Nearly 100,000 veterans currently are receiving prescriptions for both tranquilizers and narcotic painkillers from the U.S. Department of Veterans Affairs, a potentially deadly combination that is explicitly discouraged by agency guidelines.
The scale of the problem came to light in prepared testimony delivered by Carolyn Clancy, the VA’s interim undersecretary for health, ahead of a Senate Committee on Veterans’ Affairs hearing this morning into the overuse of opiates.
The VA’s use of these risky combinations has been under the microscope since January, when The Center for Investigative Reporting revealed a pattern of runaway opiate prescriptions and overdose deaths at the VA medical center in Tomah, Wisconsin.
There are “tragic and real consequences for veterans, their families and entire communities,” said Sen. Tammy Baldwin, the Wisconsin Democrat who called for the hearing after CIR’s exposé.
Questioning Clancy, Baldwin expressed concern about “dangerous drug combinations,” like the one that killed Marine Corps veteran Jason Simcakoski. The 35-year-old veteran died of a drug overdose in the Tomah VA’s psychiatric ward in August.
An autopsy report prepared by the University of Wisconsin Hospital and Clinics declared the cause of death to be “mixed drug toxicity,” including two opiate painkillers and diazepam, the generic form of the tranquilizer Valium.
An internal investigation launched by the VA in January found that veterans treated in Tomah often were issued opiates in combinations with tranquilizers – a combination that can cause a person to stop breathing.
During today’s hearing, Clancy said the agency was slowly reining in the dangerous practice nationally. Data obtained by CIR show that the number of veterans receiving both benzodiazepines and opiates has fallen from about 120,000 in September 2013 to 93,000 today.
But lawmakers wondered why powerful drug cocktails were being prescribed at all when they have no proven medical benefits.
Sen. Bill Cassidy, R-La., waved a September 2014 report from the American Academy of Neurology, which found there was “no substantial evidence” for prescribing opiates long term to patients who do not have cancer.
According to Clancy, the VA currently has about 370,000 patients who have been taking narcotics for more than three months.
“We don’t have easy alternatives,” Clancy said. “We don’t have a good answer for chronic pain that fits everyone.”
Cassidy responded: “It violates ‘first do no harm,’ ” he said. “Sometimes, the best answer is no. Otherwise, it is addiction, overdose and suicide.”
Nationally, the fatal overdose rate for VA patients is twice the national average.
Today’s hearing is the fourth in which the VA’s overreliance on narcotics has been discussed since CIR’s January report on problems in Tomah.
The oversight follows a similar series of hearings that began in October 2013 in which the VA promised to expand alternative therapies like acupuncture and yoga. Since then, the agency said the number of veterans on opiates has declined by 78,000, a 12 percent drop.
But as the problems in Tomah underscore, the rollout of promised reforms has been uneven at best. There, as across the country, veterans complain that alternative therapies have been slow to materialize.
On Monday, the Senate Committee on Homeland Security and Governmental Affairs will hold a joint hearing in Tomah with the House Committee on Veterans’ Affairs.