It’s 9/11 every 2.5 weeks.
This is how to conceptualize the jaw-dropping toll of opioid deaths in the U.S., according to Gov. Chris Christie, who chaired the President’s Commission on Combating Drug Addiction and the Opioid Crisis (which CleanSlate Board Member Patrick J. Kennedy helped prepare).
The irony is that many of these victims are the very people who return from post-9/11 deployments.Veterans and service members of all ages are disproportionately afflicted with opioid use disorder, ten times more likely than the general public to abuse opioids and twice as likely to overdose, according to the U.S. Department of Veterans Affairs. Searching for relief from service-related injuries, and often prescribed opioids to deal with PTSD and traumatic brain injuries, veterans are particularly vulnerable to the perils of painkillers. The VA estimates that 68,000 veterans are now addicted to opioids; many of these patients are not receiving sufficient treatment to alleviate this disorder.
As we observe Veterans Day this week, Americans have a moral obligation to go beyond platitudes, and honor our heroes in ways that count. That includes doing everything possible to help veterans who are suffering and dying on the opioid battlefield at home, which is happening in far greater numbers than on any battlefield overseas.
Addressing the opioid epidemic as it relates to the active duty and veteran population comes with added complications, including the stigmatization that service members worry about when they seek help within the insular military community.
But there are rays of hope on the horizon. The Substance Abuse and Mental Health Services Administration (SAMHSA) recently issued an update of its ongoing work with the VA and the U.S. Department of Defense to improve all sides of this issue, from prescribing practices to treatment options. The news offers several promising signs of better coordination and more effective measures to save and improve the lives of veterans:
1. Less reliance on medication alone. Veterans experience greater chronic and severe pain than people in the general population, with up to 75 percent of older veterans experiencing chronic pain. Finding the right balance of addressing pain without overprescribing opioids is important, and the VA is now relying less on medication and more on other approaches, including behavioral therapies, physical therapy and integrative health modalities, and emphasizing physical and mental function.
2. Attention to geography when it comes to mental health. Access to treatment for opioid use disorder - including medication-assisted treatment, one of the most crucial ways to help patients combat addiction - is particularly challenging in remote areas. More physicians must be certified so that this effective and efficient form of outpatient treatment is more widely available to all, including veterans. A pilot project by the DoD, Building Healthy Military Communities, is working to address the unique needs of service members and their families regardless of where they live, including concerns related to mental health and substance abuse. This is one of many steps taken to strengthen veterans communities in far-flung areas and improve access to critical services (more on that next).
3. Cross-agency collaboration to fill in the gaps of care. Since 2013, the DoD, VA, and the U.S. Health and Human Services Dept. (HHS) have collaborated in the Interagency Task Force on Military and Veterans Mental Health to improve access to services for veterans, service members, and their families. The combined federal effort allows risks and safety concerns across a wide range of issues to be tightly coordinated. According to its update, SAMHSA is currently providing a number of resources to DoD and VA providers, including:
- Online trainings and webinars, including medication-assisted treatment training, that not only educate prescribing professionals, but also family members who might need to administer medication if overdose occurs.
- SAMHSA review of Management of Substance Use Disorder and Management of Opioid Therapy for Chronic Pain Clinical Practice Guidelines and the subsequent development of new areas.
- The Service Members, Veterans, and their Families Technical Assistance Center (SMVF TA) that provides technical assistance to states and territories and offers policy academies, where all three departments work together to determine ways to strengthen behavioral health supports at the state level
- Video modules on safe opioid prescribing practices
- Screening, brief intervention, and referral to treatment (SBIRT) training to recognize and mobilize if someone may be at risk for or have a substance use disorder
- MAT-X mobile app to support medication assisted treatment of opioid use disorder
4. Better training of military prescribers. SAMHSA is educating providers to limit opioid prescriptions to recommended ranges, understand signs of misuse, and be knowledgeable about treatment options, including DEA waivers to prescribe Bupenorphine, a medication-assisted treatment. SAMHSA has also eliminated the co-pay on drugs like Nalaxone, making these overdose-reversal drugs more accessible to veterans and their families, and is encouraging doctors to be more creative in how they think about overdose prevention, education and treatment.
At CleanSlate, we are “warriors of hope,” helping people everywhere understand that addiction is not a moral failing but a chronic relapsing brain disease that can be addressed successfully with outpatient medical treatment and medication. On this veterans day, we say “thank you” to the warriors defending our country, and appeal to all communities to end the stigma and obstacles that prevent American heroes from getting the help they deserve.