Half of returning vets battle chronic pain, many risk pill addiction

Chronic pain tortures nearly half of returning U.S. veterans, a new study suggests, and a large number of them — as many as 15 percent — are using narcotic painkillers to manage it.

Research shows that soldiers are four times as likely to use prescription narcotics compared to the wider civilian population. Such drugs carry the risk of lifelong addiction, fatal overdose and have been linked to the nation’s epidemic levels of heroin use. 

The study, published Monday in the journal JAMA Internal Medicine, represents the first survey of an entire brigade — 2,600 infantry personnel. Understanding an entire combat unit’s relationship to pain and prescription medication is a valuable benchmark for developing new standards of treatment. And the Department of Veterans Affairs (VA) urgently needs new standards.

Although the Veterans Health Administration (VHA) has established programs like the Opioid Safety Initiative, which identifies patients at the greatest risk of addiction and overdose and tries to help taper them off prescription opiates, it may be that science has only just begun to encounter the particular risks to veterans returning from combat.

In 2013 testimony before the House Committee on Veterans’ Affairs, VHA principal deputy undersecretary for health, Dr. Robert Jesse, pointed out that "the long-term use of opioids is associated with significant risks, particularly in vulnerable individuals, such as veterans with post-traumatic stress disorder (PTSD), depression, traumatic brain injury (TBI) and family stress — all common in veterans returning from the battlefield, and in veterans with addiction disorders.”

Jesse also cited a study published in 2010 of “postdeployment multi-symptom disorder,” a terrible combination of post-concussive symptoms, PTSD and chronic pain that the study found in 40 percent of veterans but for which there is almost no clinical guidance.

In the new study, researchers found that of the soldiers reporting using prescription narcotics, 5.6 percent of them reported having no pain in the prior month — a finding that suggests those soldiers may already be addicted.

Once veterans become addicted, their health risks intensify dramatically.

Already, the nation’s heroin epidemic has led health officials across the country to consider the widespread distribution of Naloxone, an inhaled medication known as the “Lazarus drug,” because it can safely and instantaneously reverse the effects of a heroin or opiate overdose.

The rise of prescription-opiate addiction, which can lead to the same type of overdose, has prompted the VA to begin investigating the possibility of distributing Naloxone within its system, simply to deal with the deadly risk of prescription opiate overdose.

This new study could prompt the VA to speed that process along.