ptsd Drugged To Death: Accidental Overdoses From Rx Cocktails Alarm Military Officials

[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/

[Pete53]

I have wondered about sleeping meds and diagnosed sleep apnea. I also wonder about sleep apnea and drinking.

[john999]

I think sleeping meds, anxiety meds, pain meds and any med that depresses breathing if mixed with alcohol could be a problem. If you mix that up with sleep apnea then that is probably dangerous. Has it just dawned on the VA that certain drug cocktails could be dangerous. I never heard anything about this stuff until just a few months ago when my local newspaper started beating the drum about people dying from taking prescription pain meds. When I got the fentanyl prescription from the VA that is when the pain doctors started to lecture me about the danger of clonazepam. Hey, I have been taking this stuff for years. I took morphine and methadone with clonazepam and I did not hear a word from any doctor at the VA (these drugs are cheap). Why all the hub bub now? I take urine tests each time I use the VA and if they find one molecule of alcohol they kick me out of the pain clinic. I think both tricare and the VA use the same formulary which is to say cheap.

[kimmig]

this is what happened to my husband. the va had him on 14 medications, he died three days later after back surgery. had four drugs in system,oxy,valium,sleeping pill and zoloft.

[Irish-7]

Perhaps treatment methods have changed recently. It was always my observation that the military was highly reluctant to issue narcotic medications. The 800mg Motrin was a favorite cure for whatever injury you had. These deaths are indeed tragic. I pray for their families. Present day pharmacies issue a computer generated print-out that gives all the warnings of the prescribed medicine. It only takes a few minutes to read it. In my view, the extended release formulas that have surfaced in the past decade are a miracle for those who suffer with crippling injuries and chronic pain. No service member should live out their remaining time unable to perform basic functions. My civilian physician explained the dangers of the pills that he gave me. He stated that pain medications could NOT be taken within several WEEKS of many anti-anxiety drugs. I hope that veterans treated at the VA benefit from coordination between their psychiatrist and primary care managers so as to avoid mixing these powerful medications.