The doubling of the military suicide rate over the past decade has received a lot of attention lately -- including national headlines, multimillion-dollar research programs, and much-needed prevention efforts -- but veterans of the wars in Iraq and Afghanistan face many other serious behavioral health problems as well. Post-traumatic stress disorder, domestic violence and alcohol abuse are problems that have been widely chronicled among returning veterans of our recent wars. Often left out of the discussion, however, is the terrible toll that prescription medications -- opioid painkillers such as Oxycontin and Vicodin -- take on veterans' lives. Few people involved in the national dialogue on combat veterans' issues are talking about this or seem to recognize the grave threat it poses to the health and well-being of our active duty troops and more than 2 million veterans.
Among civilians, prescription drug use of opioids rose dramatically over the past half-generation, becoming America's deadliest drug epidemic. According to the CDC, more than 15,000 people in the U.S. die each year from overdoses or toxic combinations of prescription medication painkillers. Remember the deaths of Heath Ledger, Michael Jackson and Anna Nicole Smith in recent years? This is more than a 300 percent increase since 2000, and the numbers are rising. The number of people who died from abuse of prescription painkillers is greater than the number who died from cocaine, heroin and all other illegal drugs combined. In 2009, opioid-related deaths surpassed traffic accidents to become the leading cause of accidental death in America.
In a large-scale study of veterans, the Austin American-Statesman recently conducted an examination of all-cause mortality among Iraq and Afghanistan war veterans who were beneficiaries of the VA in Texas. Their results, published in three-part series Sept. 30, Oct. 1 and Oct. 2, 2012, showed that slightly more veterans died by overdose or toxic combinations of prescription drugs than by suicide. Of the 266 deaths with known causes, 16.9 percent were ruled as suicides, 18.8 percent were motor vehicle accidents, and 17.7 percent were drug-related deaths. Mirroring national trends among civilians, 85 percent of the drug-related deaths involved prescription medications -- signaling this is problem created in part by the medical establishment.
Presently, 45 percent of Iraq and Afghanistan veterans have already applied for disability benefits from the VA, a frighteningly high rate when compared to 11 percent and 16 percent for veterans of WWII and Vietnam, respectively, to this point. This unprecedented and dramatic spike in disability applications has thoroughly overwhelmed the VA system, which now faces a backlog of almost 1 million claims. It also means that many veterans are seeking medical care from the VA system and pursuing medical solutions to problems such as headaches and chronic back and joint pain. Potentially this could lead to rising rates of opioid prescriptions.
Even for those who do not die by them, opioids cause long-lasting changes to the brain, rewiring pleasure centers so that the drug eventually becomes necessary, not to get high or alleviate pain, but to feel normal. Ironically, drugs being prescribed to help our soldiers and veterans today may pose an even greater threat to their long-term health and well-being, something prior generations of combatants did not face.
Looking back, can the historical record help contextualize or validate any of these concerns? We recently published data on active-duty military suicides, insanity, and alcoholism in Union forces who served during the U.S. Civil War (1861-1865). Somewhat surprisingly given current trends, there were only 278 documented suicides during the four years of this high-intensity war, whereas the U.S. military documented 295 suicides in the single year of 2010 alone. Moreover, the documented rates of "insanity," "nostalgia," and "alcoholism" were all extremely low during the Civil War (all under 1 percent). Of course, many things were different in that era and these data almost certainly represent an undercount of the true psychological consequences of war. Nevertheless, it further highlights the reality that combat exposure is not the most accurate predictor of suicide, and does not alone explain the recent spike in the military suicide rate.
It is worth pausing to wonder: How much are veterans' behavioral health problems in the modern era driven by prescription medications? We need more study, more information, and more awareness of this rising threat to veterans' health.
B. Christopher Frueh, Ph.D. is a clinical psychologist, and is professor of psychology at the University of Hawaii, Hilo, Hawaii, and he directs the research programs at The Menninger Clinic, Houston, Texas. Jeffrey A. Smith, Ph.D. is an American historian, and assistant professor of history at the University of Hawaii, Hilo, Hawaii.