Before he found relief from crippling back pain with an electrode embedded in his spine, retired Army First Sgt. Justin Minyard downed OxyContin, oxycodone and Vicodin pills and sometimes slapped on a Fentanyl patch prescribed by Veterans Affairs Department doctors to vanquish his pain.
The Iraq war veteran, who first hurt his back during search and recovery operations at the Pentagon on 9/11, became addicted to the powerful painkillers, living life in a fog and counting the minutes until his next dose, he said.
“I was taking enough pills daily to treat four terminally ill cancer patients,” Minyard testified before Congress on Thursday.
According to media reports, the Government Accountability Office, and widows and retired troops speaking before a House Veterans Affairs health panel Thursday, VA physicians are over-prescribing medications, writing scripts for addictive drugs and issuing multiple medications to patients without regard to their distribution, side effects or potential lethality.
Data obtained by the Center of Investigative Reporting through the Freedom of Information Act published last month shows prescriptions for opiates like hydrocodone, oxycodone, methadone and morphine have increased 270 percent in the past 12 years at VA.
The investigation also found that on average, VA has issued more than one opiate prescription per patient for the past two years.
The hearing took a detailed look at VA’s oversight of prescriptions, the transition of care and medications between the Pentagon and VA when troops leave active duty, and quality control measures at VA to ensure patient safety.
Witnesses tearfully described lives shattered by addiction, unmanaged pain and accidental drug overdoses.
Heather McDonald found her husband Scott “cold and unresponsive” on Sept. 13, 2012. Among the causes of death for the 35-year-old former Army specialist: liver failure caused by drug toxicity.
Her husband never was offered or received a test to monitor whether the drugs he was prescribed were harming his kidneys or liver.
“Tests that can save lives are not being performed,” McDonald said. “A simple ‘I am in pain’ seems to be a good enough evaluation to prescribe painkillers.”
Dr. Robert Jesse, principal deputy under secretary for health at the Veterans Health Administration, expressed deep regret to the widows and former troops and said VA historically has been at the forefront of chronic pain management and mental health treatments associated with prescribing opiates.
He added that VA is working to address issues with ongoing initiatives and improved training.
VA and the Defense Department in 2003 established clinical practice guidelines for prescribing opioids for chronic pain.
“VA cares for a veteran population that suffers much higher rates of chronic pain than the civilian population ... in recognition of the seriousness of the impact of chronic pain ... VHA was among one of the first health systems in the country to establish a strong policy on chronic pain management,” Jesse said.
But witnesses testify that many VA providers don’t follow the department’s own guidelines.
Dr. Pamela Gray said she was named a pain management specialist at the VA facility where she worked even though she is a primary care physician with no specialized training in chronic pain.
“My concern is that it’s not standard of care. If you are going to portray yourself as an obstetrician, you better have obstetrics training. It’s just common sense,” Gray said. “I was coerced by non-medical employees to write for large amounts of opiates.”
Lawmakers blasted what they called “indefensible” policies that allow providers not skilled in pain management to treat patients for chronic pain and prescribe risky, highly addictive narcotics.
“A disturbing number of pain, psychiatric and sleeping medications are being prescribed without any clear consideration or special attention paid to how these powerful drugs interact with one another or affect physical and mental well-being of veterans,” said Rep. Dan Benishek, R-Mich., a physician and subcommittee chair.
“I leave compelled that the system appears to be broken. I’m going to have faith that there are pockets of excellence, but how do you respond to a system of ‘quick and cheap’ over ‘good and thorough?’ The principles of medicine appear to have been abandoned,” said panel ranking member Rep. Julia Brownley, D-Calif.
Benishek indicated that he will meet one-on-one with Jesse during the next several months to ensure that VA is moving toward vociferously promoting its own recommended guidelines.