Dependence Day

Author: Johanna Ryan, Labor Activist with Illinois Workers Compensation Lawyers (Chicago) 

Last month I watched as forty Iraq and Afghanistan vets led an antiwar march to the gates of the NATO summit in Chicago, and handed back their medals. At the rally, they described the toll the wars had taken on the troops as well as the people of Iraq and Afghanistan, and demanded their “right to heal.” Chief among the problems on their minds were post-traumatic stress disorder, suicide … and psychotropic drugs.

“It’s really appalling that when our brothers and sisters get home and they ask for help, the only help they can get is some type of medication, like Trazodone, Seroquel, Klonopin— medication that’s practically paralyzing, medication that doesn’t allow them to conduct themselves in any type of regular way,” veteran activist Aaron Hughes told Democracy Now. “And yet those are the same medications that service members are getting redeployed with, and conducting military operations on, and the same medications that we are trying to reintegrate into the world with.”

Conducting military operations? On Seroquel? There must be some mistake, I thought. But a little research confirmed Aaron’s accounting: the United States armed forces are increasingly marching on pharmaceuticals. Twenty percent of active-duty troops are on psychotropic medications, including 17% of the combat troops in Afghanistan.

The results are not pretty. Eighteen vets commit suicide each day. The Veterans Administration reports 1,000 suicide attempts, and 10,000 calls to its suicide hotline each month. Last year, 301 active-duty soldiers took their own lives. A 2010 Army internal report on the suicide crisis estimated that prescription drugs were involved in one-third of soldier suicides. Their estimate is probably conservative. “We have never medicated our troops to the extent we are doing now …. And I don’t believe the current increase in suicides and homicides in the military is a coincidence,” said Bart Billings, a former military psychologist who hosts an annual conference at Camp Pendleton on combat stress. (“A Fog of Drugs and War,” Kim Murphy, Los Angeles Times, April 7, 2012.) Rates of domestic violence, murder, child abuse and other violent crimes are also rising in military base communities across the nation.

Clearly there are multiple reasons for this epidemic. The Iraq and Afghanistan wars themselves are the bedrock cause. The stress increases as soldiers are forced into second, third and fourth combat deployments. However, the military’s increasing reliance on drugs has at best failed to “manage” a grim situation, and may have made it worse.

Prior to 9/11, the military did not send soldiers into combat on psychotropic drugs. In many cases, they were a bar to serving in the military at all. But as the Iraq and Afghan conflicts expanded and multiple combat deployments became the rule, the military embraced the idea that medications could keep troops “deployable.” Drug companies took their place in the military-industrial complex, positioning their products not just as medicine for wounded veterans, but as fuel that could keep exhausted and traumatized soldiers on the battlefield.

SSRI antidepressants became widely prescribed for symptoms of post-traumatic stress disorder as well as depression and anxiety.  The evidence that this was good medicine was thin, especially for patients being medicated and sent back into a traumatic situation. All these drugs carry warnings that they can cause agitation, hostility and suicidal and homicidal impulses. In 2007 the FDA expanded its suicide warning for children and teens to include young adults ages 18 to 24 – the group that forms the backbone of the Army. “All of these drugs increase suicide risk, which is why it’s probably not good to give it to guys who carry guns,” said Brown University professor David Egilman. By 2007, one in eight soldiers surveyed in Iraq and one in seven in Afghanistan said they had taken sleeping pills or antidepressants.

The careful monitoring needed to use these drugs safely just doesn’t exist in a war zone. While the Pentagon insisted that medicated troops were only deployed after they’d been “stabilized”, many were on a plane to Iraq or Afghanistan within four weeks of getting their prescriptions. Soldiers suffering from acute stress in combat have often been prescribed drugs and returned to the front lines in as little as three days. (“A Potent Mix: Zoloft and a Rifle,” Lisa Chedekel and Matthew Kauffman, Hartford Courant, May 16, 2006). Therapy is often totally unavailable, and mental health staffing is so short that psych evaluations and “monitoring” is often done by videoconference.

In the PBS Frontline documentary The Wounded Platoon, young soldiers from Fort Carson, Colorado shared their experiences during the 2006-2007 surge: “I was having, like, a total mental breakdown,” said Kenny Eastridge; “…They put me on all kinds of meds too, and I was still going out on missions. They had me on Ambien, Remeron, Lexapro, Celexa, all kind of different stuff. They tried different medications at different doses and nothing would work.” When stationed away from the base, Eastridge said, he would run out of meds. “It was hard to find someone who wasn’t on Ambien,” recalled medic Ryan Krebbs. “It helps you sleep. It also gets you pretty high. You have trouble remembering things. It lowers your inhibitions, all that stuff. They shouldn’t give soldiers Ambien in Iraq.”  Several soldiers told Frontline that their platoon became trigger-happy, opening fire on Iraqi civilians for any reason or no reason.

More recently, Army doctors have found what they thought was a better fix for the  insomnia, nightmares and rages of soldiers under stress from multiple deployments: antipsychotics, chiefly Seroquel. Pentagon spending on Seroquel doubled from 2003-2007, with larger increases in demand for the highest doses.

Spending on Topamax, an anti-convulsant, quadrupled as military doctors added it to the cocktail for thousands of soldiers diagnosed with traumatic brain injuries. And a rising number of active-duty troops were returned to duty on Oxycontin, Percocet and other narcotic painkillers. Meanwhile, in an effort to keep its medicated troops from running out of pills in theater, the Army’s Central Command authorized soldiers to ship out for Iraq and Afghanistan with 180-day supplies of their medications – making it all too easy to swap and share meds, or to take double doses on a bad day.

In 2008, in separate incidents, four young veterans in West Virginia died in their sleep from multiple drug toxicity. Twenty-three year old Andrew White was on a cocktail that included Klonopin, Paxil, opoid pain medications and up to 1,600 mg of Seroquel per day. In the weeks leading up to his death, Andrew gained forty pounds and suffered from tremors, slurred speech and disorientation. His father, Stan White, claims to have identified eighty-seven similar deaths among soldiers on Seroquel.

Veterans and their families are rebelling against this grotesque system of “care.”  They have had some small victories – the VA recently announced it would hire another 2,000 mental health staff, and the Department of Defense placed some restrictions on use of Seroquel by active-duty personnel – but much more is needed. If the rest of us support their fight for humane and effective care from the VA, perhaps it could become a model for the civilian mental health system we desperately need.