical and Administrative Reviews Still Ongoing

Washington – The Department of Veterans Affairs (VA) today released key findings and recommendations of its initial clinical review into opioid prescription practices at the Tomah VA Medical Center (VAMC).

Based on these preliminary findings, the team recommended that VA consider a more in-depth evaluation of the clinical and administrative practices at the Tomah VAMC. An administrative review team from VA’s Office of Accountability Review (OAR) is continuing to look at allegations of retaliation against employees and other accountability issues related to Tomah VAMC leadership.

Investigators from the independent VA Office of Inspector General and the Department of Justice’s Drug Enforcement Administration have also been on site.

Yesterday, VA announced the accelerated deployment of a nationwide opioid therapy tool for use at all Veterans Health Administration (VHA) facilities.

In January, Secretary of Veterans Affairs Robert A. McDonald directed Interim Under Secretary for Health Dr. Carolyn Clancy to lead a comprehensive review of medication prescription practices at the Tomah VA Medical Center. Dr. Clancy charged the Clinical Review Team to assess the practice patterns, controlled substance prescribing habits, and administrative interactions with subordinates and clinical leadership as related to prescribing practices.

The release of the key findings comes as VA’s Deputy Secretary Sloan Gibson met today with employees and stakeholders in Tomah.

91,614 fewer patients receiving opioids;
29,281 fewer patients receiving opioids and benzodiazepines together;
71,255 more patients on opioids that have had a urine drug screen to help guide treatment decisions;
67,466 fewer patients on long-term opioid therapy

Wisconsin VA "Breeding Drug Addicts" Instead of Healing Veterans?

You know it is really bad when the Wisconsin VA gets called "Candy Land" because of the drugs they have been handing out. This is from NBC News.

"I just feel that he didn't have a chance," Simcakoski's mother, Linda, told Farrow. "We trusted them and we expected them to know what to do...and it just seems like they just kept giving him more and more."

A Wisconsin VA hospital nicknamed "Candy Land" by some for an alarming surge in pain-killer prescriptions is under investigation — six months after a Marine Corps veteran died of an overdose in the psychiatric ward.

The amount of opiates doled out by the U.S. Department of Veteran Affairs Medical Center in Tomah nearly quadrupled over eight years, under the leadership of the chief of staff, Dr. David Houlihan, as the non-profit Center for Investigative Reporting first revealed.

Prescriptions for just one of them, often-abused oxycodone, shot up ten-fold — from about 78,000 pills in 2005 to almost 712,000 in 2012, the center found.

Meanwhile, some staffers complained they were pressured to refill prescriptions early and to keep giving powerful narcotics to patients who may not have been taking the doses themselves.

"They're breeding drug addicts," Jason Bishop, an Air Force veteran who is a patient at the Tomah facility, told MSNBC's Ronan Farrow, who reported this story in collaboration with NBC Investigations.

The problem is, some member of Congress will jump on this story and write a bill with his name on it or some other veteran who tried to get help only to end up in the grave.

Why not? They've gotten away with it all these years. The reports go back to at least 2008 on what the VA has been doing with handing out drugs instead of therapy. Some find it all too easy to numb them instead of work with them. Others, well, they do the best they can but even the best VA doctors are overwhelmed by the number of veterans looking for help to heal.

If you are thinking that veterans would be better off outside the VA, think again. Years ago I work for a group of psychiatrists and they made a lot more money with med appointments than they did providing actual therapy sessions. These appointments were done in 15 minutes meaning they could see at least 4 patients an hour every hour they were in the office. When they needed time off, appointments had to be changed. I had to do the med appointments first and then squeeze everyone else in afterwards.

So why is it still this way after all these years of sad outcomes? Drugs aren't free and someone is making money off the veterans who fought to retain the freedom we still have. The other reason is that members of congress are "doing something" about all this without a clue as to what that something actually should be.

Baldwin Sat on Report Others Pretended They Didn't Know Years Ago

"Sen. Baldwin had Tomah VA report for months" was the headline on the use of opiates as if it was anything new. None of this is new but it seems as if some bloggers have just discovered this issue. The story was linked on a report Town Hall.com had up Sunday but as you can see, it is far from new and it appears that there have been many politicians just sitting on what they knew, since nothing was done about any of it.

"In September, the Center for Investigative Reporting revealed that VA prescriptions for four opiates - hydrocodone, oxycodone, methadone and morphine - surged 270 percent from 2001 to 2012. That far outpaced the increase in the number of VA patients and contributed to a fatal overdose rate that the agency's researchers put at nearly double the national average."

That was reported in 2013 by Aaron Glantz, Center for Investigative Reporting. The kicker was that also in the same report was the stunning admission of doctors writing prescriptions for these drugs without seeing the patient. Glantz followed that report up with another testimony told this part of what was going on.

"There are multiple instances when I have been coerced or even ordered to write for Schedule II narcotics when it was against my medical judgment," said Dr. Pamela Gray, a physician who formerly worked at the VA hospital in Hampton, Va. Primary care doctors who don't want to prescribe large amounts of opiates may resign, do as they are told or be terminated, Gray said. Gray was fired.

Dr. Robert Jesse gave testimony to the House Veterans Affairs Committee

Hearing on 10/10/2013: Between Peril and Promise: Facing the Dangers of VA’s Skyrocketing Use of Prescription Painkillers to Treat Veterans

"We also know that the long-term use of opioids is associated with significant risks, particularly in vulnerable individuals, such as Veterans with Post-Traumatic Stress Disorder (PTSD), depression, Traumatic Brain Injury (TBI) and family stress – all common in Veterans returning from the battlefield, and in Veterans with addiction disorders. Chronic pain in Veterans is often accompanied by co-morbid mental health conditions (up to 50 percent in some cohorts) caused by the psychological trauma of war, as well as neurological disorders, such as TBI caused by blast and concussion injuries. In fact, one study documented that more that 40 percent of Veterans admitted to a polytrauma unit in VHA suffered all three conditions together – chronic pain, PTSD, and post-concussive syndrome."

But as bad as all this is, the reports of troops being medicated while still in the military have been going on longer.

Investigation needed Ambien and military use

Links to medications suspected with non-combat deaths

More Than Half A Million Veterans on Opioids Face Rule Change

New rules on narcotic painkillers cause grief for veterans and the VA 
Washington Post
Emily Wax-Thibodeaux
February 18, 2015

More than half a million veterans are now on prescription opioids, according to the VA.

Craig Schroeder, shown on Feb. 6, 2015, was injured in 2006 while serving with the Marines in Iraq and suffers from traumatic brain injury and pain, for which he has been on a steady regimen of opioids.
TED RICHARDSON/THE WASHINGTON POST

WASHINGTON — New federal rules that make it harder to get narcotic painkillers are taking an unexpected toll on thousands of veterans who depend on these prescription drugs to treat everything from missing limbs to post-traumatic stress.

The restrictions, adopted last summer by the Drug Enforcement Administration to curb a national epidemic of opioid abuse, are for the first time, in effect, forcing veterans to return to the doctor every month to renew their medication, although many were already struggling to get appointments at overburdened VA health facilities. And even if patients can get appointments, the new rules pose an additional hardship for many who live a good distance from the health centers.

While the tighter regulation applies to everyone on opioid painkillers, it's hitting veterans especially hard because so many are being treated for horrific injuries sustained during the long wars in Iraq and Afghanistan and have become dependent on the VA's beleaguered health-care system for medical care.

The rules come at a time of turmoil for the Department of Veterans Affairs. The agency's widespread problem with patient backlogs burst into view last year with revelations that employees had covered up how long veterans had to wait for care, even for such pressing matters as cancer and suicide prevention.
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Ex-VA doctor says she was forced out after limiting opiate prescriptions

The stories we need to know!
RETURNING HOME TO BATTLE

Ex-VA doctor says she was forced out after limiting opiate prescriptions
The Center for Investigative Reporting
Aaron Glantz
The Center for Investigative Reporting
Byron Pitts
ABC News
Feb 25, 2014

Dr. Basimah Khulusi says she was forced out of her job as a rehabilitation specialist at the Department of Veterans Affairs hospital in Kansas City, Mo., after patients complained that she would not prescribe high doses of opiates. She says many of her patients had been addicted to opiates for years yet received escalating doses from VA doctors as their tolerance built.
Credit: ABC News

On the eve of a congressional hearing about the Department of Veterans Affairs’ skyrocketing use of narcotic painkillers, a former VA doctor has stepped forward with new allegations about the agency’s prescription practices.

In an exclusive interview with The Center for Investigative Reporting and ABC News, Dr. Basimah Khulusi said she was forced out last year after patients complained that she would not prescribe high doses of opiates.

“I had to do something about it. And I tried,” said Khulusi, a rehabilitation specialist who worked at the VA hospital in Kansas City, Mo., for five and a half years. “And then, you know, I was let go.”

In September, CIR revealed that VA prescriptions for four opiates – hydrocodone, oxycodone, methadone and morphine – surged by 270 percent between 2001 and 2012.

That far outpaced the increase in VA patients and contributed to a fatal overdose rate of nearly double the national average, the agency’s own scientists found.

CIR’s report helped spark a congressional hearing. At that hearing in October, VA officials promised to present a plan to address problems with opiate prescriptions within 30 days. A follow-up oversight hearing is scheduled for Wednesday.

Khulusi said the majority of veterans she saw in the pain clinic already were addicted to prescription opiates – receiving doses as high as 900 narcotic pain pills a month and 1,000 milligrams of morphine a day, 10 times the level she considered safe.
read more here VA's lack of pain treatment options led to opiate addiction, veteran says VA’s opiate overload feeds veterans’ addictions, overdose deaths

Veterans dying from overmedication

Veterans dying from overmedication
CBS News
By Jim Axelrod
September 19, 2013

(CBS News) Veterans by the tens of thousands have come home from Iraq and Afghanistan with injuries suffered on the battlefield. Many of them seek treatment at Veterans Affairs hospitals. Now a CBS News investigation has found that some veterans are dying of accidental overdoses of narcotic painkillers at a much higher rate than the general population -- and some VA doctors are speaking out.

Five tours of duty in Iraq and Afghanistan left 35-year-old Army Spc. Scott McDonald with chronic back pain.

His wife Heather said over the course of a year, VA doctors in Columbus, Ohio prescribed him eight pain and psychiatric medications.

"It just got out of control," said Heather. "They just started pill after pill, prescription after prescription...and he'd come home with all brand-new medications, higher milligrams."

Then a VA doctor added a ninth pill -- a narcotic called Percocet. Later that evening, Heather came home from work and found Scott disoriented on the couch.

"And I asked him," Heather recalled, "'You didn't by chance by accident take too many pills, did you?' And he's like, 'No, no. I did what they told me to take, Heather.' I popped a pillow under his head and that's how I found him the next morning, exactly like that."

McDonald wasn't breathing. The coroner's report ruled his death accidental. He had been "overmedicated" and that he died from the combined effects of five of his medications.
read more here

Military Rise in drug prescriptions may signal abuse

Rise in drug prescriptions may signal abuse
By Gregg Zoroya - USA TodayPosted : Saturday Nov 1, 2008
The sharp rise in outpatient prescriptions paid for by the government suggests doctors rely too heavily on narcotics, says Army Col. Chester “Trip” Buckenmaier III, of Walter Reed Army Medical Center in Washington.

Recently, at least 20 soldiers in an engineer company of 70 to 80 soldiers at Fort Leonard Wood, Mo., shared and abused painkillers prescribed for their injuries, according to court testimony.

“The groundwork for this toxic situation was laid out through the continual prescription of highly addictive, commonly overused drugs,” said Capt. Elizabeth Turner, the lawyer for one defendant in the case.

In response to six suicides and seven drug-related deaths among soldiers in Warrior Transition Units — created for the Army's most severely injured — aggressive efforts are underway to manage prescription drugs, says Col. Paul Cordts, chief of health policy for the Army surgeon general. These include limiting prescriptions to a seven-day supply and more closely monitoring use.
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Narcotic pain relief use for troops raises fears

picture from MSN

Increase in painkillers for troops raises fears

By Gregg Zoroya - USA Today
Posted : Tuesday Oct 21, 2008 8:41:24 EDT

WASHINGTON — Narcotic pain-relief prescriptions for injured U.S. troops have jumped from 30,000 a month to 50,000 since the Iraq war began, raising concerns about the drugs’ potential abuse and addiction, a leading Army pain expert said.

The sharp rise in outpatient prescriptions suggests doctors rely too heavily on narcotics and don’t manage pain with a complex array of treatments, said Army Col. Chester “Trip” Buckenmaier III, director of the Acute Pain Service Management Initiative at Walter Reed Army Medical Center in Washington.

By 2005, two years into the war, narcotic painkillers were the most abused drug in the military, according to a survey that year of 16,146 service members.

Among soldiers, 4 percent surveyed in 2005 admitted abusing prescription narcotics in the previous 30 days, with 10 percent doing so in the last 12 months. Researchers said the higher abuse figures might be due to respondents mistakenly referring to legal use of pain medication. A 2008 survey has not been released.

go here for more

http://www.armytimes.com/news/2008/10/gns_painkillers_abuse_102108/