Veterans and the Fentanyl / Opioid Epidemic – Challenges and Solutions

People of all classes are impacted by the national opioid problem, but none more so than veterans. Veterans are twice as likely to die from an opioid overdose as non-veterans.

As they are more prone to experience chronic pain, veterans are more vulnerable to developing an opiate addiction.

Additionally, a large number of veterans experience mental health issues including Post Traumatic Stress Disorder (PTSD), which increases their propensity to abuse alcohol and narcotics as a kind of self-medication.

There is an urgent need for overdose prevention programs among military members.

Definition of Fentanyl and Opioid Use Disorder

Fentanyl is a completely synthetic opioid that is 50 to 100 times more potent than morphine. 

Although there are instances of non-medical misuse of pharmaceutical fentanyl, the majority of the opioid overdose crisis in recent years has involved illicitly manufactured fentanyl.

Prescription fentanyl can be administered as an injectable solution, transdermal patch or lozenge. Synthetic opioids, including fentanyl, are the most frequently cited types of drugs involved in overdose deaths in the United States.

The illicit forms of this drug are sometimes sold as powder or pressed into pills that resemble prescription medications. 

What are the Forms of Fentanyl and How is it Used? 

When prescribed by a doctor, fentanyl can be given as a shot, a patch that is put on the skin or cough drop-like lozenges. It is also used to treat patients with chronic pain who are physically tolerant to other opioids.

Tolerance occurs when you require a higher and/or more frequent dosage of a drug to achieve the desired effects. Like morphine, it is typically used to treat patients with severe pain, particularly after surgery. Fentanyl is sold under the brand names Actiq, Duragesic and Sublimaze when it is prescribed.

The illegally used form that is most frequently linked to recent overdoses is made in labs and sold as powder, blotter paper, eye drops, nasal sprays and pills.

Fentanyl is being mixed with heroin, cocaine, methamphetamine and MDMA by many drug dealers recently. This is because it only takes a small amount of fentanyl to get high, making it cheaper for the dealers. This has a major impact on the number of overdose cases.

The Challenges Veterans Face in Addressing Fentanyl and Opioid Misuse

The opioid overdose crisis has had a significant impact on veterans of the United States military. Between 2010 and 2019, drug overdose mortality rates increased by 53%. Psychological, socio-structural, and physiological/biological factors constantly interact to influence veterans’ risk of overdose.

It is more likely that members of the United States Armed Forces who are on active duty will find themselves in hazardous circumstances that could injure them. 

Veterans are also more likely to misuse opioid narcotics because they struggle with specific issues like post-traumatic stress disorder (PTSD), chronic pain, depression and suicidal ideation. It is said that one in 15 US Veterans struggle with a substance use disorder.

Opioids are used to treat injuries that occur on the battlefield or after the fact. The user may, regrettably, abuse opioids, which have the potential to lead veterans and service members into addiction.

Specific Experiences for Veterans

There are some specific things that influence the likelihood of veterans becoming addicted to substances. These include:

• Exposure to combat leads to increased risk of developing PTSD, stress and other mental health related issues. Using substances is commonly used as a coping mechanism for these disorders. Alcohol is commonly used as a coping mechanism during deployment. 
• Injuries increase the risk of abuse and addiction of pain killer drugs among veterans is very high because these drugs are prescribed quite frequently when there is an injury to treat. The problem is that one soon develops tolerance and needs to consume more. The ease of availability of these opioids needs to be looked at to reduce the large number of addiction cases among veterans. 
• Multiple deployments: increase the risk of stress on veterans which leaves them at a higher risk of developing substance use issues. 

Access to Treatment

Increasing the number of low-threshold wrap-around services, such as medications for opioid use disorder (MOUD) and holistic/complementary approaches, are two promising interventions for drug abuse.

Many of the obstacles to opioid-related risk mitigation that veterans face may be best addressed by peer-led interventions, which are delivered by people who share key experiential or sociodemographic characteristics with the population being served.

The vast majority of veterans who are not connected to the Veterans Health Administration and veterans who, for a variety of reasons, including mental health issues and the desire to avoid stigma, are socially isolated or reluctant to utilize traditional substance abuse services may benefit from community care models.

The more socially isolated veterans who may not have access to naloxone or the social support they need in an overdose situation must be targeted by interventions.

Trauma-Related Disorders Among Veterans

Post-traumatic stress disorder (PTSD) diagnoses are common among veterans. Having PTSD raises the risk of substance use disorders, including opioid addiction.

On the other hand, a veteran with PTSD or another mental health condition may be more likely to receive a prescription opioid, likely because these mental health conditions exacerbate chronic pain.

According to one study, opioid prescriptions were filled by 17.8% of veterans with post-traumatic stress disorder (PTSD) and 11.7% of veterans with another mental health issue.

Sedative-hypnotic prescriptions were also filled more frequently among veterans with insomnia. Veterans with co-occurring mental health and substance use disorders who suffer from chronic pain and sleep problems brought on by underlying mental illness are more likely to receive opioids and sedatives than comprehensive mental health treatment. 

Chronic Pain Contributing to Opioid Crisis for Veterans

Pain management is a very real issue for veterans. They engage in activities that pose a high risk of physical injury. Veterans are frequently prescribed two or more opioid drugs to treat their chronic pain problems and it has been found that a large number of these veterans have as many as three different prescribers.

• Back pain affects more than 20% of veterans
• 16% suffer from joint pain
• More than 25% suffer from migraines
• 27% of have neck pain
• 34% of veterans suffer from both sciatica and back pain
• Jaw pain affects 37% 

Female veterans are more likely to experience chronic pain than their male counterparts. All veterans experience higher rates of severe pain compared to non-veterans. 

What Medications are being Prescribed?

Painkillers are frequently prescribed to recently returned veterans.  764 of these combat-related veterans were surveyed in 2008 and the results showed that 64% received at least one opioid prescription in the year following their return.

• Oxycodone is most frequently prescribed by the VA at 46.9%
• Hydrocodone: 39.5%
• Codeine: 6.8%
• Opioids were given to 59% of patients as short-term treatment
• To treat chronic pain, 41 percent received long-term prescriptions
• Short-acting opioids had been prescribed to 51% of long-term opioid users with one third having received a sedative-hypnotic prescription at the same time

Public Health Solutions for Substance Use Disorders Among Veterans

 
Increased Access to Treatment Programs

Veteran overdose dangers must be understood as the result of ongoing interactions between psychological, social, and structural factors, as well as biological and physiological ones. To address drug overdose in veterans, accessible, non-judgmental, low-threshold, all-encompassing solutions that take into account the complex etiology of overdose risk for veterans are necessary.

Medication-Assisted Treatment (MAT)

• MAT medications are effective as they block euphoric effects and eliminate painful withdrawal symptoms.
• MAT helps promote abstinence success and reduces the number of overdoses and deaths. 
• MAT should always be combined with therapy.
  
• MAT used a whole-patient approach.

What medications?

1. Methadone – started being used in the 1940s for pain and in the 1970s for OUD. It reduces pain, cravings and withdrawal symptoms. Methadone tends to have an increased risk for abuse and addiction. 
   
2. Buprenorphine (Suboxone, Subutex) – effective in reducing pain, cravings and withdrawal symptoms. Targets parts of the brain that are responsible for feelings of pleasure. Buprenorphine has a reduced risk of abuse.
3. Naltrexone – blocks the effects of opioids and reduces the withdrawal symptoms without any impact on the brain, reducing risk of abuse.

Increased Awareness About the Risks of Fentanyl and Opioid Abuse

The VA acknowledges that physicians require enhanced training to manage Veterans’ opioid treatment. A comprehensive understanding of opioid addiction and overdose among veterans must look at the relationship between pain, pain treatment and stress, as well as psychological and social experiences before, during and after military service.

Interventions that address each of these dimensions are necessary for comprehensive efforts to address the veteran addiction and overdose crisis. 

Increase Access to Mental Health Services and Support Groups for Veteran Addicts

The vast majority of veterans who are not connected to the Veterans Health Administration and veterans who, for a variety of reasons, including mental health issues and the desire to avoid stigma, are socially isolated or reluctant to utilize traditional substance abuse services may benefit from community care models.

The more socially isolated veterans who may not have access to naloxone or the social support they need in an overdose situation must be targeted by interventions.

Cognitive behavioral therapy (CBT) is one method of mental health treatment that has proven successful in treating underlying mental health conditions. PTSD treatment should be trauma-centered to be successful. Another therapy that has been successful is meditation and mindfulness. 

PTSD can be effectively treated with CBT and antidepressants and treating these conditions reduces stress, which in turn reduces the severity of pain.

Developing New Therapies to Help Manage Long-term Recovery from Addiction

Increasing the number of low-threshold wrap-around services, such as medications for opioid use disorder (MOUD) and holistic/complementary approaches, are two promising interventions.

Many of the obstacles to opioid-related risk mitigation that veterans face may be best addressed by peer-led interventions, which are delivered by people who share key experiential or sociodemographic characteristics with the population being served.

Warning Signs

If you suspect your loved one is using opioids, there are some signs to watch for including:

• Mood changes: opioid use leads to changes in mood, irritability, depression and anxiety.
• Unusual behavior: people abusing opioids have a likelihood of social withdrawal, having issues at work, financial problems, hygiene issues, engaging in risky behaviors, lying and becoming confused or disorientated.
• Drug seeking: people with opioid addiction are going to run out of their prescribed medications quite quickly and will resort to trying to get more in any way they can. They may try to borrow from a friend, pretending to lose their medication. These people will usually have more than one doctor in order to receive multiple prescriptions. This usually leads to seeking illegal forms of the drug. 

Get Help with Fentanyl and Opioid Use Disorder

If you or a loved one are struggling with fentanyl or opioid addiction, please get in touch with Luxe Recovery today. There are various treatment options which our knowledgeable admissions team can discuss with you.

Luxe Recovery offers a world class substance abuse and mental health treatment program to our clients as they make a commitment to overcome their addiction and live a fulfilling life of sobriety.