HOW THE VA FUELED THE NATIONAL OPIOID CRISIS AND IS KILLING THOUSANDS OF VETERANS

Excerpts republished from Newsweek - 10/12/17 

Late one summer night in 2014, Kevin Keller broke into his best friend’s 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: “Marty, Sorry I broke into your house and took your gun to end the pain! FU VA!!! Can’t take it anymore.” 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’s 9 mm pistol to his head and shot himself.

Suicides like Keller’s 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 year. Opioids, mostly illegally obtained 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 of soldiers killed in the Iraq and Vietnam wars. There’s 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 investigation—based on this reporter's book, Mental Health, Inc.—found, is that for over a decade, the VA recklessly overprescribed opiates and psychiatric medications. Since mid-2012, though, it has swung dangerously in the other direction, ordering a drastic cutback of opioids for chronic pain patients, but it is bungling that program and again putting veterans at risk. (It has also left untouched one of the riskiest classes of medications, antipsychotics—prescribed overwhelmingly for uses that aren’t approved by the Food and Drug Administration (FDA), such as with post-traumatic stress disorder.)

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 obtained by Newsweek. The team helped develop the initial VA–Department of Defense guidelines that concluded opiates "rarely" cause addiction. A 2001 budget plan outlining Purdue’s marketing schemes hailed “additional corporate initiatives and partnering efforts [that] were very successful with the Veterans Administration” and other major health organizations in promoting the phony campaign, “Pain: The 5th Vital Sign.”

Today, the number of patients affected by the VA’s swinging opiate pendulum is staggering: 60 percent of veterans who fought in the Middle East and 50 percent of older veterans have chronic pain. Since 2012, though, there has been a 56 percent dropto a mere 53,000 chronic pain VA patients receiving opioids—leading to swift, mandated cutoffs regardless of patient well-being and with virtually no evidence that it’s a safe approach. For a taste of the kind of indifferent care vets with chronic pain are getting, consider Marine veteran Robert Rose. He is now mostly confined to a wheelchair, suffering from severe spine, neck and knee injuries from his military service—but until he was cut off from opioid pain medications last year (despite not abusing them), he didn’t 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, “You 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.”

Rose is ignoring that advice and raging against how he and other veterans are being treated—and mistreated: “I am going crazy 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’re doing to so many Americans and veterans.”

‘Don’t Fix the Problems’

In 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 and protect whistleblowers. He was joined by his new Veterans Affairs secretary, Dr. David Shulkin, and Sergeant Michael Verado, 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—making him a living symbol of the agency’s wait-time scandals.

"In just a short time, we've already achieved transformative change at the VA—and 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…. Today, we are finally changing those laws to help make sure that the scandal of what we suffered so recently never, ever happens again—and that our veterans can get the care they so richly deserve.”

To some VA critics, Trump's selection of Shulkin to head the agency makes it unlikely that significant changes will be made. “For veterans who voted for Donald Trump, this is going to feel like a bait and switch,” says Benjamin Krause, founder of DisabledVeterans.org. “Keeping Shulkin will keep a host of flunkies and criminals who should have been part of the whole ‘drain the swamp’ promise.” (His own reputation as an ethically pure reformer was undercut by The Washington Post report  in late September that he billed the government for his wife’s travel during a 10-day business jaunt that also included side-trips to the Wimbledon finals and a  visit to Copenhagen’s “Little Mermaid” statue; these  expenses were somehow approved by the VA’s ethics team but  are now under investigation by the department’s Inspector General.)

The fetid VA swamp has been spreading for years under the last three VA secretaries, including Shulkin. It’s an institution long notorious for vicious retaliation against whistleblowers and a penchant for falsehoods, obfuscation and delay, as well as rampant cover-ups of unsafe and sometimes deadly conditions—or even fraud—by the VA's watchdog agencies. This is all kept from view by what some longtime employees call “the code”—the institutional silence and protection offered wrongdoers. Likening it to the mob’s “omertà,” one high-ranking VA administrator, who insisted on anonymity, tells Newsweek, “You don’t break ‘the code,’ or your career is over…. It’s a fearful environment.

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