Over medicating in the VA/military health care.
Well I have been looking for a reason excuse to talk about this and this is about as good as any. This is about a Veteran that died from “over-medicated”.
“It just got out of control,” said Heather. “They just started pill after pill, prescription after prescription…and he’d come home with all brand-new medications, higher milligrams.”
I have recently seen this in regards to the medication that I take for my ADD.
Short history, diagnosed at the age of five. Was on Ritalin for the better part of twenty years, and started taking adderall. off and on since 2010. So I have a general idea of what to expect from the medication and the risks.
For example, this medication is not a cure all. It will not make one have the mental discipline to do the needed tasks, it will just help you do it. A better way of saying this how vision glasses help people. It will help you see clearly, but it will not influence you on were you look.
Second is the idea of taking “drug holidays” to prevent the body from becoming desensitized to the medication does. Also it allows the body to recover from the reduced appetite that comes with this type of drug. Just keep this in mind for the next part.
I am going through school right now and I was having some trouble with my ADD and I wanted to talk to Behavioral Health about ideas for better coping mechanism for school. The first thing that I was told that I needed to be on a medication regiment. When I told them that I was already taking 1 20mg of Adderall XR (extended release) on weekdays, that it was not enough. That until I was on a working regiment that any coping mechanisms would be ineffective.
So I wait for my appointment to talk to the doctor. We got some basic history about my ADD. He increases my dose to 30mg XR and that I need to take on the weekends when I study. Ok we get that out of the way and I was ready to talk about now coping ideas that I have been wanting to talk about for over two weeks.
Nope, nothing. It seems that the Adderal will take care of everything and that i did not need to do anything else. Remember when I was talking about what these drugs can and cannot do earlier? Yea I was very surprised to hear that and was thinking about the newer patients who get Adderal and get told the same thing. I go about my schooling and about two weeks later I have a follow up.
I told that the increased medication seems to have helped me in the hands on portions and helping with studying I was concerned about two things. The first one was the effects real or was this a placebo effect, and that I was unconsciously looking/wanting to see better results. The second was with no drug holidays that what is there to prevent my body from becoming desensitized to the medication.
His first answer was to evaluate for long term and if it was a placebo effect would reduce rather then maintain. The second was that if I become desensitized to the medication that we could just increase the dose.
I asked him what happens if I keep finding myself having to keep increasing the medication dosage over and over to keep the same therapeutic levels. His answer was that there was a point that the body will not be desensitized to the medication and to remain on that dosage.
The answer that I wanted to say was “you mean death”? Considering what the drug is and that it it highly abused in colleges and other schools that you would want to control the dosage by drug holidays (It is in the medication instructions) to keep the risk of becoming dependent on the medication. So I wonder when I see comments like this if anyone else has had similar experiences.
“I have seen people that have not had an exam of that body part that they’re complaining of pain in for two years,” said a doctor who presently treats pain patients at the VA and had asked not to be identified. “It’s easier to write a prescription for narcotics, and just move along, get to the next patient.”
Category: Veteran Health Care
FERES might be a problem when the poor wife tries to sue.
My own experience with VA pain management was a whole range of prescription opiads and they told me I was depressed and gave me some antidepressants that reacted with the pain meds and really set me off. luckily I only took them for two days and quit cold. I got all the negative reactions immediately. They are too quick to prescribe meds and not follow up. If you read the VA statement about the Navy Yard shooter, he has practically no history whatsoever of any mental issues and no indication to them he could have a problem.
Dana: doubt that very seriously. Feres only applies to those currently serving in the military. Those who have been discharged are civilians and are not affected by Feres. They can indeed sue the Federal government. I have personal knowledge of one claim paid by the Federal government relating to medical malpractice on the part of a government doctor.
I figured out that I have to take 5,100 pills a year for the rest of my life.
I pretty much just deal with pain without meds. At he first mention of pain the VA quacks here look at you like you are a med seeker with a dick sticking out of your forehead.
ADD- drugs? Never heard of ADD until the 80s. A pharmacological wonder and money maker. Our students never had ADD- maybe it was because of pull-ups and rope climbing during EVERY classroom break. PT helps- especially in large and challenging doses.
A pharmacist once told me – “Remember, drugs basically are poison.”
I’m not advocating no drugs by any means (believer in ibuprofen, beer, antibiotics, etc.)…but the PHARMACEUTICAL INDUSTRIAL COMPLEX is obviously out of control. A pill for everything! It’s fast and easy, an it also leads to sloppy medicine.
From another blog:
“Hints of identifying hyperactive kids in school go back to Germany in 1856, but no real clinical interest developed before the mid-1920s. Effectively, in other words, before then the disease had no effective existence. Even then it did not take off: that would wait until the 1960s and 1970s, with U.S. parental advice, doctors, and increasingly parents and teachers themselves gaining a lead over the rest of the world. Why then? Possibly school was becoming more onerous, more probably patience with kids was wearing thin because of changes in parents’ lives, and even more probably the introduction of a new drug (Ritalin, 1955) helped open the floodgates. The history since then involves steady intensification…”
More: http://provostblog.gmu.edu/archives/1531
I seem to be encountering more and more people on anti-psychotics and anti-depressants; although anecdotal, bipolar and other mental conditions seem more prevalent now than ever. This is real, I lost a close friend to depression.
I have been perscribed meds by the VA for things like my nerve pain, but do not feel as if I have been overperscribed.
I was never medicated for PTS, never felt that I needed it and made that clear to my doctors at the time… Same with meds that are narcotics for pain. I avoid them, and prefer to use non perscription meds whenever possible, and physical therapy.
My pain managment only got to the point of taking meds when my ulna nerve in both hands got messed up and I now suffer some severe pains in my left, and am not seeing the beginning of the same symptoms in my right hand. Back pain is painful, but I get through it with Electro muscular stimulation, and heat and ice.
just because someone in a white coat offers it to you, doesn’t mean you have to take it
my point?? For a lot things it is your choice what you put into your body. You do not have to just take the meds and move on.
mental health issues beyond mild PTS and depression, you may very well need that medication but you need to be educated about all the risks involved. I think the military has been over medicating with opiates for PTSd, we see it with patients here who come out hooked on Oxy, then they go for the heroin when they can not afford to be buying their fix of oxy on the street. Like a revolving door here with a lot of vets. Come in detox, back out… back in…
Sporkmaster-
Part of the issue might be who you are going to for help- psychiatrists and primary care doctors are MDs. They’ve been taught that pills are the way to handle any condition that might be impacted by what is going on in your mind (e.g. ADD, pain, sleep problems) even though there is strong scientific evidence that behavioral and other psychotherpeutic interventions are often as effective or even more effective than medication (sleep problems are a great example of this).
You might want to consider asking to be evaluated by a psychologist or neuropsychologist (a good idea if there is a possibility of head injury, including history of concussions as this can present very similarly to ADD). To be fair, some MDs recognize there are other options and refer people for help.
Some VAs have very good programs in place to provide the kind of counseling you are talking about, but not all do at this point. At some facilities the speech/language pathologists are the ones who do this kind of treatment. If you are already working with Voc Rehab for the GI Bill, etc., they might be able to guide you in the best direction for where you receive care.
Sounds like you, if possible, need to find another DOCTOR (not pill-pushing quack) who will take the time to listen to YOUR needs and concerns, not just proscribe another/more medicine “just because”.
I have finally gotten into the VA’s Spinal Injury pain management program. I’m waiting for the 1st appointment. Mostly, I’m hoping for some sort of relief, if possible, without the continued use of meds.
I’ve been prescribed all sorts of narcotics, but I just cannot handle them. They take the edge off the pain, and sometimes relieve it for awhile, but when they wear off I feel like I’m hungover and those side effects aren’t worth the relief they provide.
Like Beretverde, I’ve also turned to OTC meds like Ibuprofen, bourbon, self-hypnosis and warming pads to keep things at bay, coupled with exercise as best as I can. There ARE times when I turn to Ambien to help me get a night’s rest when the pain is giving me problems.
I can agree, though, that the VA seems to be more interested in dealing with the symptoms, rather than the root causes of the problems, and that’s why you see the increasing prescriptions for various meds. It’s much easier, and less costly, to deal with symptoms, and keep the patients flowing through the system, than to spend the time needed and address the causes of the problems.
If the VA can address the latter, start to work on the underlying issues vice just providing surface coping measures, than we’d see a LARGE reduction in both prescribed medications, and the need for them by both patient and physician.
I heard from a Pharmacist that the DEA is clamping down on narcotic scripts and making them wait a couple of days or so before sending another order (i went to 2 pharmacies that ran out of p-set before finally getting one – for my wife who had a C-Section for our 4th).
I do think that Docs have a quick trigger when it comes to meds. I have gone through getting a pacemaker, a kindey disease, fractured tibia and migraines (since childhood and before my concussion)and I don’t always want something that will make me feel like a zombie. Sometimes you just have to take motrin/advil and fight through it so you know you are improving or how to handle pain when it comes or to find ways to prevent it from getting worse.
AW1 Tim: I’m sorry you have to suffer through a Spinal Injury -I know that is one of the worst pains.
I thought they were developing a device (like a pacemaker) to be inserted in the back to relive pain?
Also have you tried Jin Shin Jyutsu? I know it sounds hokey but a co-worker recommended to me and my wife learned it a little from the handout and it was a way for me to prevent/stop migraines without taking meds.
I went to the VA to get x-rays of my cervical vertebrae so that my chiropractor could see what was wrong. This is how I found out that I have severe arthritis in my neck and back. The NP gave me 2 prescriptions, one for naproxen (prescription level of Aleve) and the other for a muscle relaxant. I asked my sister to check the PDR to see if either of them had any narcotic side effects, and she said no. There were, at least, warning labels on the bottles.
Naproxen, like Aleve, upsets my stomach, so I stick to occasionally taking Advil instead. The muscle relaxant put me to sleep but didn’t do anything else, so that was the end of that. That’s all still sitting in the bottom draw in the bathroom, has been for 3 years.
There are many alternative practices to relieve the symptoms that include neurological pain. Unfortunately, most of them take time to be effective, but are more permanent than pills, which give quick relief that doesn’t really last.
I would recommend a chiropractor who uses the Palmer methdo, which is a little airgun that provides a form of acupressure; therapeutic massage by someone who actually knows how to do it; acupuncture and acupressure; and maybe even a visit to a someone properly trained in traditional Chinese medicine. These things do work. They just take a bit longer but they are permanent with no side effects.
I don’t think any long-term use of these quick-acting modern medications is a good idea. I knew students who were popping pills – amphetamines – to stay awake and study in the 1960s and 1970s, and when they crashed, it was horrifying.
Any time someone hands me a prescription for something, I look at it with suspicion. Then I go dig up the pharma info on it. If the side effects are bad, I don’t bother with it.
Sporkmaster, one other idea, if you’re at a college seek out their resources. They interact with students all the time and sometimes have staff dedicated to veteran needs. This resource may be the best for developing coping mechanisms and being successful in your studies. It’s what they do.
I injured my knee in Iraq. Have the LOD and everything. Spent a year trying to get treatment through the VA, and it was all about the pills (well pills and flannel shirts soaked in hot linseed oil). It wasn’t until I said screw it, went to my private doctor, and got the treatment I needed (draining the swelling with a syringe followed up with lots and lots of physical therapy). She figured out in six weeks, with two sets of x-rays, and an MRI what the VA couldn’t be bothered to figure out in a year.
And the difference is the volume. She had the time (and motivation) to treat me.
So I blame the Sick Call Rangers.
Army and VA doctors are just so overwhelmed with the volume of treatment that they don’t and can’t take the time to properly investigate, treat, and monitor their patients like they should. And they know that at least half of the people they are treating are “faking it”. They know that guy who showed up with “non-specific back/knee pain” is either trying to get out of an upcoming PT test, or trying to get his disability rating upped, so they reach for the quick fix and hope someone at some point will take care of the real problem, because they don’t have the time to do it themselves.
As one of our resident medical types, I’m going to take a slightly different position here.
Medication is WAY over prescribed. The western medicine model is very heavily ‘medication centric’ going back to the Victorian era medical models. We give a pill for a symptom, but the pill itself causes side effects, which we then treat with more pills.
Want some alternatives? Go to alternately trained medical providers, like nurse practitioners and osteopathic doctors and ask for nonpharmacological interventions. When properly applied, you’ll find that a lot of the reasons to drug people to their eyeballs decreases significantly.
Spork: Find yourself a nurse practitioner and ask about non-pharmacological interventions. Accupuncture, massage, guided meditation, Chinese medicine, all good things to help with this kind of stuff. Some of it works really well, some not as much. Some of it is damn good, and when combined with the right dosages of conventional medication, can be very effective.
Hang in there, brother. The right providers are out there, but you have to go find em.
ANCCPT.
and lest we forget, 50% of doctors graduated in the bottom half of their classes. What percentage of them winfd up at VA … well….
@15, I agree with your advice. I have a back injury and tried all sorts of conventional and non-conventional treatments, including physical therapy, chiro, acupuncture, yoga, rich platelet treatment, shots into the L5/S1, SI joint and ichial tuberosity(sp?). Had MRIs, ultrasounds, etc.
It came down to mostly one – yoga is what helps me manage the pain. While ADHD isn’t a back injury, the same advice applies imo.
I finally got on my wife’s insurance and I am getting “modern” medicine. Her…well my new Dr prescribed me a new medicine that handles multiple issues. Unfortunately it is not on the VA formulary. I cannot get the VA to prescribe the medication unless I meet a certain set of criteria, that I don’t. Now if I wanted to I could go get multiple prescriptions that handle all of the symptoms from the VA free of charge, but instead I am paying out of pocket for one medication.
What bothers me, literally, is the effects of medicines on othr parts of the body. My VA docs prescribed NSAIDs and painkillers. I was warned that eventually my kidneys and liver would fail. Dropped the painkillers, stuck with the NSAIDs and now my insides look like road rash.
Piss poor military medicine, with the command decision to throw soldier care over the transom to the VA is why the VA is so swamped with patients.