Weekly Columns

This is the final in a series of columns on efforts to help veterans struggling with mental health issues. Read the first entry on veteran suicides here, the second one on PTSD here and the third one on homelessness here.

It is clear that our nation is in the throes of a deadly and dangerous epidemic. Widespread abuse of opioids has fueled a major spike in overdoses across the United States, both accidental and intentional. Our veterans’ population is not immune to this horrific trend. 

Veterans, particularly those from the Afghanistan and Iraq wars, often return home with high levels of chronic pain. Frequently, they were prescribed a pain management routine during active duty that placed a heavy emphasis on opioids. For far too long, the Department of Veterans Affairs (VA) followed suit with a reliance on opioids to help veterans continue to cope with chronic pain. This is a dangerous road to continue down. 

Several large studies have shown an increased risk of suicides among Americans, including veterans, addicted to opioids. For example, one National Institutes of Health (NIH) study which examined five million veterans struggling with substance use disorders found women were eight times as likely as others to be at risk for suicide, while men face a twofold risk. 

The question this study, and others like it, have not been able to answer is whether this trend is the result of underlying mental health issues or if an opioid addiction triggers a mental health crisis for an individual. Equally as hard to pin down is an accurate number of intentional versus unintentional opioid overdose deaths. What is clear is that opioid addicts struggling with despair have the means by which to carry out suicide at the ready and we should be doing more to reduce that tragic ending.    

For its part, VA is making strides, albeit belatedly. Earlier this year, VA became the first health-care system in the country to publicly post information on its opioid prescribing rate. At the time of the announcement, the administration called it “an innovative way to raise awareness, increase transparency and mitigate the dangers of over-prescribing.” This effort, along with others to address over-prescribing, has helped the VA reduce its opioid prescription rate by 41 percent over the past five years. 

Among those other efforts is a program to educate VA providers on best practices related to pain management and the optimal use of opioids. This is welcome news. I have long advocated that VA needs to “think outside the box” and seek alternatives to opioids as part of its comprehensive pain management practices. Treatments such as physical therapy, acupuncture and yoga are now among the therapies VA considers for veterans to manage chronic pain. 

This is not to say there isn’t a need for medication in VA’s pain management treatment practices, but that must be moderated given the mounting evidence of the dangers of long-term opioid use. Mental health concerns aside, VA’s data suggests veterans are twice as likely to die from an accidental overdose compared to the rest of the population. That alone would be enough to trigger concern about prescription rates. Add to it the link between opioid abuse and suicide, and you have reason to sound the alarm. 

I am pleased to see the VA taking steps to turn the corner. These efforts will clearly help us save lives. I am committed to working with the VA to build on this progress and help our veterans recover from their physical ailments without putting their mental health in jeopardy.