Local 12 Investigates: Addicted Veterans: Pain Pill Problems
CINCINNATI (WKRC) - The opioid epidemic that continues sweeping across the country is having an even more profound effect on our nation’s military veterans, with studies revealing a nearly 300 percent rise in opioid prescriptions at the VA from 2001 to 2012 as other studies show twice as many veterans are dying from pain pill overdoses as the general population.
Against this backdrop, the Veterans Administration has responded with an Opioid Safety Initiative, drastically cutting the number of opioids to a much lower level for all but cancer patients. But the program and past level of prescriptions has left veterans across the country encountering what they describe as unbearable pain, severe withdrawal, and a dilemma about where to turn now.
A WAR VET
For Ron Hamilton, a former Army Sergeant who was honorably discharged nearly two decades ago, “Operation Desert Storm” never faded. Hamilton, a gunner on an M1-A1 Abrams tank, led the assault on Iraqi forces in the desert in 1991. When asked if he’s proud of his service, Hamilton doesn’t blink.
“Yes. Sir. Every bit of it,” adding he would do it again. “This is my home and nobody’s going to take that away from us,” Hamilton observes, as an American flag waves in a nearby window.
But Hamilton, who is visibly shaking and bent unnaturally, has had plenty taken away from him.
“Literally, my life is falling apart because I can’t function anymore,” Hamilton exclaims, as he begins to answer questions about his health.
After many years of chronic compression of his spine and debilitating disc issues, Hamilton clearly expresses pain, explaining he can now barely walk or stand. When asked if he is in pain as Local 12 talks to him at his parent’s home, Hamilton doesn’t hesitate, “Yeah. Oh Yeah.”
Hamilton’s trouble started before his service on the front lines of the Gulf War. He and his crew were trying to fix the tracks on the tank, lifting a section that weighed 800 pounds, when the crew members lost their grips. Hamilton was alone to hang on to the sheer weight.
“I was holding on to it,” Hamilton explains, remembering that awful day, adding, “I went down on my knees in excruciating pain.”
Since that moment, Hamilton has been dealing with the same excruciating pain, off and on for more than two decades.
NEARLY EVERY TYPE OF OPIOID
In the 1990’s doctors at the Veterans Administration Medical Center in Cincinnati operated on Hamilton’s back to fix his issues, but Hamilton’s pain only got worse. To manage that pain, Hamilton, like hundreds of thousands of vets, was prescribed highly-addictive opioids. Hamilton’s pharmacy records reveal a list of nearly every pain pill, opioid, and opiate dating back seventeen years from OxyContin to Oxycodone, Methadone to Morphine. Hamilton provided Local 12 News with a complete copy of his medical file, agreeing to allow us to review and show those records.
“I have no problem with that, showing my medical records,” Hamilton stated.
His records revealed a staggering amount of opioids, prescribed to Hamilton by the VA over that same 17-year period. In June, Hamilton’s prescription for opioids reached its highest level: 280 10 milligram doses of Methadone, an opioid commonly used to treat heroin addicts, combined with 224 5 milligram pills of another opioid, Oxycodone. While the amount of each drug would change, the total number of 504 pain pills a month would not over the next two and a half years.
“I was on a regimen of 12 methadone a day, which is 120 milligrams. And 6 oxycodone,” Hamilton explained, adding he took them all because they were all prescribed to treat his pain.
TOO MANY PILLS?
On the Ohio Pharmacy Board’s website you can calculate Opioid Risk by plugging in pill numbers and dosage in a calculate that determines your Morphine Equivalent Doses, or M.E.D. The M.E.D. is a universal measurement to evaluate whether the doses and amounts of opioids.
According to the Pharmacy Board, a score of 80 M.E.D. or higher is the danger zone where the state says all pain pills should be stopped and reassessed. Plugging in the number and dose of Hamilton’s opioids at the highest point brought a total of 405 M.E.D. which is five times higher than what the state pharmacy board says is dangerous.
Hamilton says his addiction is real and clear, “Anybody who's been prescribed the medicine I have for the amount of years, how could you not be an addict?”
Hamilton says his addiction became clear when the VA began cutting the number of pain pills he received, starting in 2015. Under the Opioid Safety Initiative, The VA began cutting the number of highly-addictive pills to more than 100,000 vets a year each year since 2013. The goal of the Initiative is cut the M.E.D. to 100 or less for all but cancer patients.
Hamilton is still prescribed more than 100 opioids a month, but he says even that amount isn’t enough to stop his pain and prevent severe symptoms of withdrawal, which include diarrhea, sweating and shaking. While Local 12 was documenting Hamilton and his struggle, we were interrupted.
“Hang on. Hang on,” Hamilton said, as he began to search in and under a couch and around and under a table.
When asked why he was searching so frantically, he responded, “Methadone.”
It was a half of a pill. Hamilton cut it to ration his supply and the thought of losing it had sent him in to near panic. After a few minutes where Hamilton began lifting furniture, Hamilton finally found his half pill of methadone in the pill bottle. It was there the whole time.
THE VA RESPONSE
When asked who make him an addict, Hamilton is clear, “The VA,” he answers, without blinking.
But did doctors at the VA Medical Center let Hamilton down, prescribing too many pills and getting him hooked on them? After weeks of trying to get a comment from the VA about Hamilton’s case, the VA turned down our request for an interview, instead choosing to finally answer questions in writing.
The opioid epidemic sweeping across the United States extends well beyond the Veterans Administration and the Veterans who are treated at VA Medical Centers and Clinics across the country. Starting in the late 1990’s state medical boards curtailed restrictions on laws governing the prescribing of opioids for the treatment of chronic non-cancer pain. This was partially in response to new pain management standards implemented by the Joint Commission in response to complaints that pain was not being addressed. Thus pain as the 5th vital sign was implemented and pain began to be assessed in terms of a numeric 1-10 scale. Moreover, new medications were being aggressively marketed by the pharmaceutical companies. Despite lack of evidence for using opioids in treating chronic pain, there were not many alternatives early on.
With new evidence of the risks versus benefits of using opioids for chronic pain, the VA and others are taking a more proactive approach to provide alternative modalities for treating chronic pain either with or without the use of opioids. Chronic pain is a complex, lifelong condition that has no “fix” or “cure”. Teaching Veterans to engage in active treatments such as physical therapy, behavioral and cognitive therapies, relaxation and mindfulness training and problem solving, engages Veterans in their care. Passive treatments, just as pharmacotherapy, massage, chiropractic or acupuncture in may be used more for short term relief of pain. All of these services are available to veterans at the Cincinnati VA Medical Center. Providers may enter a consult for a multidisciplinary pain assessment for Veterans with chronic pain. This Pain Team determines a plan that is tailored to the veteran and might include a slow taper of opioids.
When discussing opioid tapers, one needs to define the difference between physical dependence and the discomfort that can result from this and addiction. Physical Dependence refers to a normal predictable, physiological response that occurs with the continuous daily use of certain medications, including opioids. Physical dependency is an expected occurrence in all individuals taking opioids either for therapeutic or non-therapeutic purposes. It does not, in and of itself, imply addiction. Withdrawal symptoms caused by physical dependence can be managed with slowly tapering the medication and other behavioral and pharmacological interventions
Addiction on the other hand, is an uncommon but clinically significant syndrome characterized by a persistent pattern of dysfunctional or maladaptive opioid use that may occur independent of analgesic results. Typically, addiction to opioids is for reasons other than pain control, and result in clinically significant dysfunction. This clinical syndrome can be difficult to diagnose correctly – often requiring consultation with clinicians well versed in the intersection of both pain and addiction. The Cincinnati VA offers a wide variety of programs for veterans who may become addicted to pain medications.
In its answer, the VA states, "Addiction... is uncommon" and “The opioid epidemic sweeping across the United States extends well beyond the Veterans Administration,” adding that, “Chronic pain is a complex, lifelong condition that has no "fix" or "cure." When it comes to cutting the number of pain pills in its Opioid Safety Initiative, the VA states, "(a) Pain Team determines a plan that is tailored to the veteran and might include a slow taper of opioids."
“You might be weaning me off the drug, but my pain is way worse than what it was.” Hamilton responded, adding, “I can no longer function as I was,”
The pain and the withdrawal is not a pretty picture for Hamilton, who concedes vets he knows are now turning to the streets to get heroin to ease the pain, something even he says he can’t completely rule out.
When asked if he thought about it, Hamilton says, “Yes,” but adds he hasn’t done it yet.
But when asked whether he will turn to heroin, he could only answer, “I hope not.”