I was disheartened to read about US Army Corporal Eric Small in last week’s Boston Globe article, “For Addicted Veteran, Regulation is Enemy.” In 2008, Small returned home from Iraq addicted to the painkillers that had been prescribed for his injuries. “I wasn’t a drug addict,” says Small of his pre-combat days. “I didn’t do drugs. Suddenly I’m going through withdrawals, wanting my body to stop being the way it is.” To make matters worse, the government refused to pay for buprenorphine, the addiction treatment recommended by Small’s doctors – until, months and thousands of dollars later, his insurance finally approved the use of the drug.
Unfortunately, Small’s story – and his battle with substance abuse – is not unusual among active duty military personnel returning home. The military gives soldiers opiates to manage their pain, yet they don’t always provide an after-care plan that addresses the potential for addiction or withdrawal. Later, when soldiers try to quit these painkillers, they often turn to other substances (alcohol, illicit drugs) in an attempt to deal with their withdrawal symptoms. It’s a slippery slope.
The issue of addiction treatment for veterans is very complex. There are federal regulations involved, and some soldiers may have had preexisting addiction problems. In Small’s case, however, the concern was with buprenorphine, a leading medication for opiate dependency that Small’s doctors felt would be the most appropriate and effective treatment – it is FDA-approved and considered to be less risky than methadone. However, Tricare, one of the main healthcare providers for active duty personnel, would not initially approve coverage of the drug for ongoing treatment of opioid dependency, despite its FDA approval for detoxification.
Here’s my question: why would Tricare refuse to cover buprenorphine – again, considered to be less risky than methadone – when the Veteran’s Administration has more methadone clinics than any treatment provider in the country? If the military is going to treat soldiers with painkillers, managing their aftereffects should be part of that treatment. Drugs like buprenorphine are merely one method of treatment; the military should also provide complementary methods such as physical therapy, behavioral health interventions, and psychiatric counseling.
The stigma surrounding substance abuse and mental health issues in the military is already a major issue and needs to be addressed; many veterans are reluctant to get help. Soldiers are especially concerned when Tricare is involved and their treatment will go on record – they are worried about future job searches, etc. One way of allaying these fears is to provide anonymous therapy services. For example, Colorado’s Fort Carson is beginning a program that will provide alcohol abuse treatment for soldiers without requiring that they notify their supervisors. The goal here is to eliminate psychological, financial, and bureaucratic barriers for soldiers in need of substance abuse treatment.
It’s clear that many veterans who need help don’t seek it out. So why refuse those who do? Corporal Small was denied access to FDA-approved, evidence-based, and effective treatment – would this have occurred if his disease had been cancer or diabetes instead of addiction? If a soldier loses a limb in combat, they are provided with a prosthesis; why isn’t addiction treatment just as straightforward?
For veterans struggling with substance abuse, treatment is not a luxury, but a necessity that will enable them to move forward with their lives. These people are dedicated to serving our country – providing them with accessible, affordable, effective treatment is the least our country can do in return.
Dr. Laura Blandy, PsyD
Clinical Director of Military Services, Phoenix House