VA: Too many pills, not enough care
Tom was a troubled man.
Except during a marriage that lasted nearly 20 years, his life was marked by wrecked cars, fights, addiction, two gunshot wounds and, in his youth, several jail stints.
He dropped out of high school in 1961. As difficult teens often did at the time, he joined the military the next year as he neared his 18th birthday.
He was based in Long Beach on the minesweeper USS Pluck and spent stretches of time in Hawaii and the Philippines. From those Pacific ports, he sometimes sent his mother orchids packed in dry ice, so exotic when they arrived at her home in southeast Nebraska.
The Pluck did two tours off the coast of Vietnam, and at one point, Tom said, he was among sailors sent ashore for armed patrols. It was hard to know much about his Vietnam experience, which in his telling became more dramatic as he aged.
When he got out of the Navy, he’d seen the world and sampled heartily of its hedonistic temptations. A full-blown alcoholic deep into other drugs, he wandered the country. It was the 1960s and he was a tough single man in his 20s. He always carried a knife in his backpack and reveled in calling himself a street person.
As the ‘70s came and he aged, his addictions deepened. He ended up in a couple of mental institutions and, finally in one of them, met a counselor who took him under her wing.
Tom sobered up and married Char. First he became an addiction counselor himself. Then he became a massage therapist, and had a remarkable touch that enabled him to go into business for himself. It was a tale of recovery and redemption. He regularly visited his parents and was financially stable — until Char died in 2003.
Without her, he made a series of bad decisions, eventually ending up back in his hometown broke. His siblings were sure he was looped out on pain pills he got from Veterans Affairs doctors for back and neck pain, and confronted him more than once.
His legs deteriorated and he wasn’t licensed for massage in Nebraska, so sought disability and further help from the VA. He ultimately got two hip replacements — and lots of pain pills before and after the surgeries.
His timing caught the proliferation of pain medicine in the United States since 1999, with prescriptions up 300 percent for Americans as a whole and up 270 percent for VA patients.
The VA was a trailblazer in medicating America, which consumes 99 percent of the global hydrocodone supply and 83 percent of oxycodone, the two most common active ingredients in prescription painkillers.
In 1999, the VA made pain a “fifth vital sign,” adding it to pulse, respiration, temperature and blood pressure. This was the birth of medical professionals asking you to rate your pain on a scale of 1-10.
The VA, of course, is a major customer for pharmaceutical companies, so if you make a pain pill — say OxyContin, approved by the FDA in 1996 — it’s a really good deal for you if the VA adopts guidelines to more aggressively treat pain. You might back organizations that call for widespread adoption of the VA pain standard, which would further increase prescriptions of your blockbuster profit maker.
That’s exactly what happened. Purdue Pharma, the maker of OxyContin, along with other pharmaceutical companies, backed organizations such as the American Pain Society and turned pain treatment on its head. Powerful opiate drugs that were sharply restricted in America, even for the terminally ill, became the standard of care.
In 2001, the Joint Commission, which accredits U.S. hospitals and health systems and thus wields tremendous power, adopted more aggressive pain management standards. Pharmaceutical companies controlled doctor education in a cozy arrangement with the Joint Commission.
Prescriptions exploded. As I wrote last week in arguing that Americans take too many medicines of all kinds, by 2010, enough painkillers were prescribed every year to medicate every American adult around-the-clock for one month.
The results have been addiction, 17,000 American deaths per year from prescription opiates and the nation’s worst-ever problem with heroin, a chemical sibling to prescription opiates.
Compounding this continuing tragedy, the aggressive pharmaceutical approach is a failure. A study of VA patients in 2006 concluded that “routinely measuring pain by the fifth vital sign did not increase the quality of pain management.”
It’s one of many studies that show, overall, opiates do not work in the long run for treating chronic pain.
They are extremely effective in creating addicts, though.
None of that changed VA practices, as documented last year by the Center for Investigative Reporting.
As the VA works to address a range of deficiencies in its health care, it can be a leader again in how America handles pain. It can stop buying and supplying the pills in bulk. It can improve its internal communication so veterans who become addicts can’t doctor shop within the system — which is exactly what Tom did.
By 2012, his renewed addiction was inescapably evident. A VA psychiatrist was working to get him in treatment and in early 2013 canceled his OxyContin prescription.
My brother died in February 2013 alone in a small, drafty rental house in our hometown, about a quarter mile from the home where, as a 4-year-old, I waved goodbye to him when he left for the Navy.
The autopsy found significant levels of opiates in his system. Police found a bottle of morphine tablets, prescribed 10 days earlier by a VA doctor who didn’t find notice of the OxyContin cancellation in Tom’s records.
People bear responsibility for their own choices and actions. While he was clean and recovering when he entered its care, the VA didn’t kill my brother. Nor did it care for him very well. It replaced his hips, but gave him exactly the wrong medicine for someone with his history.
Our veterans deserve better.
Randy Essex is editor of the Post Independent.
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