November 13, 2016
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Opiate Prescriptions Down at the VA, Alternatives on the Rise

By Aaron Glantz, Reveal News

The Department of Veterans Affairs is doling out narcotics to 160,000 fewer veterans than it was three years ago, a reduction of nearly 25 percent, and alternative treatments are on the rise.

Government prescription data also shows that the number of veterans receiving prescriptions for both a narcotic and a tranquilizer, a combination that often leads to overdose, has been cut in half.

Although some veterans complain that the alternatives remain sparse, experts say the change – which followed a 2013 investigation by Reveal from The Center for Investigative Reporting – is likely saving lives.

“This is a big story,” said G. Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. “One would expect large reductions in the number of veterans experiencing addiction and overdose.”

The drop in opiate prescriptions occurred even as the VA added nearly half a million patients, many of them younger veterans returning from Iraq and Afghanistan.

Reveal’s coverage exposed a dramatic rise in the number of opiate prescriptions at the agency and a fatal overdose rate among VA patients of double the national average.

Veterans say they’ve noticed the change.

“When I first got back they would send me to a doctor, and he would just ask me, ‘Hey, is there a medication that you would prefer?’” said Vince Emanuele, 32, a Marine Corps veteran who served two tours in Iraq. “People were being prescribed an absurd amount of drugs.”

Now, Emanuele said, when he goes to his local VA hospital in Northern Indiana, he’s offered transcendental meditation or yoga, counseled on his nutrition and exercise regimen, and queried about the strength of his social network.

“It’s much different than: Let’s give you medication, and I’ll see you in 60 days,” he said.

Still, many veterans also complain that the VA cut down on narcotics without a commensurate boost in alternatives. The result, said Anthony Hardie, director of the advocacy group Veterans for Common Sense, is that veterans often face long waits for treatment and remain in excruciating pain.

“Pain is now,” Hardie said. “People don’t call up and say, ‘Hey, I might get pain in three weeks.’”

In an email, the VA said it had trained 1,000 providers in “Battlefield Acupuncture” and now employs chiropractors at about half of its hospitals. Classes on stress management and relaxation are available at 112 VA facilities, the agency said, while the number of hospitals offering tai chi or yoga has doubled.

Hardie, a Gulf War veteran who battles neck pain, knee pain and fibromyalgia, said he was offered chiropractic treatment by the VA. But since the closest hospital is a nearly two-hour drive from his home in Bradenton, Florida, accessing that care would mean missing work.

This July, President Barack Obama signed sweeping narcotics reform legislation that further regulates the way the VA dispenses and monitors opiates. The Jason Simcakoski Memorial Opioid Safety Act was prompted by a Reveal investigation published in January 2015.

The story disclosed that veterans at the VA hospital in Tomah, Wisconsin, showed up to appointments stoned on prescription painkillers and muscle relaxants, dozed off and drooled during therapy sessions, and burned themselves with cigarettes.

The law, named after a veteran who died in the Tomah hospital’s psychiatric ward, created stronger opioid prescribing guidelines for VA providers, including stricter standards against prescribing narcotics in combination with other drugs such as tranquilizers, and restrictions on prescribing opiates to patients with mental health issues.

Alexander, with Johns Hopkins, commended the VA for moving faster than the private sector to address the national epidemic of painkiller addiction. But the legislation’s requirements for oversight of progress toward goals and alternative therapies will be key.

“It’s important that these changes be enduring,” he said.

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