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Top News arrow Safety Issues arrow Military Deaths Linked to Prescribed Psych Drugs
Military Deaths Linked to Prescribed Psych Drugs Print E-mail
Friday, 11 March 2011

If mentally incapacitated troops are being drugged with dangerous, mind-altering drugs and deployed to battle against their will, how can we say that we have a volunteer army?

The increasingly high number of DEATHS in the US military--from suicides, accidental overdose, and, increasingly, lethal drug interactions--has been linked to the exponential increase in the prescribing of powerful, psychotropic drugs.

Since The Hartford Courant first published several investigative reports (2006) about the deadly consequences of prescribing powerful psychotropic drugs to US troops who were deployed to battle with a supply of these mind-altering drugs--where those ingesting them pose a danger both to themselves and to the other troops--a series of reports have documented the continued rise in the death toll.. 

The latest report in The New York Times (February, 2011, below), confirms that the norm and practice in the military is reliance on potentially lethal psychotropic drug combinations continues--even as the body count climbs. 

 "After a decade of treating thousands of wounded troops, the military’s medical system is awash in prescription drugs — and the results have sometimes been deadly.

By some estimates, well over 300,000 troops have returned from Iraq or Afghanistan with P.T.S.D., depression, traumatic brain injury or some combination of those. The Pentagon has looked to pharmacology to treat those complex problems, following the lead of civilian medicine. As a result, psychiatric drugs have been used more widely across the military than in any previous war.

But those medications, along with narcotic painkillers, are being increasingly linked to a rising tide of other problems, among them drug dependency, suicide and fatal accidents — sometimes from the interaction of the drugs themselves.

An Army report on suicide released last year documented the problem, saying one-third of the force was on at least one prescription medication.

“Prescription drug use is on the rise,” the report said, noting that medications were involved in one-third of the record 162 suicides by active-duty soldiers in 2009. An additional 101 soldiers died accidentally from the toxic mixing of prescription drugs from 2006 to 2009."

 THE HARTFORD COURANT / ASSOCIATED PRESS   MAY 14, 2006   Military Ignores Mental Illness

"The U.S. military is sending troops with serious psychological problems into Iraq and is keeping soldiers in combat even after superiors have been alerted to suicide warnings and other signs of mental illness, a Courant investigation has found.  Once at war, some unstable troops are kept on the front lines while on potent antidepressants and anti-anxiety drugs, with little or no counseling or medical monitoring. And some troops who developed post-traumatic stress disorder after serving in Iraq are being sent back to the war zone, increasing the risk to their mental health.

"Some service members who committed suicide in 2004 and 2005 were kept on duty despite clear signs of mental distress, sometimes after being prescribed antidepressants with little or no mental health counseling or monitoring, the Courant reported. Those findings conflict with regulations adopted last year by the Army that caution against the use of antidepressants for "extended deployments."

"I can't imagine something more irresponsible than putting a Soldier suffering from stress on (antidepressants), when you know these drugs can cause people to become suicidal and homicidal," said Vera Sharav, president of the Alliance for Human Research Protection, a New York-based advocacy group. "You're creating chemically activated time bombs."

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TIME MAGAZINE   FEBRUARY 9, 2009  America's Medicated Army 

"For the first time in history, a sizable and growing number of U.S. combat troops are taking daily doses of antidepressants to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan. The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource:soldiers on the front lines.

Data contained in the Army's fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope. Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say." 

TRUTHOUT  Hearing Debates Link Between Psychiatric Drugs and Veterans' Suicides Thursday 25 February 2010  

Beginning in 2002, the suicide rate among soldiers rose significantly, reaching record levels in 2007 and again in 2008 despite the Army's major prevention and intervention efforts,

 THE NAVY TIMES   Mar 17, 2010   Medicating the military

 EXCERPT:  The DLA records detail the range of drugs being prescribed to the military community and the spending on them:

• Antipsychotic medications, including Seroquel and Risperdal, spiked most dramatically — orders jumped by more than 200 percent, and annual spending more than quadrupled, from $4 million to $16 million.

• Use of anti-anxiety drugs and sedatives such as Valium and Ambien also rose substantially; orders increased 170 percent, while spending nearly tripled, from $6 million to about $17 million.

• Antiepileptic drugs, also known as anticonvulsants, were among the most commonly used psychiatric medications. Annual orders for these drugs increased about 70 percent, while spending more than doubled, from $16 million to $35 million.

• Antidepressants had a comparatively modest 40 percent gain in orders, but it was the only drug group to show an overall decrease in spending, from $49 million in 2001 to $41 million in 2009, a drop of 16 percent. The debut in recent years of cheaper generic versions of these drugs is likely responsible for driving down costs.

Antidepressants and anticonvulsants are the most common mental health medications prescribed to service members. Seventeen percent of the active-duty force, and as much as 6 percent of deployed troops, are on antidepressants, Brig. Gen. Loree Sutton, the Army’s highest-ranking psychiatrist, told Congress on Feb. 24.

In contrast, about 10 percent of all Americans take antidepressants, according to a 2009 Columbia University study.

XXX cut XXX

Doctors — and, more recently, lawmakers — are questioning whether the drugs could be responsible for the spike in military suicides during the past several years, an upward trend that roughly parallels the rise in psychiatric drug use.

From 2001 to 2009, the Army’s suicide rate increased more than 150 percent, from 9 per 100,000 soldiers to 23 per 100,000. The Marine Corps suicide rate is up about 50 percent, from 16.7 per 100,000 Marines in 2001 to 24 per 100,000 last year. Orders for psychiatric drugs in the analysis rose 76 percent over the same period.

“There is overwhelming evidence that the newer antidepressants commonly prescribed by the military can cause or worsen suicidality, aggression and other dangerous mental states,” said Dr. Peter Breggin, a psychiatrist who testified at the same Feb. 24 congressional hearing at which Sutton appeared.

Other side effects — increased irritability, aggressiveness and hostility — also could pose a risk.

 ~~~~~~~~~~~~~

USA TODAY  January 20, 2011  More Army Guard, Reserve soldiers committing suicide

The Army released final year-end statistics Wednesday. There were 301 confirmed or suspected soldier suicides in 2010, including those on active duty and reservists or National Guard troops on an inactive status, the Army reported Wednesday. This compares with 242 in 2009.

See also chart documenting US Military Suicides, 2003-2010 at Peace Patriotic.org 

The prescribing practices border on reckless endangerment--which is a felony. Two questions arise:

1. If mentally incapacitated troops are being drugged and deployed against their will, how can we say that we have a volunteer army?

2. How is this prescribing practice any less deplorable than prison chain gangs?

 

Vera Hassner Sharav

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 THE NEW YORK TIMES  February 12, 2011

For Some Troops, Powerful Drug Cocktails Have Deadly Results 

By JAMES DAO, BENEDICT CAREY and DAN FROSCH
This article was reported by James Dao, Benedict Carey and Dan Frosch and written by Mr. Dao.

In his last months alive, Senior Airman Anthony Mena rarely left home without a backpack filled with medications. He returned from his second deployment to Iraq complaining of back pain, insomnia, anxiety and nightmares. Doctors diagnosed post-traumatic stress disorder and prescribed powerful cocktails of psychiatric drugs and narcotics.

Yet his pain only deepened, as did his depression. “I have almost given up hope,” he told a doctor in 2008, medical records show. “I should have died in Iraq.”

Airman Mena died instead in his Albuquerque apartment, on July 21, 2009, five months after leaving the Air Force on a medical discharge. A toxicologist found eight prescription medications in his blood, including three antidepressants, a sedative, a sleeping pill and two potent painkillers.

Yet his death was no suicide, the medical examiner concluded. What killed Airman Mena was not an overdose of any one drug, but the interaction of many. He was 23.

After a decade of treating thousands of wounded troops, the military’s medical system is awash in prescription drugs — and the results have sometimes been deadly.

By some estimates, well over 300,000 troops have returned from Iraq or Afghanistan with P.T.S.D., depression, traumatic brain injury or some combination of those. The Pentagon has looked to pharmacology to treat those complex problems, following the lead of civilian medicine. As a result, psychiatric drugs have been used more widely across the military than in any previous war.

But those medications, along with narcotic painkillers, are being increasingly linked to a rising tide of other problems, among them drug dependency, suicide and fatal accidents — sometimes from the interaction of the drugs themselves. An Army report on suicide released last year documented the problem, saying one-third of the force was on at least one prescription medication.

“Prescription drug use is on the rise,” the report said, noting that medications were involved in one-third of the record 162 suicides by active-duty soldiers in 2009. An additional 101 soldiers died accidentally from the toxic mixing of prescription drugs from 2006 to 2009.

“I’m not a doctor, but there is something inside that tells me the fewer of these things we prescribe, the better off we’ll be,” Gen. Peter W. Chiarelli, the vice chief of staff of the Army who has led efforts on suicide, said in an interview.

Growing awareness of the dangers of overmedicated troops has prompted the Defense Department to improve the monitoring of prescription medications and restrict their use.

In November, the Army issued a new policy on the use of multiple medications that calls for increased training for clinicians, 30-day limits on new prescriptions and comprehensive reviews of cases where patients are receiving four or more drugs.

The Pentagon is also promoting measures to prevent troops from stockpiling medications, a common source of overdoses. For instance, the Navy, which provides medical care for Marines, has begun pill “give back” days on certain bases. At Camp Lejeune, N.C., 22,000 expired pills were returned in December.

The Army and the Navy are also offering more treatments without drugs, including acupuncture and yoga. And they have tried to expand talk therapy programs — one of which, exposure therapy, is considered by some experts to be the only proven treatment for P.T.S.D. But shortages of mental health professionals have hampered those efforts.

Still, given the depth of the medical problems facing combat veterans, as well as the medical system’s heavy reliance on drugs, few experts expect the widespread use of multiple medications to decline significantly anytime soon.

The New York Times reviewed in detail the cases of three service members who died from what coroners said were toxic interactions of prescription drugs. All were classified accidents, not suicides.

Airman Mena was part of a military police unit that conducted combat patrols alongside Army units in downtown Baghdad. He cleaned up the remains of suicide bombing victims and was nearly killed by a bomb himself, his records show.

Gunnery Sgt. Christopher Bachus had spent virtually his entire adult life in the Marine Corps, deploying to the Middle East in 1991, Iraq during the invasion of 2003 and, for a short tour, Afghanistan in 2005. He suffered from what doctors called survivor’s guilt and came back “like a ghost,” said his brother, Jerry, of Westerville, Ohio.

Cpl. Nicholas Endicott joined the Marines in 2003 after working as a coal miner in West Virginia. He deployed twice to Iraq and once to Afghanistan, where he saw heavy combat. On one mission, Corporal Endicott was blown more than eight feet in the air by a roadside bomb, medical records show. He came home plagued by nightmares and flashbacks and rarely left the house.

Given the complexity of drug interactions, it is difficult to know precisely what killed the three men, and the Pentagon declined to discuss their cases, citing confidentiality. But there were important similarities to their stories.

All the men had been deployed multiple times and eventually received diagnoses of P.T.S.D. All had five or more medications in their systems when they died, including opiate painkillers and mood-altering psychiatric drugs, but not alcohol. All had switched drugs repeatedly, hoping for better results that never arrived.

All died in their sleep.

Psychiatry and Warfare

The military medical system has struggled to meet the demand caused by two wars, and to this day it still reports shortages of therapists, psychologists and psychiatrists. But medications have always been readily available.

Across all branches, spending on psychiatric drugs has more than doubled since 2001, to $280 million in 2010, according to numbers obtained from the Defense Logistics Agency by a Cornell University psychiatrist, Dr. Richard A. Friedman.

Clinicians in the health systems of the Defense and Veterans Affairs Departments say that for most patients, those medications have proved safe. “It is important not to understate the benefit of these medications,” said Dr. Robert Kerns, the national director of pain management for the Department of Veterans Affairs.

Paradoxically, the military came under criticism a decade ago for not prescribing enough medications, particularly for pain. In its willingness to prescribe more readily, the Pentagon was trying to meet standards similar to civilian medicine, General Chiarelli said.

But the response of modern psychiatry to modern warfare has not always been perfect. Psychiatrists still do not have good medications for the social withdrawal, nightmares and irritability that often accompany post-traumatic stress, so they mix and match drugs, trying to relieve symptoms.

“These decisions about medication are difficult enough in civilian psychiatry, but unfortunately in this very-high-stress population, there is almost no data to guide you,” said Dr. Ranga R. Krishnan, a psychiatrist at Duke University. “The psychiatrist is trying everything and to some extent is flying blind.”

Thousands of troops struggle with insomnia, anxiety and chronic pain — a combination that is particularly treacherous to treat with medications. Pairing a pain medication like oxycodone, a narcotic, with an anti-anxiety drug like Xanax, a so-called benzodiazepine, amplifies the tranquilizing effects of both, doctors say.

Similarly, antidepressants like Prozac or Celexa block liver enzymes that help break down narcotics and anxiety drugs, extending their effects.

“The sedation is not necessarily two plus two is four,” said Cmdr. Rosemary Malone, a Navy forensic psychiatrist. “It could be synergistic. So two plus two could be five.”

Commander Malone and other military doctors said the key to the safe use of multiple prescriptions was careful monitoring: each time clinicians prescribe drugs, they must review a patient’s records and adjust dosages to reduce the risk of harmful interactions. “The goal is to use the least amount of medication at the lowest doses possible to help that patient,” she said.

But there are limits to the monitoring. Troops who see private clinicians — commonly done to avoid the stigma of seeking mental health care on a base — may receive medications that are not recorded in their official military health records.

In the case of Sergeant Bachus of the Marines, it is far from clear that he received the least amount of medication possible.

He saw combat in Iraq, his brother said, and struggled with alcoholism, anxiety, flashbacks, irritability and what doctors called survivor’s guilt after returning home. “He could make himself the life of the party,” Jerry Bachus recalled. “But he came back a shell, like a ghost.”

Sergeant Bachus received a diagnosis of P.T.S.D., and starting in 2005, doctors put him on a regimen that included Celexa for depression, Klonopin for anxiety and Risperdal, an antipsychotic. In 2006, after a period of stability, a military doctor discontinued his medications. But six months later, Sergeant Bachus asked to be put on them again.

According to a detailed autopsy report, his depression and anxiety worsened in late 2006. Yet for unexplained reasons, he was allowed to deploy to Iraq for a second time in early 2007. But when his commanders discovered that he was on psychiatric medications, he was sent home after just a few months, records show.

Frustrated and ashamed that he could not be in a front-line unit and unwilling to work behind a desk, he applied in late 2007 for a medical retirement, a lengthy and often stressful process that seemed to darken his mood.

In early March 2008, a military doctor began giving him an opiate painkiller for his back. A few days later, Sergeant Bachus, 38, called his wife, who was living in Ohio. He sounded delusional, she told investigators later, but not suicidal.

“You know, babe, I am really tired, and I don’t think I’ll have any problems falling asleep tonight,” he told her. He was found dead in his on-base quarters in North Carolina nearly three days later.

According to the autopsy report, Sergeant Bachus had in his system two antidepressants, the opiates oxymorphone and oxycodone, and Ativan for anxiety. The delirium he experienced in his final days was “most likely due to the interaction of his medications,” the report said.

Nearly 30 prescription pill bottles were found at the scene, most of them recently prescribed, according to the report.

Jerry Bachus pressed the Marine Corps and the Navy for more information about his brother’s death, but received no further explanations. “There was nothing accidental about it,” he said. “It was inevitable.”

Self-Medicating

The widespread availability of prescription medications is increasingly being linked by military officials to growing substance abuse, particularly with opiates. A Defense Department survey last year found that the illegal use of prescription drugs in the military had tripled from 2005 to 2008, with five times as many troops claiming to abuse prescription drugs than illegal ones like cocaine or marijuana.

The problem has become particularly acute in specialized units for wounded troops, where commanders say the trading of prescription medications is rampant. A report released last month by the Army inspector general estimated that up to a third of all soldiers in these Warrior Transition Units are overmedicated, dependent on medications or have easy access to illegal drugs.

Some of that abuse is for recreational purposes, military officials say. In response, the Army has taken several steps to tighten the monitoring of troops on multiple prescriptions in the transition units.

But in many cases, wounded troops are acquiring drugs improperly because their own prescriptions seem ineffective, experts say. They are self-medicating, sometimes to death.

“This is a huge issue, and partly it’s due to the availability of prescription drugs among returning troops,” said Dr. Martin P. Paulus, a psychiatrist at the University of California, San Diego, and the V.A. San Diego Medical Center. “Everyone knows someone who’ll say, ‘Hey, this worked for me, give it a try.’ ”

Corporal Endicott, for instance, died after adding the opiate painkiller methadone to his already long list of prescribed medications. His doctors said that they did not know where he got the narcotic and that they had not authorized it.

Corporal Endicott, who survived a roadside bomb explosion, was in heavy fighting in Afghanistan, where he saw other Marines killed. After returning from his third deployment, in 2007, Corporal Endicott told doctors that he was having nightmares and flashbacks and rarely left his house. After a car accident, he assaulted the other driver, according to medical records. Doctors diagnosed P.T.S.D. and came to suspect that Corporal Endicott had a traumatic brain injury.

Over the coming year, he was prescribed at least five medications, including the antidepressants Prozac and Trazodone, and an anti-anxiety medication. Yet he continued to have headaches, anxiety and vivid nightmares.

“He would be hitting the headboard,” said his father, Charles. “He would be saying: ‘Get down! Here they come!’ ”

On Jan. 29, 2008, Corporal Endicott was found dead in his room at the National Naval Medical Center in Bethesda, Md., where he had checked himself in for anger management after another car accident. He was 26.

A toxicologist detected at least nine prescription drugs in his system, including five different benzodiazepines, drugs used to reduce anxiety or improve sleep. Small amounts of marijuana and methadone — a narcotic that is particularly dangerous when mixed with benzodiazepines — were also found in his body.

His death prompted Marine Corps officials at Bethesda and Walter Reed Army Medical Center to initiate new procedures to keep Marines from inappropriately mixing medications, including assigning case managers to oversee patients, records show.

Whether Corporal Endicott used methadone to get high or to relieve pain remains unclear. The Marine Corps concluded that his death was not due to misconduct.

“He survived over there,” his father said. “Coming home and dying in a hospital? It’s a disgrace.”

Trying to Numb the Pain

Airman Mena also returned from war a drastically changed man. He had deployed to Iraq in 2005 but saw little action and wanted to go back. He got the chance in late 2006, when sectarian violence was hitting a peak.

After coming home, he spoke repeatedly of feeling guilty about missing patrols where a sergeant was killed and where several platoon mates were seriously wounded. Had he been driving on those missions, he told therapists, he would have avoided the attacks.

“On my first day, I saw a total of 12 bodies,” he said in one psychological assessment. “Over there, I lost faith in God, because how can God allow all these dead bodies?”

By the summer of 2008, he was on half a dozen medications for depression, anxiety, insomnia and pain. His back and neck pain worsened, but Air Force doctors could not pinpoint a cause. Once gregarious and carefree, Airman Mena had become perpetually irritable. At times he seemed to have hallucinations, his mother and friends said, and was often full of rage while driving.

In February 2009, he received an honorable discharge and was given a 100 percent disability rating by the Department of Veterans Affairs, meaning he was considered unable to work. He abandoned plans to become a police officer.

Now a veteran, his steady medication regimen continued — but did not seem to make him better. His mother, Pat Mena, recalls him being unable to sleep yet also listless, his face a constant shade of pale. Shocked by the piles of pills in his Albuquerque apartment, she once flushed dozens of old prescriptions down the toilet.

Yet for all his troubles, he seemed hopeful when she visited him in early July 2009. He was making plans to open a cigar store, which he planned to call Fumar. His mother would be in charge of decorating it.

The night after his mother left, he put on a new Fentanyl patch, a powerful narcotic often used by cancer patients that he had started using just five weeks before. The Food and Drug Administration issued warnings about the patches in 2007 after deaths were linked to it, but a private clinic in Albuquerque prescribed the medication because his other painkillers had failed, records show.

With his increasingly bad memory, he often forgot what pills he was taking, his mother said. That night when he put on his new patch, he forgot to remove the old one. He died early the next day.

Was the Fentanyl the cause? Or was it the hydromorphone, another narcotic found in his system? Or the antidepressants? Or the sedative Xanax? Or all of the above?

The medical examiner could not say for sure, noting simply that the drugs together had caused “respiratory depression.”“The manner of death,” the autopsy concluded, “is accident.”

Toby Lyles contributed research.

 

 
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