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.”

Facing the Fog of War through a Fog of Drugs 

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.

Zoloft and a Rifle

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.

A total mental breakdown

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.

When death comes in the night

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.

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  1. While not, as yet, publicized in Canada, we have a situation in the Armed Forces that creates a huge hole through which events such as described by Ms Ryan may and probably do, occur. “QR&O 20 (Queen’s Regulations and Orders) defines a drug as “a controlled substance… in the Controlled Drugs and Substances Act” or any other physiologically or psychologically impairing substance, except for alcohol. QR&O 20 prohibits the use of any drug unless it is authorized by a medical professional, is a non-prescription medication used in accordance with accompanying instructions or is required in the course of military duties.” So, again we have the prescription issue making drugs appear to be “safe” and what drug, pray tell, could be “required in the course of military duties?” Why not give them all Ritalin for “alertness” and Ativan to promote violence then wash it all down with alcohol for relaxation? That’s what we want in soldiers isn’t it? A new form of chemical warfare, perhaps?

  2. In Johanna’s post she quotes medic Ryan Krebbs saying “it was hard to find someone who wasn’t on Ambien”.

    The medication guide that is enclosed in packets of Ambien states:

    “Serious side effects of Ambien include abnormal thoughts and behavior. Symptoms include more outgoing or aggressive behavior than normal, confusion, agitation, hallucinations, worsening of depression, and suicidal thoughts or actions” – perhaps this in part explains the increasing rates of suicide and of violent crime seen in the US military.

    “Ambien is a federally controlled substance (C-IV) because it can be abused or lead to dependence” – and soldiers are allowed 180 days, i.e. 6 MONTHS, supply!

    “You may still feel drowsy the next day after taking Ambien. Do not drive or do other dangerous activities after taking Ambien until you feel fully awake.” – I would count being in a war zone a dangerous activity.

    “Do not take Ambien unless you are able to stay in bed a full night (7-8 hours) before you must be active again [emphasised in bold in medication guide].” – does anyone seriously think soldiers are able to get a full nights sleep in a combat situation?

    It would appear that psychotropic drugs, like Ambien, are currently not being used in a safe manner in the US military and can adversely impact on the mental and physical capabilities of service personnel. Ethical reasons aside, it makes one wonder what the military advantage can be?

  3. It is very depressing. If only people knew what war is about, but most people who decide to become soldiers don’t know what it means.

    I often think of Aldous Huxley’s “Brave New World” where everyone receives a soma pill every day to keep them happy. We are already past that stage, as so many drugs are sold in Denmark that every person can be in treatment with a full adult dose of 1.5 drugs every day, from cradle to grave. The sales of the newer antidepressant drugs, the selective serotonin reuptake inhibitors (SSRIs), are so high in Denmark that 7% of the whole population can be in treatment with such a drug every day for their entire life (1). It is telling that a 2007 survey of 108 Danish psychiatrists showed that 51% felt they used too much medicine and only 4% felt they used too little (2).

    In the USA it is even worse. The most sold class of drugs in 2009 (in dollars) was antipsychotics and antidepressants came fourth, after lipid lowering drugs and proton pump inhibitors (3). It is hard to imagine that so many Americans can be so mentally disturbed that these sales reflect genuine needs. Obviously, such massive use of drugs that affect the brain is not healthy. The reason for the massive use is that the drug companies have committed widespread and repeated fraud in clinical trials and marketing of psychotropic drugs, as outlined in Healy’s books and elsewhere. This has often involved kickbacks to doctors who are therefore complicit to the crimes (unpublished observations; do a Google search and you will find many examples of bribery of psychiatrists and other doctors, e.g. as described by the US Department of Justice and the FBI).

    1. Nielsen M, Gøtzsche P. An analysis of psychotropic drug sales. Increasing sales of selective serotonin reuptake inhibitors are closely related to number of products. Int J Risk Saf Med 2011;23(2):125-32.

    2. Arbejdsmiljø og behandlingsformer i den danske psykiatri. Nordjyske Medier, 2007.

    3. Press release: IMS Health reports U.S. prescription sales grew 5.1 percent in 2009, to $300.3 billion. IMS Health 2010; April 1.

  4. Debra Rees says:

    An interesting article in The Guardian today (11/7/12), also covered on the Today programme on Radio 4, reported that an inquiry by the Howard League for Penal Reform has found that military veterans are twice as likely to be convicted for sex offences than other people and are also more likely to commit violent offences. Three-quarters of veterans in jail have served in the army, 1 in 7 have served in the navy and 8% in the RAF. The study also found little evidence that ‘combat trauma’ is directly linked to offending.

    In view of the content of this post it would be interesting to know how many, if any, of these crimes might have been related to any psychotropic drugs that had been prescribed for these servicemen during their periods of service or since their discharge.

    Sir John Nutting, who chaired the inquiry, has said that he has no idea why former servicemen go on to commit these offences and has called for more research to be done into the matter.

  5. Johanna says:

    A Soldier’s Story

    The sad story of Iraq veteran Robert Quinones could shed some light on Debra’s question, above. Combat-related trauma was one big factor in causing Quinones to break down. But the medications he was given for PTSD, and his dehumanizing treatment by the Army and the VA, may have had even more to do with the “crime” he committed – if you want to call it that.

    In September of 2010, Quinones showed up outside the psychiatric ward of the Army hospital at Fort Stewart, Georgia with automatic weapons. He took three hostages, held them at gunpoint for two hours and demanded … someone to talk to. Luckily he found that in one of the hostages, Maj. Sabon Shelton, R.N., who finally persuaded him to surrender peacefully (“A Soldier’s Story”, WSAV-TV, July 14, 2011). Unfortunately, he is still in jail awaiting trial on federal kidnapping charges.

    Robert Quinones’ whole story can be found here (Stars & Stripes, August 11, 2011). He was from a military family, joined the Army at 24 and was respected as a loyal and selfless team player. He spent 15 months in Iraq at the bloodiest stage of the 2006-2007 “surge,” surviving a dozen IED explosions and living with violent death every day. By the time he returned to the States, he was in crisis, with several suicide attempts that finally got him restricted from handling weapons.

    He was put on a laundry list of medications, including Seroquel, Klonopin, Prozac and unspecified sleeping pills (possibly Ambien). In 2009 he overdosed twice on alcohol and medications. Despite pleas from the base psychiatrist, however, he wasn’t referred for intensive treatment of his PTSD symptoms; instead, he was medically retired from the Army in February 2010. Quinones, his commander wrote, was “not a problem maker — he just has a condition that doesn’t mesh with the Army.”

    Back in Fort Stewart with his parents, Quinones went further downhill. He couldn’t tolerate being out in public, even on a trip to Wal-Mart, and his drinking increased. He sought help from the VA, which took several months to issue him an appointment in Savannah, an hour’s drive from his home. When he got there, he was surprised to find himself ushered into a room with a TV for a ten-minute teleconference with a VA psychiatrist in Charleston … who upped his meds. Quinones pleaded with his caseworker for more meaningful help, but got nowhere.

    Finally, on September 5, after a night spent drinking and taking sleeping pills, he stormed the Wynn Army Hospital at Fort Stewart. “All they ever do is throw meds at me,” he told Major Shelton, the nurse in charge. “Do you know how those meds make you feel? They make you feel horrible!”

    Quinones may well have been suffering from akathisia – his complaints sound very different from the more common ones you hear, that the meds make people groggy and don’t really solve their problems. He also insists that he has no memory of the hostage-taking episode, for which he expresses great remorse. That could well be true, especially if he topped off a night of drinking with a large dose of Ambien.

    All three of his former hostages have expressed sympathy for his plight. Sabon Shelton, the psychiatric nurse who talked Quinones down, has become his advocate. Unless the Army is willing to look at the reasons this incident took place, he says, “it will happen again.”

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