Soldiers returning from battle continue their fight on the home front, but the enemy is often invisible.
Many military veterans don’t want to talk about it and don’t want to admit it, but after their tour of duty, injury and chronic pain earned in battle often follows them home. Nearly half of all vets returning from deployment in Afghanistan and Iraq suffer from chronic pain, with one in six (15%) turning to opioids for pain relief. Compare that statistic to the general population – approximately 26% of people suffer from chronic pain with 4% using opioids – and it’s clear that you have a dangerous epidemic.
A study published in the June 30, 2014 issue of JAMA Internal Medicine found that not only were more soldiers taking opioids for chronic pain, but some soldiers also admitted to taking opioids daily when no pain was present. Just under half of the 2,600 soldiers in the study admitted to no pain or only mild pain in the previous month. From the study authors:
“This might imply that opioids are working to mitigate pain, but it is also possible that soldiers are receiving or using these medications unnecessarily. This is cause for concern because opioids should be prescribed generally for moderate to severe pain and have high abuse and overdose potential.”
Of the remaining soldiers:
- 48% reported pain lasting more than a year
- 56% suffer daily pain
- 51% classify their pain as moderate or severe
This daily chronic pain and the disproportionate rates of opioid prescriptions among returning military suggest that we are not doing enough to care for our soldiers after deployment. Lead author Robin L. Toblin, PhD, MPH, from the Center for Military Psychiatry and Neuroscience at the Walter Reed Army Institute of Research in Silver Spring, Maryland, writes:
“These findings suggest a large unmet need for assessment, management, and treatment…in military personnel after combat deployments.”
A study published earlier in 2014 found that of the one million vets taking opioid pain medications, almost half of them were still taking them daily or longer than three months. Vets taking opioids daily or longer than three months also had high incidence of some or all of the following:
- Post-traumatic stress disorder
- Tobacco use
- Multiple chronic pain conditions
- Multiple opioid prescriptions
- Use of 100 mg or more daily
These vets were also more likely to be married which may prompt them to attempt to deal with their chronic pain in a manner that they view as efficient as possible (e.g., medication). Mental health issues in the military did not correlate with continued use of opioids, a pattern that is the opposite in the general population.
The issue of opioid overprescription is not confined to the military population, but the reasons behind its opioid use are complex. Soldiers are trained to work through pain, to ignore it when it is inconvenient. Many times soldiers in combat sustain injuries that are made worse by the very thing that saves their lives: adrenaline. Adrenaline governs the fight-or-flight response, blocking the sensation of pain in the moment when that choice must be made. When the adrenaline ebbs after the fact, soldiers are left with a severe injury that they then may or may not seek treatment for.
Even though soldiers who use opioids do not experience mental health issues at a higher rate than the general population, their rates of post-traumatic stress disorder are much higher. Returning home, it can be very difficult to process what they have seen, heard, and done. Returning home to a loving family who has not seen that side of the solider can place tremendous pressure on them to acclimate to home life quickly. Opioids are a sedative that can calm and relax the body in addition to taking the edge off the pain.
But research is mounting that, in cases of non-cancer chronic pain, opioids may do more harm than good. Opioids work on pain receptors in the brain. These pain receptors get used to the opioids very quickly and demand more to perform the same pain-relieving function. This demand can result in dependence and a high tolerance.
Other potentially fatal side effects of opioid use include:
- Accidental overdose: Soldiers taking opioids long-term may develop a high tolerance and take increasing amounts of medication. Combined with other medications or alcohol, this high tolerance places vets at high risk for accidental overdose. In 2013, 81% of drug overdoses were unintentional, and nearly 44,000 people died of drug overdose. Over half of these deaths involved pharmaceuticals, and of that half, 71% involved opioids.
- Depressed breathing and sleep apnea: The sedative effects of opioids can lead to a slower respiratory rate. For those in the military who smoke or have asthma, this can be a fatal side effect.
If someone you love is returning from deployment, welcome them home with loving arms, then take these steps to support them as they reintegrate into civilian life.
Encourage your soldier to talk about their experiences, but don’t force it
Actions taken in war can be haunting to many returning soldiers. They may need some time to figure them out before they are willing to share. They may never be ready and may feel like they need to spare their family the pain or trauma. Encourage them to talk to someone: if not you, a veterans group or trusted friend.
Help your soldier get into a routine
Immediately after returning home, a hot, home-cooked meal and a comfortable bed may be a priority, but after that is taken care of ease your vet into a normal routine if possible. If you have children, this is helpful to keep stability and so that they can see that their parent is still their parent.
After the physical effort of deployment and shock of coming home, exercise can be a great way to adjust to a different way of life, to burn off excess energy, and to boost mood. Exercise is also research-proven to help with chronic pain. Some exercises such as yoga combined with mindfulness meditation can help soldiers cope with post-traumatic stress.
Our military and their families make tremendous sacrifices in service to our country, and a legacy of opioids are not the way to show our gratitude. Find out more about how you can support them when they return home.
Image by DVIDSHUB via Flickr