Our veter­ans are over­med­i­cated

Baltimore Sun - - COMMENTARY - By Pa­trick D Hahn Pa­trick D Hahn is an af­fil­i­ate pro­fes­sor of bi­ol­ogy at Loy­ola Univer­sity Mary­land and a free-lance writer. He can be reached at patrick­hahn@hot­mail.com.

This sum­mer, the U.S. Depart­ment of Veter­ans Af­fairs Of­fice of Sui­cide Pre­ven­tion re­leased its long-awaited re­port, “Sui­cide Among Veter­ans and Other Amer­i­cans 2001-2014,” the most com­pre­hen­sive analysis of vet­eran sui­cides ever con­ducted. The re­port notes that prior to 2006, the vet­eran sui­cide rate, ad­justed for age and sex, was ac­tu­ally lower than that of the gen­eral pop­u­la­tion. By 2014, that ad­justed sui­cide rate for veter­ans was 21 per­cent higher. In ab­so­lute terms that works out to about 20 sui­cides a day.

That’s the bad news. Here’s the worse news: Since 2003, the sui­cide rate for male veter­ans of over­seas con­tin­gency op­er­a­tions ages 18-24 has risen a stag­ger­ing 359 per­cent.

The VA has an­nounced ini­tia­tives for low­er­ing the vet­eran sui­cide rate. How is that work­ing out? Ta­ble 1 of the re­port shows sui­cide rates for VA health ser­vices users. The sui­cide rate for those who re­ceived men­tal health treat­ment is higher than those who did not. No sur­prise there: It seems rea­son­able to as­sume that those who re­ceived men­tal health treat­ment were more im­paired.

The sur­prise comes when we com­pare users who had no di­ag­no­sis of men­tal health or sub­stance abuse is­sues (and who­pre­sum­ably were less im­paired) with those who did have a di­ag­no­sis (and were pre­sum­ably more im­paired). The sui­cide rate for the less-im­paired users who got men­tal health treat­ment was higher than that of the more-im­paired users who did not.

What is go­ing on? A study pub­lished last March by re­searchers at the South Texas Veter­ans Health­care Sys­tem gives us a clue. They found that polyphar­macy (which they de­fined as five or more psy­chotropic drugs ad­min­is­tered con­cur­rently) was cor­re­lated with a nearly four­fold in­crease in the rate of drug and al­co­hol over­doses and a nearly four­fold in­crease in the rate of sui­cidere­lated be­hav­iors. This was after con­trol­ling for age, sex, eth­nic­ity and co-mor­bid con­di­tions.

Is any­one sur­prised? An­tide­pres­sants, an­tipsy­chotics, an­ti­con­vul­sants, hyp­notics and stim­u­lants all have been linked to sui­ci­dal­ity and/or com­pleted sui­cides. Much of this ev­i­dence comes from tri­als bought and paid for by the drug com­pa­nies that have a fidu­ciary duty to do ev­ery­thing in their power to min­i­mize the harms and max­i­mize the pur­ported ben­e­fits of their wares. These tri­als are ran­dom­ized and placebo-con­trolled and there­fore proof of cau­sa­tion, not mere cor­re­la­tion. What hap­pens when doc­tors pre­scribe these drugs, in com­bi­na­tions that have never been tested, for years and years beyond the du­ra­tion of most clin­i­cal tri­als? Looks like we’ve got our an­swer.

Peter Breg­gin, a psy­chi­a­trist of 48 years’ ex­pe­ri­ence who tes­ti­fied at the 2010 con­gres­sional hear­ings on vet­eran sui­cides, told me, “The kinds of is­sues that peo­ple deal with that re­sult in their get­ting psy­chi­atric drugs are not helped by psy­chi­atric drugs, which can only harm the brain and make it more dif­fi­cult to feel your feel­ings and to think clearly. They drug the veter­ans, hop­ing ba­si­cally to stu­pefy them and make them pas­sive so they won’t de­mand ser­vices. I think it’s a crime that those who are veter­ans, who have sur­vived our wars, are be­ing killed off by the phar­ma­ceu­ti­cal em­pire and its prac­tices.”

A Navy vet­eran with PTSD who be­came dis­abled and sui­ci­dal after in­gest­ing a ver­i­ta­ble cor­nu­copia of psy­chi­atric drugs, most of them pre­scribed by VA docs, agreed. “The VA is there to get us all in the grave as fast as pos­si­ble,” he said to me. “In­stead of say­ing, ‘Have a shoe­box full of med­i­ca­tions,’ there should be a higher ac­count­abil­ity.”

On Sept. 28, Sen. John McCain in­tro­duced the Veter­ans Over­med­i­ca­tion Pre­ven­tion Act to pre­vent the over­med­i­ca­tion of veter­ans and to com­bat sui­cide deaths. The bill would di­rect the U.S. Na­tional Academy of Sciences to con­duct an in­de­pen­dent study to re­view the num­ber of veter­ans who died of sui­cide or over­dose dur­ing the last five years, the pres­ence of med­i­ca­tions or il­le­gal sub­stances in the sys­tem of each vet­eran who died, the preva­lence of polyphar­macy among veter­ans, and the per­cent­age of veter­ans who are re­ceiv­ing non-med­i­ca­tion treat­ment (such as CBT) and its ef­fec­tive­ness com­pared to med­i­ca­tion. This is a pro­posal ev­ery Amer­i­can ought to sup­port.

Our na­tion should spare no ex­pense in help­ing veter­ans who have been harmed by their mil­i­tary ser­vice. Such ex­hor­ta­tions have been stan­dard op-ed page fare on Veter­ans Day for years now. But we owe our veter­ans more than that. We owe it to them to take a good hard look at whether the help we are of­fer­ing them is re­ally help­ing.

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