Agency overprescribed painkillers to returning veterans; now treatment options are scarce
BY VALERIE BAUERLEIN AND ARIAN CAMPO-FLORES
FAYETTEVILLE, N.C.—Robert Deatherage, a 30-year-old Army veteran who has battled addiction to pain pills and heroin since suffering severe injuries in Afghanistan, says he reached rock bottom a year ago when he holed up in an empty church and tried to kill himself. Twice.
“I was just so sick of being as sick as I was,” he says. He put a gun in his mouth and pulled the trigger, but it didn’t fire. He says he then used two syringes to shoot all the drugs he had, but didn’t overdose.
Mr. Deatherage took the failure as a spiritual sign and walked to the nearby Veterans Affairs Medical Center. The facility didn’t have any space and turned him away, offering only a jacket from the lost and found and a phone number for a homeless veterans coordinator. After he picked up his disability check a few days later, he checked into a hotel where he knew other addicts, including veterans.
“It gets discouraging,” Mr. Deatherage says. “It makes it easier to just say, ‘F— it, I’ll just keep doing what I’m doing.’ ” The U.S. Department of Veterans Affairs acknowledges its role in creating a large population of opioid-addicted veterans by overprescribing painkillers for injuries and post-traumatic stress disorder. After the agency tightened prescribing practices in 2013, many veterans bought pain pills sold illicitly on the streets. When those
became too expensive, they sought heroin and fentanyl, a potent synthetic narcotic.
The VA is now struggling to undo the damage. Hampered by budgetary and bureaucratic obstacles, it has failed to build a rehabilitation program robust enough to meet the overwhelming demand for treatment from the tens of thousands of veterans with opioid addiction, say analysts who have studied the issue. That has left many veterans to fend for themselves, tapping whatever resources they can find to battle a chronic, complex—and frequently fatal— condition.
In Fayetteville—home to Fort Bragg, the largest military installation in the U.S.—47% of opioid prescriptions are abused, according to an April study by Castlight Health Inc., a health enterprise-software company. Yet the VA health system here has no residential addiction- treatment program, no inpatient opioid detoxification facility and only five doctors in a 21-county area able to dispense medications like buprenorphine, used to treat opioid- use disorder.
“The Fayetteville VA is one of the worst in the country,” says Justin Minyard, a retired Army first sergeant who has battled opioid addiction and testified before Congress about the issue. “There’s no help for veterans dealing with the addiction they now have.”
Elizabeth Goolsby, director of the Fayetteville VA Medical Center, says Mr. Deatherage’s “is not a typical story.” He should have been sent to the local hospital emergency room if the VA’s crisis mental health unit was full, she says.
The Fayetteville VA serves the fastest-growing veteran population in the nation, with 70,000 patients last year, up from 42,000 in 2010. It is moving quickly to meet demand, Ms. Goolsby says. It has added facilities and reduced wait times for primary care to four days, from 29 days in 2014, when an audit found the hospital had among the longest wait times of 700 VA facilities in the country.
The VA is working to increase treatment capacity nationwide and expand alternatives to the use of painkillers, such as acupuncture, says Carolyn Clancy, deputy undersecretary for health for organizational excellence at the Veterans Health Administration. The department also is aggressively addressing the supply of prescription opioids. Since 2012, the peak of opioid prescribing, the VA has reduced the number of its patients on long-term or high-dose painkillers by about a third.
“We owe it to the nation’s veterans to help them end their dependence on opioids,” said Veterans Affairs Secretary Robert McDonald in a September speech, “and break the downward spiral that all too often ends in homelessness, prison or suicide.”
More than a decade of war in Afghanistan and Iraq produced a flood of veterans with severe physical and mental conditions. Because of advances in battlefield armor and combat care, serious injuries now have 90% survival rates, compared with 40% in the Vietnam War, according to Rollin Gallagher, director of the national pain management program at the VHA. Yet many survivors are returning with permanent damage, such as amputations and spinal-cord injuries.
While many injured veterans required opioids, VA medical centers prescribed the drugs in too many cases, and often for months instead of days or weeks, department officials now say.
The VA’s Mr. McDonald said veterans are 10 times as likely as the average American to abuse opioids and that such abuse is the leading factor contributing to veteran homelessness.
Military communities are magnets for veterans seeking camaraderie. In Fayetteville, the metropolitan population of 349,000 people includes 77,000 soldiers and civilians working at Fort Bragg, 63,000 activeduty family members and 98,000 veterans and their family members. Units based here, including the 82nd Airborne Dioptions vision, have deployed repeatedly to the Middle East since 9/11, sending home a steady stream of severely injured soldiers.
Air Force veteran Ken Grady, 45, says the local VA prescribed him OxyContin, Percocet, Vicodin and fentanyl patches in the 2000s because of a series of surgeries for back injuries. “The VA made it so easy,” he says. “It was endless, and I abused it.”
When he couldn’t get prescriptions, Mr. Grady says he could easily obtain opioids on the street. He has been struggling to get clean, and has spent all but 65 days of the past 2-½ years in VA-funded treatment or in jail, as he is currently.
During one stay at the VA’s crisis mental health unit, a doctor in another section prescribed him Percocet for his chronic back pain, he says. “Please don’t give me that,” he says he told the doctor. Mr. Grady says he has sometimes bought drugs from veterans selling just-filled narcotic prescriptions outside VA facilities.
Last month, Mr. Grady had several teeth pulled by a VA contractor, who prescribed him Vicodin for the pain. Mr. Grady says he protested, but “you don’t have to twist my arm too much.” He relapsed, bought more pills on the street and landed back in jail. He hoped to be out by Christmas but his mother says it is taking longer than expected to find treatment and a place to stay.
Ms. Goolsby, director of the Fayetteville center, says VA facilities are sprawling public places, and it would be regrettable but not unheard of for veterans to sell pills on campus. She also says the VA has improved its record-keeping to better track prescriptions for veterans with substance-use disorder.
The VA system’s treatment are limited. The Fayetteville VA has an outpatient alcohol detox unit but no opioid detox unit. It refers veterans to other local facilities for detox, the initial period of up to about a week when an addict comes off drugs, endures withdrawal and is stabilized. The VA then refers them to its outpatient substance-abuse treatment program, the much longer process of overcoming addiction and underlying issues through therapy, group programs and medication. The outpatient program has 1,000 visits a month, and saw a total of 2,800 new patients from January to October of this year.
Addicted veterans can be referred to one of the VA’s 43 inpatient rehab centers around the country, which combined have 906 beds, according to a 2014 VA audit. Waits are usually longer than 30 days, though, which deters referrals, and beds often stay empty because of lack of staffing, the audit said.
The nearest inpatient VA facility to Fayetteville is in Salisbury, N.C., nearly three hours away.
Given the scarcity of VA services, addicted veterans often turn to public and private providers, which typically are also overwhelmed by demand. Cape Fear Valley Health System has a contract to provide mentalhealth services for the county, and has 16 detox beds, which stay full.
Users seeking methadone or other medication to treat their addiction mainly rely on a handful of private clinics. The largest is the Carolina Treatment Center, in an office park behind the hospital. The clinic dispenses medication to 600 patients each day, with lines forming before the clinic opens at 5 a.m.
Alan Shay Davis, a moonlighting obstetrician, started filling in as the medical director three years ago after a loved one became addicted to opioids. “I’ve been a part of the problem for some patients,” he says, by prescribing opioids in his obstetric practice. “Hopefully now I’m part of the solution.”
One of Dr. Davis’s patients at the clinic is Mr. Deatherage, who is taking Vivitrol, a longacting drug that attaches to receptors in the body and blocks the effects of opioids.
Shortly after enlisting in 2006, Mr. Deatherage was prescribed Percocet for a back injury from paratrooper training. He says he took pills during most of his deployment in Afghanistan in 2009 and 2010. His armored vehicle was bombed repeatedly while clearing roads in remote areas. He suffered back, neck, facial and shoulder injuries, and cracked his skull in an explosion that he later learned caused a traumatic brain injury.
“I got blown up seven times,” he says. “I would go see my medic, get bandaged, get Percs and get on with it.”
Back home, he was prescribed opioids for his injuries while stationed on the West Coast and in Hawaii. As his tolerance increased, he started buying pills from other soldiers. He lost his marriage, his savings and his job, and was medically discharged for substance use in February 2014.
“They threw me out there and said, ‘Take care of yourself,’ ” he says. “So I did.”
Mr. Deatherage says he sought substance-abuse treatment from the VA over the years, including the spring of 2014 when he says he was told there was a four-month wait for residential treatment. The VA continued to prescribe opioids for his injuries.
He overdosed six times, once at his mother’s house in Oklahoma. She has trained as an emergency medical technician and revived him. “That’s how my family found out,” he says. “They thought I was just depressed.”
His mother, Louise Johnson, 54, says her son had been fooling no one since he came home with a blank stare and a gallonsized Ziploc bag full of VA prescriptions.
Mr. Deatherage would call home during his 18 months in Afghanistan and tell her horror stories, like cleaning up after a bomb severed his buddy’s leg and fatally shooting a civilian whom he feared was carrying a bomb. “The things that he saw and the things that he did hurt him deep,” she says.
She says she was close to finding a VA facility for him to check into when he left town.
Mr. Deatherage says he bounced around Texas awhile before heading to his brother’s house west of Fayetteville in early 2015. By then he could no longer get pills from the VA because of tighter prescribing policies. He got kicked out of his brother’s house after stealing his nephew’s prescription cough syrup and replacing it with Robitussin. He started using heroin, which was cheap and plentiful.
Mr. Deatherage was arrested for theft and other charges, and spent stretches of the past two years homeless or in jail. He was referred earlier this year to one of two area veterans treatment courts, which allow low-level offenders to avoid prison by completing programs that address their underlying conditions.
In court this fall, Mr. Deatherage, looking thin and disheveled, told the judge he was sleeping in his car and spending half of his $3,000 monthly disability check on child support for his two sons, and the other half on heroin. Court staff arranged for him to start medication at Carolina Treatment Center, and to stay at a local halfway house that has a federal contract to serve up to 18 homeless veterans at a time.
There, he made friends with another veteran in the court program, Reggie Scott. In an interview in the fall, Mr. Scott said he was grateful for the VA’s help connecting him to treatment. “I’d be dead without them,” he said. But he still felt unmoored and prone to relapse.
In October, Mr. Deatherage and Mr. Scott used heroin together, and both went to jail under the terms of the court program.
Mr. Scott got out in October and kept using. He overdosed on heroin on Dec. 9 and went back to jail. He says he’s going to drop out of the veterans treatment program and serve his original sentence.
In court last week, Mr. Scott shuffled out of a holding cell in shackles to address other addicted veterans, his father and his mother, who was crying in the front row. “I want to give up. I’m done,” Mr. Scott said. “I don’t know if I’ll ever quit using drugs. But I do love y’all, I do.”
“Love you, Reggie!” several veterans said.
Mr. Deatherage was in the courtroom. He got out of jail in November and has been sober more than two months. He starts a 10-week training program in January to be a foreman at a natural-gas company.
He is optimistic that he will finally get clean. “I can’t worry about Reggie,” he says. “I’ve got to focus on me.”
In Fayetteville, 47% of opioid prescriptions are abused, according to an April study.
Robert Deatherage, a 30-year-old Army veteran who was injured in Afghanistan, stands outside a halfway house in Fayetteville, N.C.
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