‘Any soldier can deploy on anything’ - Army News | News from Afghanistan & Iraq - Army Times

‘Any soldier can deploy on anything’

Sgt. Chuck Luther wasn’t on any psychotropic drugs when he deployed to Iraq in October 2006, settling in at Camp Taji with the 1st Cavalry Division during the war’s darkest days, shortly before the surge began.

But after a few months, he was shaken by the deaths in his unit.

“I started having nightmares ... having to go and pick up the body bags at the gate and deliver them to the mortuary affairs units; nightmares about getting killed, getting blown up,” Luther recalled.

He told his command he was depressed, angry and having trouble sleeping. They sent him to a social worker who suggested he begin taking psychotropic drugs. But the social worker, a lieutenant colonel, lacked the legal authority to prescribe such drugs.

“He sent me to a captain, a psychiatrist who could actually prescribe medicine,” Luther said. “We had five minutes of face time. We call it ‘checking the box’ in the military. He says, ‘I heard you’re having thoughts of suicide, I hear you’re having anger. We’re going to try this. Just go over to the pharmacy and pick it up.’ ”

Luther returned to his trailer that night with four bottles of pills: Selexa, an antidepressant; Seroquel, an antipsychotic; Ambien, sleeping pills; and the anti-anxiety drug Valium.

Sending drugs downrange

In late 2006, the Pentagon issued a rule barring troops who were taking some drugs from deploying to a combat zone. They include “antipsychotics used to treat bipolar and chronic insomnia symptoms; lithium and anticonvulsants used to control bipolar symptoms.”

The rule came in response to a congressional mandate to tighten mental health screening for deployed troops. Doctors say they help ensure that troops can handle the demands of deployment while also having access to the medical supervision and follow-up care these drugs can require.

But the rules are ambiguous; drugs specifically mentioned in the policy are, in fact, making their way to the war zones, according to deployed troop data maintained by Tricare.

“Any soldier can deploy on anything,” said Capt. Maria Kimble, an Army reservist and clinical social worker who served as the primary behavioral health officer for brigade combat teams in Iraq and Afghanistan. “It’s always kind of subjective. If they really want someone to deploy, they can always find a loophole.”

The quantities of these heavy psychiatric medications going downrange is unclear.

Officials at Tricare and the Defense Logistics Agency say they do not have comprehensive estimates for the quantity and type of drugs heading specifically into the war zones.

One Tricare official said some drug shipments to clinics in U.S. Central Command, which oversees the Iraq and Afghanistan war zones, “fall into a black hole.”

Another official, Rear Adm. Tom McGuiness, chief pharmacy officer for Tricare, acknowledged in an interview that “the records aren’t great in the forward units.”

Tricare’s estimates on drugs provided to deploying troops appear to show some quantities of antipsychotics and anticonvulsants are being issued to troops heading overseas.

About 89,000 antipsychotic pills and 578,000 anticonvulsant pills were prescribed and provided to deploying troops in 2008, according to Tricare data provided to Military Times.

Yet when asked about these drugs and their potential conflicts with the Pentagon’s rules, McGuiness said his agency’s best guess was imprecise and that those drugs may have gone to nondeploying troops.

Military studies have estimated that from 5 percent to 17 percent of troops in the war zones from 2007 to 2009 were taking medications for mental health problems or combat stress.

Army Brig. Gen. Loree Sutton, an Army psychiatrist, said 3 percent to 6 percent of troops are using antidepressants.

Anecdotally, the numbers may be far higher. Kimble, the Army social worker, put the figure at upwards of 50 percent in some individual units.

Many military psychiatrists acknowledge that the use of mental health drugs is uniquely complex in military medicine, especially in combat zones.

Military physicians must consider not only the health of the individual patients, but also their duty to the mission, said Grace Jackson, a psychiatrist and former Navy lieutenant commander who resigned her commission in 2002 because she was uncomfortable with the military’s heavy and growing use of psychotropic drugs.

“There has always been an added complication with military medicine,” Jackson said. “The physician in uniform takes two oaths — an oath to serve the patient and an oath to serve the nation, commander in chief and the larger military. Where do you draw the line between performance enhancement and the treatment of pathology?”

Oversight questioned

The issue of psychiatric drug use in the war zones has begun to attract attention on Capitol Hill.

In November, Sen. Ben Cardin, D-Md., asked Defense Secretary Robert Gates for details on “how many troops serving in Iraq and Afghanistan have been prescribed antidepressant medications while deployed.”

Gates agreed to provide the data later this year, Cardin said.

“We are concerned about the appropriate use of medicine with the proper protocols for those who are in combat zones,” Cardin said in an interview. “What we are trying to do is get the statistical information to get a better handle on what is being used and whether we are following the best medical protocols.”

Luther said drug use was common among troops he served with, and many passed around these controlled substances — technically a crime under state and federal law — just like any other piece of essential gear shared among a tightly knit unit.

“We didn’t just share MREs and water; we shared Ambien, too,” Luther said. “One time another soldier said, ‘Hey, I’m running out of my Ambien and I can’t get it until I get back to refit our truck in a few days.’ I said, ‘Sure, I can help you out, as long as you get me back when you refill.’”

Luther was separated from the Army because doctors said he had a “personality disorder” — essentially they blamed his problems on a pre-existing condition rather than on his combat experience.

These days, Luther lives near Fort Hood, where he has a job driving a truck delivering snack food. He believes he was improperly discharged and has been fighting the Army’s medical determination.

He said he’s tried to wean himself off the psychiatric medications he began taking a few years ago. “I was a zombie; I couldn’t remember my kids’ names,” he said.

But even now, he remains on two daily medications — Trazodone, an antidepressant, and Buspar, typically used as an anti-anxiety drug. They were prescribed by VA doctors.

Drug types

• Antipsychotics: Use of antipsychotic drugs in the military community has tripled since 2001, more than any other psychiatric drug.

These drugs aim to block or reduce certain chemicals in the brain, primarily dopamine, that are associated with psychotic episodes.

Older versions of anti-psychotics such as lithium and Thorazine have been around for decades, used to treat conditions like psychosis, bipolar disorder and schizophrenia.

But newer versions of these drugs — with brand names like Abilify, Risperdal and Seroquel — now are often used for treating moderate to severe depression.

They are also effective sleep aids that reduce nightmares. Preliminary studies using them as a treatment for post-traumatic stress disorder are promising, and VA is conducting a large-scale study of the drugs.

These drugs also can effectively treat depression, particularly the kind rooted in anxiety, rather than driven by persistent melancholy, doctors say.

• Anticonvulsants: Often referred to as anti-epileptics or “mood stabilizers,” these drugs, which include Klonopin, Neurontin and Topamax, aim to calm hyperactivity in the brain in various ways.

Originally designed to prevent seizures in epileptics, they are now often prescribed for severe psychiatric conditions such as bipolar disorder, as well as migraine headaches and neuropathic pain.

More recently, doctors are prescribing anticonvulsants for PTSD, but its effectiveness for that purpose remains unclear. Clinical testing has been limited to “small and poorly controlled trials,” said Dr. Matthew Friedman, executive director of VA’s National Center for PTSD.

Nevertheless, their use for PTSD and its symptoms is not uncommon.

These drugs also are commonly used to treat traumatic brain injury and “phantom limb syndrome,” when the brain continues to receive pain signals from a missing limb.