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Late one summer night in 2014, Kevin Keller broke into his best friend\u2019s home. Keller was a U.S. Navy vet wracked with constant pain, and because his right arm had been crippled by a stroke, he had to use his left hand to scrawl a note of apology to his buddy: \u201cMarty, Sorry I broke into your house and took your gun to end the pain! FU VA!!! Can\u2019t take it anymore.\u201d He then drove to his nearby Veterans Affairs outpatient clinic in Wytheville, Virginia, and pounded on the locked doors of the medical office, probably out of frustration or as a final protest, since the facility had been closed for hours. Keller then put the barrel of his friend\u2019s 9 mm pistol to his head and shot himself<\/a>.<\/p>\n

Grieving friends told The Roanoke Times<\/em> that Keller couldn\u2019t handle how the VA was weaning him off painkillers. His doctors had told him cutting back would extend his life, but Marty Austin, whose gun Keller stole that night, told the paper, \u201cHe did not want a longer life if he was going to be miserable and couldn\u2019t do anything because of the pain.\u201d<\/p>\n

Suicides<\/a> like Keller\u2019s and the widespread despair behind them are yet another tragic element of a national opioid crisis blamed for most of the 64,000 fatal drug overdoses<\/a> a year. Opioids, mostly illegally obtained<\/a> counterfeit pills and heroin, now account for 63 percent of all drug deaths in the U.S., with fatalities climbing at an astounding rate of nearly 20 percent a year. In fact, the estimated number of drug deaths in 2016 topped the total number<\/em> of soldiers killed in the Iraq and Vietnam wars<\/a>. There\u2019s a grim irony in that statistic, because the Department of Veterans Affairs has played a little-discussed role in fueling the opioid epidemic that is killing civilians and veterans alike. In 2011, veterans were twice as likely to die from accidental opioid overdoses as non-veterans. One reason, as an exhaustive Newsweek<\/em> investigation\u2014based on this reporter’s book, Mental Health, Inc.<\/em><\/a>\u2014found, is that for over a decade, the VA recklessly overprescribed<\/a> opiates and psychiatric medications. Since mid-2012, though, it has swung dangerously in the other direction, ordering a drastic cutback of opioids<\/a> for chronic pain patients, but it is bungling that program and again putting veterans at risk<\/a>. (It has also left untouched one of the riskiest classes of medications, antipsychotics\u2014prescribed overwhelmingly for uses that aren\u2019t approved by the Food and Drug Administration (FDA), such as with post-traumatic stress disorder.)<\/p>\n

A key role in spreading opiate use was played by Purdue Pharma, the OxyContin manufacturer convicted of hiding the drug’s addictive properties. It gave $200,000 to the VA pain management team that essentially turned the VA into its propaganda arm, according to secret corporate documents<\/a> obtained by Newsweek<\/em>. The team helped develop the initial VA\u2013Department of Defense guidelines that concluded opiates “rarely” cause addiction. A 2001 budget plan outlining Purdue\u2019s marketing schemes<\/a> hailed \u201cadditional corporate initiatives and partnering efforts [that] were very successful with the Veterans Administration\u201d and other major health organizations in promoting the phony campaign, \u201cPain: The 5th Vital Sign.\u201d<\/p>\n

Today, the number of patients affected by the VA\u2019s swinging opiate pendulum is staggering: 60 percent of veterans<\/a> who fought in the Middle East and 50 percent of older veterans have chronic pain. Since 2012, though, there has been a 56 percent drop<\/a> to a mere 53,000 chronic pain VA patients receiving opioids\u2014leading to swift, mandated cutoffs<\/a> regardless of patient well-being and with virtually no evidence<\/a> that it\u2019s a safe approach. For a taste of the kind of indifferent care vets with chronic pain are getting, consider Marine veteran Robert Rose<\/a>. He is now mostly confined to a wheelchair, suffering from severe spine, neck and knee injuries from his military service\u2014but until he was cut off from opioid pain medications last year (despite not abusing them), he didn\u2019t need a wheelchair and was able to play with his grandkids and build finely crafted woodworks. The primary care doctor at the Mountain Home, Tennessee, VA Medical Center told a hobbled, diabetic Rose and his wife during an office visit in May, \u201cYou should continue smoking, as it will help you with the stress and frustrations you are dealing with now. And you should continue to drink Mountain Dew, as the sugar molecules will attach to the pain receptors and block the pain you are experiencing without pain medications.\u201d<\/p>\n

Rose is ignoring that advice and raging against how he and other veterans are being treated\u2014and mistreated: \u201cI am going crazy<\/em> because of the pain and burning up with anger at the VA, the [Centers for Disease Control and Prevention] and [Drug Enforcement Administration (DEA)] for what they\u2019re doing to so many Americans and veterans.\u201d<\/p>\n

\u2018Don\u2019t Fix the Problems\u2019<\/h4>\nIn a ceremony in the East Room of the White House in late June, President Donald Trump signed a law making it easier for the Department of Veterans Affairs to remove bad employees<\/a> and protect whistleblowers. He was joined by his new Veterans Affairs secretary, Dr. David Shulkin, and Sergeant Michael Verado<\/a>, who lost his left arm and leg to an improvised explosive device in Afghanistan in 2010, but had to wait 57 days for a properly fitted prosthetic, and over three years for the VA to correctly equip his home with accessibility equipment<\/a>\u2014making him a living symbol of the agency\u2019s wait-time scandals.<\/p>\n
“In just a short time, we’ve already achieved transformative change at the VA\u2014and believe me, we’re just getting started,” the president declared. “For many years, the government failed to keep its promise to our veterans. Veterans were put on secret waitlists, given the wrong medication, given the bad treatments and ignored in moments of crisis for them. Many veterans died waiting for a simple doctor’s appointment. Yet some of the employees involved in those scandals remained on the payrolls\u2026. Today, we are finally changing those laws to help make sure that the scandal of what we suffered so recently never, ever happens again\u2014and that our veterans can get the care they so richly deserve.\u201d<\/p>\n
To some VA critics, Trump’s selection of Shulkin to head the agency makes it unlikely that significant changes will be made. \u201cFor veterans who voted for Donald Trump, this is going to feel like a bait and switch,\u201d says Benjamin Krause, founder of DisabledVeterans.org<\/a>. \u201cKeeping Shulkin will keep a host of flunkies and criminals who should have been part of the whole \u2018drain the swamp\u2019 promise.\u201d (His own reputation as an ethically pure reformer was undercut by The Washington Post<\/em><\/a> report \u00a0in late September that he billed the government for his wife\u2019s travel during a 10-day business jaunt that also included side-trips to the Wimbledon finals and a \u00a0visit to Copenhagen\u2019s \u201cLittle Mermaid\u201d statue; these \u00a0expenses were somehow approved by the VA\u2019s ethics team<\/a> but \u00a0are now under investigation<\/a> by the department\u2019s Inspector General.)<\/p>\n
The fetid VA swamp has been spreading for years under the last three VA secretaries, including Shulkin. It\u2019s an institution long notorious for vicious retaliation<\/a> against whistleblowers and a penchant for falsehoods, obfuscation and delay, as well as rampant cover-ups of unsafe and sometimes deadly conditions\u2014or even fraud<\/a>\u2014by the VA’s watchdog agencies. This is all kept from view by what some longtime employees call \u201cthe code\u201d\u2014the institutional silence and protection offered wrongdoers. Likening it to the mob\u2019s \u201comert\u00e0<\/em>,\u201d one high-ranking VA administrator, who insisted on anonymity, tells Newsweek<\/em>, \u201cYou don\u2019t break \u2018the code,\u2019 or your career is over\u2026. It\u2019s a fearful environment.<\/p>\n
\u201cThe code,\u201d that VA official says, \u201cis designed to do this: don\u2019t fix the problems.\u201d<\/p>\n
$\"FE_Opioids_07\"$ <\/picture><\/span> A pile of not all of the prescription medications Marine Corps veteran Jason “Jake” Simcakoski who died in the Tomah VA psychiatric center was on at time of death Saturday Janurary, 3, 2015 in Stevens Point Wi. <\/span> Darren Hauck <\/span> <\/span><\/span><\/p>\n
Shulkin\u2019s media office declined repeated requests for an interview with the VA secretary by this reporter to discuss the rampant problems at the VA, but he has made some progress in cleaning up the department\u2014while demonstrating a shrewd feel for public relations<\/a>. The Boston Globe<\/em> reported in mid-July that the highly rated (by the VA) Manchester, New Hampshire, VA hospital had to close an operating room because exterminators couldn’t get rid of flies<\/a>, and thousands of patients couldn’t make appointments for vital, sometimes life-saving, treatments because of a breakdown in scheduling specialized care outside the VA. Whistleblowers had been complaining about this for years, to no avail, but a few hours after the Globe<\/em> story broke, Shulkin removed the two top administrators<\/a>.<\/p>\n
But even this response was more symbolic than substantive. Many other shocking abuses have been ignored by Shulkin and his predecessors. In 2016, 34 whistleblowers turned to the Scripps News Washington Bureau and its Cincinnati TV affiliate, WCPO, to report such problems as surgeons allegedly being pressured to use blood- and bone-splattered instruments<\/a> as “sterilized” by the Cincinnati VA hospital’s then\u2013acting chief of staff, Dr. Barbara Temeck. Those complaints were backed by hundreds of dangerous incidents chronicled in internal documents given to Scripps. (Temeck has denied the allegations, although she was demoted after Scripps reported that she improperly prescribed opiates to the wife of her regional supervisor.) The VA\u2019s investigators didn\u2019t interview any of the whistleblowers quoted in the press and concluded that there were no safety problems at that VA Medical Center, a position Shulkin\u2019s VA still holds.<\/p>\n
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All told, nearly 2,000 VA whistleblowers were forced in fiscal year 2016 alone to appeal to an independent federal agency, the Office of Special Counsel (OSC), to protest retaliation while reporting fraud or unsafe conditions\u2014more than the next four problematic federal departments combined. As The Boston Globe<\/em> reported<\/a> in September, these employee complaints included nursing home residents at the Bedford, Massachusetts, Veterans Affairs Medical Center allegedly being starved of food for hours or left to lie naked in bed amid the squalor of soiled sheets.<\/p>\n
Shulkin has established a new office given a mandate to protect whistleblowers, but that hasn\u2019t yet halted the retaliation. \u201cI don’t know of a single instance when a VA employee has been held accountable for harassing whistleblowers,” says Krause.<\/p>\n
This turf-protecting has perhaps been most apparent in the VA’s belated response to the national opiate crisis it helped usher in. The VA doesn’t even keep an accurate count of how many veterans have died of legal or illegal drug overdoses, even though it officially launched an Opioid Safety Initiative in 2013 that has brought the VA’s opiate prescribing down 30 percent<\/a>. Nor does it regularly monitor opiate use by its patients who seek legal or illegal drugs outside the VA.<\/p>\n
The VA’s overmedication epidemic, which wasn’t on the list of reform priorities<\/a> Shulkin released in May, has become especially urgent because of its apparent link to the 20 suicides a day of veterans in the U.S.<\/p>\n
Even those earlier VA figures may be a gross understatement. When the VA released in September state-by-state data<\/a>, it showed, for example, that Arizona had a suicide rate as high as 53.6 per 100,000 across all age groups, nearly 40 percent higher<\/a> than what the VA was reporting nationally<\/a>. These troubling suicide rates\u2014at least double the civilian rate\u2014haven\u2019t been stemmed by all the VA\u2019s suicide-prevention efforts<\/a> (including the slowly improving crisis line, 1-800-723-8255). For Arizona veterans between 18 and 34, the suicide rate was an astonishing 76.8 per 100,000, twice as high as the national rate for all veterans. The average suicide rates were especially high in some rural areas<\/a> across the country, the new VA report said.<\/p>\n
Even if the VA has done relatively little to reform prescribing, it\u2019s becoming more evident that medications play some role in all these tragedies. For instance, a 2016 study<\/a> by researchers at the South Texas Veterans Healthcare System found a nearly 400 percent increase in overdoses and suicidal behavior by Iraq and Afghanistan war veterans given too many psychotropic and opiate medications, a practice known as \u201cpolypharmacy\u201d\u2014receiving five or more drugs affecting the central nervous system. Another recent study of veterans\u2019 suicides between 2004 and 2009 found that the suicide rate was twice as high<\/a> for those patients receiving the highest doses of opioids compared to low doses, although no causal link was established for the meds.<\/p>\n
This drug free-for-all has gotten so bad that Republican Senator John McCain of Arizona reintroduced a bill called the Veterans Overmedication Prevention Act<\/a>. It demands that the VA commission an independent study to analyze all the suicides and accidental overdoses of veterans who have died in the last five years, and itemize all medications they received. McCain said in May that the ultimate goal is to “ensure doctors develop safe and effective treatment plans for their veteran patients.” Given the reality of today\u2019s VA and its past failures, that worthy goal seems unlikely to be achieved anytime soon.<\/p>\n
The VA hasn\u2019t fully acknowledged its role in the alarming opiate addiction rates among veterans. A 2012 JAMA <\/em>(formerly the Journal of the American Medical Association<\/em>) study showed that veterans with mental health disorders and PTSD were three times<\/a> more likely to receive opioids for pain diagnoses than other veterans. \u201cThey are essentially prescribing heroin pills; the effects of these opiates are indistinguishable from heroin, and the VA jumped on this campaign to encourage highly addictive prescribing,\u201d says Dr. Andrew Kolodny, co-director of Brandeis University\u2019s Opioid Policy Research Collaborative. In Huntington, West Virginia, a city<\/a> so gripped by addiction that 28 people overdosed from heroin in a four-hour period last year, the local VA prescribes take-home opiates to roughly 18 percent<\/a> of its patients\u2014a rate that\u2019s about 230 percent higher than the national average for all adult male patients. When told about this figure, Kolodny said, after a shocked pause, \u201cWow! That\u2019s very problematic.\u201d He then added, \u201cThese are iatrogenic\u2014medically caused\u2014addictions by the VA. The chickens are coming home to roost.\u201d<\/p>\n
$\"FE_Opioids_03\"$ <\/picture><\/span> Kevin Keller, 52, of Bland County, left a suicide note on Marty Austin’s couch before he took his own life on July 25. The note read “MARTY SORRY I BROKE INTO YOUR HOUSE AND TOOK YOUR GUN TO END THE PAIN! FU VA!! CAN’T TAKE IT ANYMORE,” and sat with a bag of items Keller had brought along with it. “Unbelievable thoughts went through my mind [when I saw that note],” said Austin, 47, of Bland County. Austin said Keller was his best friend of over 25 years. Outside of a Veterans Affairs outpatient clinic in Wytheville, which he had visited many times before, Keller used Austin’s 9-mm handgun to shoot himself in the head. Austin said Keller told him repeatedly that he was unsatisfied with the care he received at the Veterans Affairs clinic. “He knew it was too late to help him,” Austin said, “but maybe it isn’t too late to help somebody else.” <\/span> Rebecca Barnett Stone\/The Roanoke Times <\/span> <\/span><\/span><\/p>\n
In West Virginia and most other states, the VA worsened the nation\u2019s opioid crisis by essentially ignoring it\u2014the VA didn\u2019t even start<\/em> reporting all patients getting opiates to state databases until the end of 2015, a delay that allowed those patients to do more doctor-shopping and drug-dealing to and with civilians. VA pharmacies were finally compelled to share prescribing records by a federal opioid abuse law passed in July 2016, but by the end of last year, 18 state VA programs still weren\u2019t reporting.<\/p>\n
In May 2016, the board chairman of the American Academy of Family Physicians wrote a letter to Shulkin, then head of the VA\u2019s health agency, the Veterans Health Administration, pleading for the department to impose mandatory opiate reporting on all VA programs. Speaking more than a year later, the AAFP\u2019s president, Dr. John Meigs, tells Newsweek<\/em> his organization has still not heard back from Shulkin or anyone else at the VA. \u201cPrescription drug\u2013monitoring programs are among the important vehicles for preventing patients from abusing opioid medications and, as such, are a cornerstone of the American Academy of Family Physicians’ advocacy on dealing with this epidemic,\u201d he declares.<\/p>\n
The disaster is likely to worsen<\/a> under the Trump administration because of its assaults<\/a> on Medicaid<\/a> and Obamacare<\/a>; this affects veterans as well, since fewer than half<\/a> of the nation\u2019s 22 million veterans receive their care from the VA. (In late August, the administration left no doubt it wanted to destroy the Obamacare marketplaces by announcing it would cut by 90 percent<\/a> the advertising needed to promote enrollment and slash funds by 40 percent for helpful \u201cnavigators\u201d to help people sign up for the program.) Nearly as troubling, the looming denial of care is aggravated by the suicides, overdoses and illegal use of opioids that are all compounded by draconian<\/a> new federal pain medication restrictions on chronic pain patients. So when New Jersey Governor Chris Christie\u2019s federal opioid commission released its initial report<\/a> at the end of July calling for swift federal action, his home state newspaper, the Newark Star-Ledger<\/em>, pointed to the “elephant in the room.\u2026 The obvious fact that Donald Trump\u2019s team is striving as hard as it can to gut Medicaid<\/a> and make it even more difficult to get treatment.\u201d (Trump referred to the opioid crisis as a \u201cnational emergency\u201d on August 10, but the federal government hasn\u2019t yet taken the steps needed to invoke emergency powers<\/a> that could allow for more spending or loosen bureaucratic restrictions on providing medication-assisted addiction treatment, such as Suboxone<\/a>, which cuts overdose fatalities<\/a>.)<\/p>\n
\u2018What if He Were Your Son?\u2019<\/h4>\n
In 2013, after the Center for Investigative Reporting (CIR) exposed skyrocketing rates of opiate prescribing<\/a> by the VA, some of its physicians told a House veterans subcommittee they were pressured to prescribe the addictive painkillers\u2014even to patients they hadn’t examined. Dr. Pamela Gray, a primary care physician fired from the Hampton, Virginia, VA hospital, said, “There are multiple instances when I have been coerced or even ordered to write for Schedule 2 narcotics when it was against my medical judgment.” VA officials deny there were any systemic problems in their prescribing practices, yet in May 2014, the VA inspector general found that clinicians were ignoring<\/a> guidelines for safe take-home opiate prescribing, with one out of 10 chronic pain opioid users also receiving benzodiazepines in the course of a year\u2014and 92 percent got them at the same time. This is a flagrantly dangerous<\/a> mixture that the federal government flagged as a lethal combination<\/a>\u2014while the FDA has recently added new warnings that it could cause “respiratory depression, coma and death.”<\/a><\/p>\n
And that\u2019s what happened to Marine Corps veteran Jason Simcakoski, who was taking 16 different VA-prescribed opiates, benzodiazepines, an antipsychotic and other sedating drugs before he died. By the time he checked himself into the Tomah, Wisconsin, VA’s inpatient psychiatric unit in the summer of 2014 for help with anxiety and a pill addiction, VA leadership had known for years that there were deadly overprescribing problems there. But they didn’t begin to address the crisis until the CIR broke this story<\/a> in January 2015: “Opiates handed out like candy to \u2018doped-up\u2019 veterans at Wisconsin VA,” leading to the deaths of over 30 veterans<\/a>. The story laid out how opiate prescribing had quintupled since Dr. Michael Houlihan\u2014nicknamed by vets \u201cthe Candy Man\u201d\u2014became chief of staff in 2005, while the number of patients served dropped. Nationwide, opiate prescribing increased 270 percent across the VA system since 9\/11, CIR discovered<\/a>, while the patient load had increased less than 40 percent by 2013. The latest guidelines<\/a> at the time for sensible opiate prescribing were routinely ignored at Tomah and many other VA facilities, and Houlihan’s reckless prescribing was exacerbated by his penchant for terrorizing any clinician and staffer who opposed him. This was especially notable in his firing of a psychologist who had objected to the excessive doping of patients, then faced relentless harassment<\/a> from his supervisor\u2014and later killed himself<\/a> after he lost his job.<\/p>\n
Noelle Johnson, a Veterans Affairs pharmacist fired from Tomah after she refused to fill high-dosage opiate prescriptions, notes that the VA’s archaic software didn’t flag any dosage or interaction warnings for the 1,080 morphine pills in 30 days she was pressured to prescribe a patient with “psychological pain.” She says, \u201cMy bosses tried to strong-arm pharmacists.\u201d She adds that she got the same kind of pressure at her new post with the Des Moines, Iowa, VA.<\/p>\n
Although it was obvious that Jason Simcakoski was an addict, the VA kept shipping him bagfuls of opiates and benzos and antipsychotics, and he was also dosed with the stimulants Adderall and Ritalin, which worsened his mood, behavior and insomnia. His doctors prescribed those for a questionable diagnosis of attention deficit hyperactivity disorder, just one of at least a dozen or so diagnoses slapped on him over the years, along with bipolar personality disorder and PTSD.<\/p>\n
\u201cWith all these medications, he went downhill real fast,\u201d says Jason\u2019s father, Marvin Simcakoski. His weight ballooned from 180 to 250 pounds, and he was too ashamed to go into a restaurant on those rare days he went into town\u2014he\u2019d only order food from drive-thru windows. Near the end, he couldn\u2019t even bend down to tie his shoes.<\/p>\n
When Jason died in August 2014 of what the local medical examiner called \u201cmixed drug toxicity,\u201d he had just been obeying his doctors\u2019 orders: He was already taking 14 different medications, including high-risk opiates, benzodiazepine tranquilizers and the sedating antipsychotic Seroquel. Yet just two days before his death, Jason was also given Suboxone, an opiate typically used to reduce dependence on other narcotics. This was soon followed by a powerful migraine medication, Fioricet, that posed a risk of respiratory failure or death<\/a> when combined with Suboxone and several<\/a> of his other drugs. He was ingesting this drug cornucopia despite the well-known dangers of potentially fatal interactions between Suboxone and all three benzodiazepines he was taking\u2014Valium, Restoril and Serax\u2014and with some of his other high-risk medications.<\/p>\n
$\"FE_Opioids_04\"$ <\/picture><\/span> Marv and Linda Simcakoski’s parents of Marine Corps veteran Jason “Jake” Simcakoski who died in the Tomah VA psychiatric center stand for a portrait at their home Saturday Janurary, 3, 2015 in Stevens Point Wi. <\/span> Darren Hauck <\/span> <\/span><\/span><\/p>\n
Marvin Simcakoski told a joint congressional field hearing<\/a> on the Tomah scandal in March 2015 that he\u2019d spent years trying to save his son, but says his fears were dismissed by VA doctors as ignorant second-guessing. \u201cI was always told that I wasn\u2019t their patient, even though I was his dad, who truly cared about him a lot more than they did!\u201d His voice quaking with an anger, he added, \u201cWhat I would like to know is, if Jason was their son, would they have had him on all of these meds?\u201d<\/p>\n
After that congressional hearing, the VA announced it was conducting a criminal investigation; that probe and other investigations led to a few Tomah medical officials getting vilified in the press, and eventually facing employment sanctions. Houlihan was fired more than a year after Jason died, but he was practicing medicine until January 2017, when he agreed to surrender his license as part of a deal with state regulators to drop their investigation of him.<\/p>\n
Jason\u2019s father and widow took their campaign against the VA\u2019s medication practices to D.C. They worked with Democratic Senator Tammy Baldwin of Wisconsin on legislation to curb and monitor opiate overprescribing, and appeared at a news conference<\/a> in June 2015. The Jason Simcakoski Memorial Opioid Safety Act was signed into law<\/a> in July 2016.<\/p>\n
Heather hopes the bill will save lives, but she and other VA critics know there are critical weaknesses in the new plan to rein in overmedication: weak oversight of staff, worsened by the VA\u2019s electronic records and drug-interaction alerts that too often fail to work, and on-screen drug warnings that are widely ignored. In 2015, the VA paid over $1 million to the widow<\/a> of former paratrooper Ricky Green, who died after getting his opiates and tranquilizer dosages cranked way up after back surgery. The VA pharmacists admitted under oath that their software hadn\u2019t flagged either the higher dosages or that Green had a sleep apnea condition that fatally interacts with those drugs.<\/p>\n
The VA\u2019s entire make-shift<\/a> health software system\u2014known as VistA\u2014is so bad Shulkin announced in June that the VA was purchasing a brand-new commercial system<\/a> at an estimated cost of $16 billion<\/a>; it\u2019s based on one recently bought<\/a> by the Defense Department so that, in part, as their electronic health records are rolled out<\/a> they could be shared seamlessly, but that won\u2019t necessarily fix the problems with the VA\u2019s pharmacy software. Even more troubling, Chris Miller<\/a>, the department\u2019s executive in charge of modernizing the Pentagon\u2019s software using the same contractor as the one hired by the VA was then sent over to advise the VA, but he fled, appalled over mismanagement, within weeks of his appointment in early June<\/a>. \u201cThe people problems are not resolved and the user problems are not resolved just because you have a new tool coming on board,\u201d a VA official says. \u201cThe people problems are at the core of the demise of the VA.\u201d<\/p>\n
That\u2019s one reason no one knows how many vets have been killed by accidental prescription overdoses in the past decade, although a handful of rigorous studies suggest the death toll is in the thousands. One of the very few scholarly reports on accidental overdose deaths of veterans, done by University of Michigan and VA researcher Amy Bohnert in 2011, used 2005 data to conclude that 1,013 patients receiving VA services died annually through unintentional overdoses, mostly from prescription medications. At that time, legal opioids, present in nearly a third of the accidental overdose deaths, were the most common substances involved, while non-narcotic psychiatric drugs and sedatives were involved in 22 percent of the deaths she studied. (Across all civilian and military populations, legitimately manufactured opioid medications account now for only 15 percent<\/em><\/a> of opioid fatalities.) When the Austin-American Statesman<\/em><\/a> looked at Texas records in 2012, nearly 20 percent of all deaths of veterans getting VA benefits they studied were due to mostly accidental overdoses of prescription drugs\u2014not from suicides.<\/p>\n
Despite the Tomah and other tragedies, veterans continued to die from overdoses in VA hospitals and residential treatment facilities, sometimes abetted by drug-peddling employees\u2014while the agency failed to accurately track the drug-related deaths of veterans. The Lowell Sun<\/em> reported last year that two veterans grappling with addictions who lived in VA residential facilities in Massachusetts died of opiate overdoses<\/a> within weeks of each other. Their deaths are now the focus of a VA criminal investigation into drug dealing by a ring of employees and patients at the hospital. Administrators initially denied anything was amiss, and the African-American whistleblower who helped expose the alleged drug ring revealed in February that he had been demoted, and harassed<\/a> by colleagues\u2014including finding on his desk a teddy bear with a noose around its neck and the sign, “Go home or die.\u201d<\/p>\n
Lethal Cutbacks<\/h4>\n
Following the Tomah overprescribing scandal, the VA said it would follow tougher new DEA guidelines on opiate prescribing that, some advocates say, harm patients with legitimate pain issues. That\u2019s in part because those patients are now required to see their doctors in person once a month for refills\u2014a near-impossible task because of the backlog and delays throughout the VA system. Equally troubling, the crackdown<\/a> on opiate prescribing\u2014a swing from one dangerous extreme to another\u2014may be contributing to an increase in heroin and illegal opiate medication use among veterans<\/a>, as well as suicides from pain-wracked veterans going through poorly monitored withdrawal<\/a>. (Even with new opioid guidelines, the number of veterans with opioid-use disorders increased 55 percent from 2010 to 2015.)<\/p>\n
Although the VA boasts that those tougher guidelines have led to a decline of nearly a third in opiate prescribing, it doesn’t track veterans who have turned to heroin and illegal prescriptions as a result of the cutbacks\u2014or notice the devastation this crackdown is causing. It has become increasingly clear that too many VA doctors are focusing on taking patients off opioids without offering appropriate addiction counseling or addressing how they\u2019re needlessly hurting all the chronic pain patients they\u2019re taking off these meds. \u201cThey\u2019re not focusing on patient-centered care; they\u2019re focusing on numbers,\u201d one VA staffer says. At one point, this employee says, a doctor in a major VA medical center was spotted crying in the hallway because he was obligated by administrative fiat to kick a chronic pain patient off opioids in a way that he knew would hurt his patient.<\/p>\n
$\"FE_Opioids_08\"$ <\/picture><\/span> Secretary of Veterans Affairs David Shulkin looks on during the White House press briefing in Washington, DC, May 31, 2017. <\/span> Jim Watson\/AFP\/Getty Images <\/span> <\/span><\/span><\/p>\n
Even when patients realize they\u2019re endangering themselves, the VA\u2019s clinicians too often don\u2019t offer much meaningful help. Take Mallory Dinkel, an Air Force infantry soldier who had her leg and hips severely damaged in an attack on her Humvee in Kuwait in 2004, but returned for multiple combat tours in Iraq before being medically discharged in 2013. Grappling with PTSD and a poorly understood form of chronic pain, complex regional pain syndrome<\/a>, she stepped up her rotating use of prescription morphine, Percocet and other drugs until she was forced in January 2016 to quickly unwind all opioids. \u201cIt was awful: I was constantly vomiting, sweating, having migraines and getting the shakes,\u201d she says, unable to move from her couch for two weeks except to crawl to the bathroom. \u201cNothing was mentioned about addiction, and I didn\u2019t get treatment.\u201d All she got before going cold turkey on her own\u2014despite the risks of sudden withdrawal without medically supervised tapering<\/a>\u2014were two one-hour classes on the dangers of opiates and how to inject herself with naloxone<\/a> to prevent overdoses. \u201cThe VA didn\u2019t do a thing,\u201d she says, turning to costly, unproven ketamine infusion treatment<\/a> for depression and pain relief through a family friend\u2019s center that she can no longer afford. \u201cI\u2019m battling on my own now.\u201d<\/p>\n
Can\u2019t Stop, Won\u2019t Stop<\/h4>\n
The callous indifference of both the VA and Congress to the overmedication crisis has only recently started to change, and that\u2019s just for opiates, not antipsychotics. What has gotten worse in the last decade is the VA\u2019s determination to hide the truth. The Senate governmental affairs committee\u2019s Republican majority, for instance, concluded in May 2016 about the Tomah VA Medical Center debacle: \u201cThe overprescription, retaliation, veterans\u2019 deaths, and abuse of authority at the Tomah VAMC did not occur in a vacuum.\u00a0Veterans, employees, and whistleblowers tried for years to get someone to address the problems.\u00a0The Tomah VAMC is a microcosm of both the VA\u2019s cultural problems with respect to whistleblower retaliation and the VA Office of Inspector General\u2019s disregard for whistleblowers.”<\/p>\n
These whistleblowers are notably skeptical about the various reform and accountability gestures such as public waiting lists<\/a> offered by Shulkin. Take Shea Wilkes, then a mental health administrator at the Shreveport, Louisiana, VA hospital who was busted back down to social worker after, in 2014, he exposed 37 wait-time deaths among those people on a secret mental health waiting list of 2,700 patients. While noting that the VA has now seemingly been able to provide some same-day crisis mental health services, as promised, he says that all too often patients can\u2019t get prompt, regular counseling: \u201cThe one thing the VA is very good at is throwing pills at the problem.\u201d<\/p>\n
In VA hospitals all over the country, dissidents such as Brandon Coleman are still punished for trying to save lives or fight fraud. He is a bearded, blunt-talking addiction therapist formerly with the Phoenix VA and a disabled Marine Corps veteran who severely shattered the bones of his left foot during a training accident at Camp Pendleton that led to nine failed surgeries, and he felt he had to file a formal federal whistleblower complaint in December 2014 over the maltreatment of veterans at that notorious VA hospital. With his past as a meth addict who came close to shooting himself in 2005, he was alarmed that the understaffed ER was allowing suicidal or homicidal patients in crisis\u2014often brought over by addiction counselors\u2014to simply wander off. One patient killed himself in the parking lot after being ignored by the staff.<\/p>\n
\u201cIt crushes me when a veteran successfully commits suicide,\u201d he says\u2014and since 2011, at least six of the addicts he counseled killed themselves before he was pushed out of his job early in 2015. \u201cThere are dozens and dozens who commit suicide in the Phoenix area each year,\u201d Coleman says. After going public with his concerns in January 2015, a specialized yearlong outpatient program he ran in the evenings for addicted veterans with criminal convictions was shut down by Phoenix VA administrators, he was forced to take administrative leave, and he was investigated for purportedly threatening a colleague.<\/p>\n
$\"FE_Opioids_10\"$ <\/picture><\/span> Marine Corps veteran Brandon Coleman with his children, all Marines, Brandon Coleman Jr., Breanna Coleman, and Trace Coleman, on Christmas Day in 2016. Coleman, a whistleblower at the Phoenix VA hospital who faced retaliation from managers in 2015, was assigned this week to the VA Office of Accountability and Whistleblower Protection. <\/span> Courtesy of Rebekah Coleman <\/span> <\/span><\/span><\/p>\n
In May 2016, the independent OSC sided with Coleman. It gave him a generous financial settlement that allowed him to pay off all his debts and help his kids buy a home and cars. He was reinstated as an addiction specialist at an outpatient clinic unaffiliated with the Phoenix system, and he was able to restart his life-changing program for addicted vets. During more than a year of forced leave, he became an informal leader of the nation\u2019s countless VA whistleblowers. He sums up his travails this way: \u201cI kicked the VA in the nuts, and I won my case.\u201d Today, he rides around in a prized new classic car, a blue 1968 Mustang, with a license plate that reads, \u201cTHX VA.\u201d<\/p>\n
Coleman may now be in a position to stop the abuse of whistleblowers\u2014he\u2019s a staff member<\/a> of the new VA whistleblower protection office. While his appointment is perhaps the most positive indicator yet that the VA might try to reform, that\u2019s a heavy burden to place on his broad shoulders. He\u2019s gotten well over 50 calls and emails from desperate staffers turning to him for help since his appointment was announced.<\/p>\n
For example, one new test case Coleman and his colleagues are reviewing involves an MIT-trained Tomah VA engineer, Jae Pak<\/a>, who was fired after trying to halt an allegedly shoddy, unsafe series of delayed hospital repair projects\u2014by a company friendly with administrators\u2014that were way over budget. He faced a spurious disorderly conduct charge (the case was dismissed). Equally troubling, critics say, he was forced out under the watch of a new Tomah hospital director, Victoria Brahm<\/a>, and a new regional VA chief, Renee Oshinski<\/a>, who both, while at regional headquarters, allegedly downplayed for nearly a decade the deadly prescribing and retaliation campaign led by Houlihan, Senate investigators<\/a> found; the officials claimed they responded appropriately.<\/p>\n
One added weapon for reform could be a new bill moving slowly through Congress<\/a> designed to quickly discipline or remove administrators who harass whistleblowers. It is named after Christopher Kirkpatrick<\/a>, the psychologist who killed himself after being driven out of his job at Tomah for protesting deadly prescribing.<\/p>\n
For now, patients at VA sites such as the Phoenix and St. Louis hospitals (where the chief of psychiatry, Dr. Jose Mathews, was forced out in 2013 after reporting that suicidal patients were ignored by staff) continue to see honest, dedicated clinicians and other employees get punished.<\/p>\n
What Coleman will do about such alleged retaliation and cover-ups remains to be seen. With a quick search on Google News, it seems there\u2019s a new retaliation or health scandal reported every few days<\/a>, although most never get much media attention. So even before Coleman\u2019s appointment was publicly announced, he told Newsweek<\/em>: \u201cI still get two to four calls a week from VA whistleblowers I have never met who are crying, scared and losing their careers all for merely telling the truth. It has not stopped<\/a> because the VA has never been made to stop.\u201d<\/p>\n
$\"171020_COV\"$ <\/picture><\/span> Photograph by Levi Brown <\/span> <\/span><\/span><\/p>\n
Adapted from the new book <\/em>Mental Health, Inc.: How Corruption, Lax Oversight, and Failed Reforms Endanger Our Most Vulnerable Citizens<\/a>, by Art Levine. Copyright \u00a9 by Art Levine, 2017. Published by The Overlook Press, Peter Mayer Publishers, Inc., OverlookpPress.com<\/a>. All rights reserved.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"
How the VA Fueled the National Opioid Crisis and Is Killing Thousands of Veterans By Art Levine On 10\/12\/17 at 3:30 AM Late one summer night in 2014, Kevin Keller broke into his best friend\u2019s home. Keller was a U.S. Navy vet wracked with constant pain, and because his right arm had been crippled by […]<\/p>\n","protected":false},"author":1,"featured_media":551,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[1,9,13,15,14,10],"tags":[],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/love.scottbruno.com\/wp-content\/uploads\/2017\/12\/VA-Fuel-opioids.jpg?fit=854%2C570","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p3nDlG-9c","jetpack-related-posts":[],"jetpack_likes_enabled":true,"_links":{"self":[{"href":"http:\/\/love.scottbruno.com\/wp-json\/wp\/v2\/posts\/570"}],"collection":[{"href":"http:\/\/love.scottbruno.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/love.scottbruno.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/love.scottbruno.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/love.scottbruno.com\/wp-json\/wp\/v2\/comments?post=570"}],"version-history":[{"count":1,"href":"http:\/\/love.scottbruno.com\/wp-json\/wp\/v2\/posts\/570\/revisions"}],"predecessor-version":[{"id":571,"href":"http:\/\/love.scottbruno.com\/wp-json\/wp\/v2\/posts\/570\/revisions\/571"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/love.scottbruno.com\/wp-json\/wp\/v2\/media\/551"}],"wp:attachment":[{"href":"http:\/\/love.scottbruno.com\/wp-json\/wp\/v2\/media?parent=570"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/love.scottbruno.com\/wp-json\/wp\/v2\/categories?post=570"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/love.scottbruno.com\/wp-json\/wp\/v2\/tags?post=570"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}