Painkillers Might Not Be Right Prescription For Veterans
April 10, 2014 12:53 p.m.
Dr. James Michelsen, San Diego VA
Jack Lyon, Co-Founder, Veterans Village of San Diego
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MAUREEN CAVANAUGH: This is KPBS Midday Edition, I am Maureen Cavanaugh. Our top story on Midday Edition, the VA hospitals are dedicated to relieving suffering and helping veterans overcome the wounds of war, but one method used to treat this promises to become a problem of its own. The Veterans Administration is noticing the fact that addiction to painkillers is increasing among veterans; addictions that can lead to death. Doctors within the system say they are developing alternatives to prescription drugs to manage pain, but this is a challenge for both doctors and veterans struggling to deal with pain problems. I would like to welcome my guest Doctor James Mickelson, welcome to the program. And Jack Lyon is founder of Veterans Village in San Diego. Welcome to the program. Doctor Mickelson, the prescription drugs causing the most concern are opioids, what kinds of drugs are these and what are they prescribed for?
JAMES MICHELSEN: Opiate medications are short acting medicines such as methadone and OxyContin, Vicodin or Percocet. They are used to both treat acute and chronic pain, and the shorter acting medicines are the ones that patients are more likely to run into problems with.
MAUREEN CAVANAUGH: Last year the Center for investigative reporting studied what kinds of painkiller prescriptions were being written at the VA health systems, and so VA systems there are writing enough prescriptions being written to cover every patient that the system actually sees, how does San Diego compare with that?
JAMES MICHELSEN: The San Diego VA uses opiate painkillers for about 17% of our patients. Any prescription drug per year. We use a lot of opiate pain prescriptions and the number in San Diego is lower than in the national, but we still use a paramount of opiate pain pills. When we look at the 76,000 veterans that we have, 13,000 who have received opiate pain pills within a year.
MAUREEN CAVANAUGH: Another statistic recently found by the American Medical Association that veterans suffering from PTSD are more likely to be prescribed pain killers, why is that?
JAMES MICHELSEN: someone with PTSD is four times more likely to wind up on opiate painkillers and there are several reasons, posttraumatic stress disorder changes the way that pain is perceived. Someone with PTSD perceives more pain. They are more likely to not have success with other treatments. So it is a challenge when our America's heroes return with posttraumatic stress disorder and end up on opiate painkillers more often. Additionally someone with PTSD may not have only suffered mental consequences of war, but physical consequences as well.
MAUREEN CAVANAUGH: During an emotional testimony last year, the testimony about people who had abused painkillers that they received from the VA and one of the wives of the man who ultimately died because he was addicted to painkillers she said that the VA wants to keep patients ìdoped up and happy,î how do you respond to that?
JAMES MICHELSEN: I think the words ìwant to keep patients doped up and happyî is a little to the extreme, but over the last 10 to 15 years, pain experts not only at the VA but nationwide have really pushed for more opiate use. The initial thought is that opiates work really well for treating cancer pain, why are we not using them for more for noncancer pain? Because of that prescriptions have gone up 300%. The VA nationally is looking at the side effects of opiates which can include sedation and mental slowing. They realize that we need to scale back on opiates especially high-end doses. That can cause those problems.
MAUREEN CAVANAUGH: What kind of impact have painkillers had on the veterans like at Veterans Village?
JACK LYON: What happens sometimes is the kids do not go through the entire treatment program and will bounce off for one reason or another, and that can have a devastating impact on the body and that is important to recognize. This is not a moral issue, are you a good or bad person, are you strong or weak, we start down this path pretty soon, the medicine will take you, rather than you taking the medicine. That is the fear. What happens, if you bounce out of the system you will want the same sort of pain relief and from an economic point of view, heroine is a better answer. There you go. Occasionally the kids that we get into the Veterans Village are homeless and they have problems with drugs or alcohol, that is an impact that can come from this and I think the answer or part of the answer is education. Knowing that when you write the script or when you as the husband of the young lady and start taking this for a good medical reason you have to understand that sooner or later you're going to probably have to wean off of it and understand that the consequence of this can be very deleterious.
MAUREEN CAVANAUGH: How easy is it to get addicted to these kinds of painkillers and our veterans are informed enough to dangers of addiction?
JAMES MICHELSEN: There are two separate issues we're taking opiates one is addiction and what is tolerance. Tolerance is something that occurs when someone has been taking opiates for a while in the body gets used to them. That happens to most people that take higher doses and when you stop, you have withdrawal symptoms just like someone who drinks 6 cups of coffee a day will have withdrawal if they suddenly stop coffee. That happens to most people and as far as addiction, addiction is someone where someone is taking medication for reasons other than pain and that can happen oh happen to a lot of people but is more likely to happen to someone who has PTSD or traumatic brain injury.
MAUREEN CAVANAUGH: There is a new program that started at the San Diego Veterans Administration to reduce prescription painkillers and it is now being tried nationally. What does that consist of?
JAMES MICHELSEN: It's called the opiate safety initiative and it has nine parts. The first part is to educate providers, the pain community has been increasing opiates for years and now the new tinnitus chose to do this dangerous especially in the high-end and the fullback. The rest of the initiative is to collect data about our individual veterans and how many of them are high in high-dose therapy is and how many are mixing opiates with other prescriptions such as Valium, and then monitoring how we're doing it keeping track of the prescription use in ensuring that it is as safe as it can be such as measuring toxicity screens to make sure that you are not bring in other substances that bring you into a higher risk of overdose. Each VA is being asked to look at each patient and weigh risk and benefit.
MAUREEN CAVANAUGH: You are also trying to get people to find new ways of managing pain?
JAMES MICHELSEN: Absolutely. There are many studies over the last two years that show a bio-psychosocial model where we look at the whole individual more successfully for pain treatment rather than just prescribing a painkiller. You want to look at their mental health and coping skills and nutrition are extraordinarily important for pain. Getting exercise, it's more challenging to treat pain then prescribing medicine but it's a better way of fixing pain.
MAUREEN CAVANAUGH: We will have a story to address this issue on our home page, pain killers may not be the right prescription for veterans, there is more in that article than we could touch in this interview. I would like to thank my guests very much, James Michelson and Jack Lyon. Thank you very much, you've been listening to KPBS Midday Edition.