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ptsd Drugged To Death: Accidental Overdoses From Rx Cocktails Alarm Military Officials
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allan
From: Brenhay@aol.com
Sent: Saturday, September 04, 2010 10:46 AM
To: colonel-dan@sbcglobal.net;
Subject: Drugged to death: Accidental overdoses from Rx cocktails alarm military
http://www.navytimes.com/news/2010/09/military-accidental-overdoses-drug-cocktails-053110/
Drugged to death: Accidental overdoses from Rx cocktails alarm
military officials
By Andrew Tilghman
Posted : Friday Sep 3, 2010 12:10:22 EDT
At least 32 soldiers and Marines assigned to their services'
most-supervised medical units for wounded troops have died of accidental
prescription drug overdoses since 2007.
The 30 soldiers and two Marines overdosed while under the care of
special Army Warrior Transition Units or the Marine Corps Wounded
Warrior Regiment, created three years ago to tightly focus care and
attention on troops suffering from severe physical and psychiatric
problems as a result of combat.
Most of the troops had been prescribed "drug cocktails," combinations of
drugs including pain killers, sleeping pills, antidepressants and
anti-anxiety drugs, interviews and records show. In all cases, suicide
was ruled out.
Army officials say the deaths are often complicated by troops mixing
medications with alcohol, taking their own medications incorrectly or
without a prescription.
It is unclear how many troops across the entire military have died from
drug toxicity. Pentagon officials have not provided information about
accidental drug deaths across the military despite a Military Times
Freedom of Information Act request submitted nearly two months ago. Data
on military deaths is compiled by the Armed Forces Institute of
Pathology and maintained at the Pentagon's Defense Manpower Data Center.
The Army deaths have shocked that service's medical community and
prompted an internal review. But despite a "safety standdown" in January
2009, the number of fatalities continued to rise last year - to 15 in
2009, up from 11 the year before. Meanwhile, the total number of
soldiers assigned to the 29 WTUs nationwide dropped from about 12,000 to
about 9,000.
The internal review found the biggest risk factor may be putting a
soldier on numerous drugs simultaneously, a practice known as
polypharmacy. According to an Army analysis from June 2009, about 9
percent of WTU patients --- 800 soldiers --- were prescribed
combinations of drugs including pain, psychiatric and sleep medications.
As a result, the Army medical community began questioning the practice
of polypharmacy and has overhauled the way it prescribes, distributes
and monitors the riskiest drugs.
An Army Medical Command memo dated May 14, 2009, highlighted the risks:
"Certain prescription medications, alone or in combination, may cause
adverse side effects that may prove lethal. These high-risk medications
include, but are not limited to, narcotic analgesics, anxiolytics, and
anti-seizure and insomnia medications."
In a handwritten note at the bottom of that memo, Army Surgeon General
Lt. Gen. Eric Schoomaker added: "Closer oversight of polypharmaceutical
use by our patients can be life-saving."
New rules and guidance to reduce drug toxicity deaths over the past two
years include:
. Warning Army doctors to be "judicious in the use of psychoactive
medications."
. Requiring soldiers to sign consent forms stating that they fully
understand the potential risks related to the drugs.
. Prohibiting some soldiers from using more than one doctor to obtain
medications.
. Reducing standard prescriptions for high-risk soldiers from 90-day
supplies to a seven-day supply.
. Establishing alcohol-free zones in WTU barracks and issuing no-alcohol
orders to some heavily medicated soldiers.
Robert Moore, a spokesman for Warrior Transition Command, which oversees
the WTUs, told Military Times that none of the fatalities resulted from
a soldier taking his medications as instructed. Rather, they involved
soldiers who took too much medication, took medication without a
prescription, or mixed medication with alcohol or illegal drugs.
"These are individuals," he said. "They will make some of their own
decisions."
Moore said the rate of deaths has decreased due to the series of new
safety measures. So far this year, two soldiers have died from
accidental drug overdoses, and several determinations about causes of
death are pending, according to interviews.
Nevertheless, the problem has become a priority for the Army's top leaders.
"With two drug-related deaths thus far this year, we are not content
that we are solving this problem and continue to look at every possible
avenue to further reduce the risk of such events, not only in the WTUs
but across our force," Army Vice Chief of Staff Gen. Peter Chiarelli
told Military Times earlier this month.
The military has a computer system designed to warn doctors when
individuals receive drugs that may cause adverse reactions. But doctors
are able to easily override the warning notification and allow patients
to receive high-risk combinations, military records show.
The details underlying each death are unique. Army Sgt. Gerald Cassidy
died in 2007 after writing in his journal that he was unsure how much
methadone he had taken, his family said.
Army Warrant Officer 1 Judson Mount died in April 2009 after trying a
new, higher-dosage patch that releases the narcotic painkiller fentanyl,
his mother said.
And Spc. Franklin Barnett died in June 2009 shortly after spending a
weekend with his wife and children and appearing to be in good health,
his wife said.
Unlike casualties in Iraq or Afghanistan, these fatalities can be
avoided through better management of the health care units, said Col.
(Dr.) Steven Swann, command surgeon for the Warrior Transition Command.
"Losing a soldier in combat is an expected and understood cost of war.
But these should be preventable," Swann said. "We will do everything we
can - more policies, more programs, more controls - to prevent every
single one of these."
Meds on the rise
During the past decade - for nearly all of which the U.S. has been at
war on two fronts - the military community has seen a dramatic rise in
the use of the types of medications linked to the WTU deaths. For
example, the military health care system's prescription orders for
painkillers nearly tripled, while those for anti-seizure medications
rose 68 percent, according to a recent Military Times analysis of
Defense Logistics Agency data.
Many of those drugs have a similar fundamental effect on the body,
slowing the central nervous system and increasing the risk that a
patient's heart or breathing will stop during sleep.
"Using alcohol and illicit drugs in combination with high-risk
medications increases the potential for adverse events and death," the
April 2009 Army Medical Command memo said.
The spate of deaths fuels criticism that the military medical community
- and the American medical community at large - puts too much emphasis
on pharmaceutical products rather than other forms of treatment.
"There is a direct correlation in the increase of use of these
medications and these sudden deaths," said Dr. Bart Billings, a retired
Army colonel and psychologist in San Diego who treats troubled troops
and has testified before Congress about the risks linked to prescription
drugs. "These are healthy young people who are dying in their sleep
because some physician prescribed a combination of medications that
killed them."
Many such drugs are tested and approved for use individually, but
research on combinations is limited. "These medications were not tested
in combination with other medications," Billings said. "They were tested
only on what they would do on their own."
Billings believes the safest and most effective treatment includes
various forms of talk therapy in which troops forge personal
relationships with counselors while trying to identify, understand and
deal with their mental health problems.
But some military doctors caution against blaming drug use in general
and note that most people respond well to painkillers and psychiatric
medications.
"The reasons we use these drugs is because they work," Swann said. "They
are effective at managing people's pain and managing their depression."
Marine drug deaths
The Marine Corps has wrestled with similar problems.
"Medication risk management is one of the recurring hot-button topics,"
said Navy Capt. William Tanner, the head doctor for the Marine Corps'
Wounded Warrior Regiment.
Last year, a spate of drug thefts in the barracks at Camp Lejeune, N.C.,
prompted the Corps to give Marines a lockbox to secure prescription
drugs, Tanner said.
Some Marines with traumatic brain injuries receive personal digital
assistants to help them keep track of their daily drugs.
The Corps also is developing a program that brings doctors, caseworkers
and Marine officials together once a week to discuss each patient and
their medications.
"We don't have a great treatment for PTSD [post-traumatic stress
disorder]," Tanner said. "There are studies and recommended treatments,
but none of them are great. It's hard to tell a doctor what to do. He's
going to do what he thinks is best for the patient, regardless of what
the guidelines say."
Suicide semblance
An accidental drug overdose initially can be confused with suicide.
After Sgt. Robert Nichols died at the WTU at Fort Sam Houston, Texas, in
2008, the Army Criminal Investigation Command grilled his wife for
possible evidence that his death was self-inflicted.
"The CID guys were like, 'Well, you know, was there anything that was on
his plate that was too much to handle? Was there anything bothering
him?'" said Susan Nichols, who now lives in Dallas. "You didn't have to
be Albert Einstein to see where they were going with that. I thought,
are you really trying to suggest this? This man? No."
Nichols, who deployed to Iraq in 2007 to a base south of Baghdad,
sustained a traumatic brain injury after a mortar round landed near him,
his wife said.
An investigation later concluded that Nichols' death was an accident.
Medical records show he was taking a cocktail of 11 drugs, including
Percocet, Valium, the antidepressant Celexa, the antipsychotic Seroquel,
and Depakote, an anti-seizure drug used to treat major depression and
bipolar disorder, his wife said.
Some psychiatric medications in the accidental overdoses come with
warnings about increased risks for suicidal thoughts and actions.
The Army estimates that about 5 percent of suicides involve prescription
drugs, documents show.
When the cause of death is unclear, the military can consult a forensic
psychiatrist, who examines in detail the victim's life and activities
and apparent frame of mind in the hours before the death. Law
enforcement investigators can also be involved.
But final determinations are not always clear-cut, said Army Col. David
Benedek, who teaches psychiatry at the Uniformed Services University of
the Health Sciences, a Defense Department school in Bethesda, Md.
Accidents and suicides, he said, "are difficult distinctions to make
sometimes, particularly if someone doesn't leave a note or indicate in
any way that they were contemplating suicide."
"Keep on, Keepin' on"
Dan Cedusky, Champaign IL "Colonel Dan"
See my web site at:
http://www.angelfire.com/il2/VeteranIssues/
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