From: 23x11.5c@gmail.com   
      
   Randy Essex    
   November 23, 2014   
      
   VA: Too many pills, not enough care   
      
   Photo   
   Tom, a veteran, circa 1968.   
      
   Tom was a troubled man.   
      
   Except during a marriage that lasted nearly 20 years, his life was marked by   
   wrecked cars, fights, addiction, two gunshot wounds and, in his youth, several   
   jail stints.   
      
   He dropped out of high school in 1961. As difficult teens often did at the   
   time, he joined the military the next year as he neared his 18th birthday.   
      
   He was based in Long Beach on the minesweeper USS Pluck and spent stretches of   
   time in Hawaii and the Philippines. From those Pacific ports, he sometimes   
   sent his mother orchids packed in dry ice, so exotic when they arrived at her   
   home in southeast    
   Nebraska.   
      
   The Pluck did two tours off the coast of Vietnam, and at one point, Tom said,   
   he was among sailors sent ashore for armed patrols. It was hard to know much   
   about his Vietnam experience, which in his telling became more dramatic as he   
   aged.   
      
   When he got out of the Navy, he'd seen the world and sampled heartily of its   
   hedonistic temptations. A full-blown alcoholic deep into other drugs, he   
   wandered the country. It was the 1960s and he was a tough single man in his   
   20s. He always carried a    
   knife in his backpack and reveled in calling himself a street person.   
      
   As the '70s came and he aged, his addictions deepened. He ended up in a couple   
   of mental institutions and, finally in one of them, met a counselor who took   
   him under her wing.   
      
   Tom sobered up and married Char. First he became an addiction counselor   
   himself. Then he became a massage therapist, and had a remarkable touch that   
   enabled him to go into business for himself. It was a tale of recovery and   
   redemption. He regularly    
   visited his parents and was financially stable -- until Char died in 2003.   
      
   Without her, he made a series of bad decisions, eventually ending up back in   
   his hometown broke. His siblings were sure he was looped out on pain pills he   
   got from Veterans Affairs doctors for back and neck pain, and confronted him   
   more than once.   
      
   His legs deteriorated and he wasn't licensed for massage in Nebraska, so   
   sought disability and further help from the VA. He ultimately got two hip   
   replacements -- and lots of pain pills before and after the surgeries.   
      
   His timing caught the proliferation of pain medicine in the United States   
   since 1999, with prescriptions up 300 percent for Americans as a whole and up   
   270 percent for VA patients.   
      
   The VA was a trailblazer in medicating America, which consumes 99 percent of   
   the global hydrocodone supply and 83 percent of oxycodone, the two most common   
   active ingredients in prescription painkillers.   
      
   In 1999, the VA made pain a "fifth vital sign," adding it to pulse,   
   respiration, temperature and blood pressure. This was the birth of medical   
   professionals asking you to rate your pain on a scale of 1-10.   
      
   The VA, of course, is a major customer for pharmaceutical companies, so if you   
   make a pain pill -- say OxyContin, approved by the FDA in 1996 -- it's a   
   really good deal for you if the VA adopts guidelines to more aggressively   
   treat pain. You might back    
   organizations that call for widespread adoption of the VA pain standard, which   
   would further increase prescriptions of your blockbuster profit maker.   
      
   That's exactly what happened. Purdue Pharma, the maker of OxyContin, along   
   with other pharmaceutical companies, backed organizations such as the American   
   Pain Society and turned pain treatment on its head. Powerful opiate drugs that   
   were sharply    
   restricted in America, even for the terminally ill, became the standard of   
   care.   
      
   In 2001, the Joint Commission, which accredits U.S. hospitals and health   
   systems and thus wields tremendous power, adopted more aggressive pain   
   management standards. Pharmaceutical companies controlled doctor education in   
   a cozy arrangement with the    
   Joint Commission.   
      
   Prescriptions exploded. As I wrote last week in arguing that Americans take   
   too many medicines of all kinds, by 2010, enough painkillers were prescribed   
   every year to medicate every American adult around-the-clock for one month.   
      
   The results have been addiction, 17,000 American deaths per year from   
   prescription opiates and the nation's worst-ever problem with heroin, a   
   chemical sibling to prescription opiates.   
      
   Compounding this continuing tragedy, the aggressive pharmaceutical approach is   
   a failure. A study of VA patients in 2006 concluded that "routinely measuring   
   pain by the fifth vital sign did not increase the quality of pain management."   
      
   It's one of many studies that show, overall, opiates do not work in the long   
   run for treating chronic pain.   
      
   They are extremely effective in creating addicts, though.   
      
   None of that changed VA practices, as documented last year by the Center for   
   Investigative Reporting.   
      
   As the VA works to address a range of deficiencies in its health care, it can   
   be a leader again in how America handles pain. It can stop buying and   
   supplying the pills in bulk. It can improve its internal communication so   
   veterans who become addicts can'   
   t doctor shop within the system -- which is exactly what Tom did.   
      
   By 2012, his renewed addiction was inescapably evident. A VA psychiatrist was   
   working to get him in treatment and in early 2013 canceled his OxyContin   
   prescription.   
      
   My brother died in February 2013 alone in a small, drafty rental house in our   
   hometown, about a quarter mile from the home where, as a 4-year-old, I waved   
   goodbye to him when he left for the Navy.   
      
   The autopsy found significant levels of opiates in his system. Police found a   
   bottle of morphine tablets, prescribed 10 days earlier by a VA doctor who   
   didn't find notice of the OxyContin cancellation in Tom's records.   
      
   People bear responsibility for their own choices and actions. While he was   
   clean and recovering when he entered its care, the VA didn't kill my brother.   
   Nor did it care for him very well. It replaced his hips, but gave him exactly   
   the wrong medicine for    
   someone with his history.   
      
   Our veterans deserve better.   
      
   Randy Essex is editor of the Post Independent.   
      
      
   http://www.postindependent.com/news/13888561-113/pain-tom-care-addiction   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)