Veterans who saw combat after 9/11 are more likely to be victims of America's opioid crisis, adding "an important front in the Global War on Terrorism," according to a study.
The study, which relies on multiple federal data sets, finds that post-9/11 veterans who saw combat are significantly more likely to have been prescribed opioids and to self-report having abused them, often alongside other prescription drugs. This finding helps explain why veterans are up to twice as likely as civilians to die from opioid overdoses.
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Military service has long been linked to opioid addiction. The first drug crisis in U.S. history followed the Civil War, as soldiers on both sides returned home hooked on the opium pills and morphine they received as treatment on the battlefield. American G.I.s serving in Vietnam were exposed to cheap and plentiful heroin with similar results.
In 2019, America is gripped by the deadliest drug crisis in at least a century, a crisis that has grown steadily since the turn of the millennium. Researchers from the University of Georgia, San Diego State University, and the University of Connecticut found that those who had seen combat were especially vulnerable to the epidemic.
According to the paper, 45 percent of veterans suffer from chronic pain, a rate three times higher than the civilian population. Veterans are 15 percentage points more likely to have been issued an opioid prescription, and those that did receive a prescription were likelier to receive a prescription for three months or more, which increases the risk of dependency. Among post-9/11 veterans specifically, roughly a third were prescribed opioids to treat pain.
What is more, the new paper notes, VA doctors were not required to—and generally opted not to—check veterans against a prescription drug monitoring program until 2017. Such programs, known as PDMPs, are considered some of the most effective tools to combat the opioid crisis, obliging doctors to check if a patient has a history of lengthy prescriptions or drug-seeking behavior. The lack of monitoring meant that veterans were uniquely at risk for developing opioid addictions unbeknownst to their medical providers.
"Given these risk factors, the Department of Defense has speculated that the Global War on Terror (GWOT) may have contributed to opioid addiction among post-9/11 veterans," the study said. It cited a Department of Defense brief that concluded "[Opioid abuse] may relate to deployment effects, such as injuries, combat exposure, and mental health conditions."
Using data from two datasets—the National Longitudinal Study of Adolescent to Adult Health and the Department of Defense's Survey of Health Related Behaviors—the study tries to examine how exposure to actual combat is linked to opioid use and misuse. It takes advantage of what the authors argue is a "natural experiment" produced by the apparently random assignment of given members of the military to combat or non-combat zones.
Being deployed to a combat zone does increase an individual's probability of being prescribed a prescription opioid—although this is contingent on seeing active combat—of self-reporting prescription opioid abuse, and of self-reporting heroin use. Combat also increases a person's risk of abusing "sedatives and tranquilizers," drugs that are incredibly dangerous when paired with opioids. The researchers noticed the effect among those who suffered physical combat wounds, as well as psychological trauma.
"The effects of combat exposure on opioid use and abuse are largest, by a large margin, among servicemen wounded in battle," the paper said. "Traumatic battlefield experiences—such as witnessing deaths, particularly those of unit members or allies—increase opioid abuse."
In a sense, nothing about this finding is revolutionary — fighting in a war can take an enormous physical and psychological toll, as it has in wars past. But this fact, combined with the increased prevalence of both licit and illicit opioids in America over the past two decades, made veterans vulnerable to drug addiction and death.
The paper notes that the Departments of Defense and Veterans Affairs have already moved to address opioid abuse. The Pentagon has sought to promote alternative pain-management strategies, increased availability of the anti-overdose drug naloxone, expanded education, and more aggressive random drug testing. The V.A., for its part, has reduced opioid prescriptions by 40 percent since 2012, thanks to more limited prescribing requirements and the use of monitoring.
The new paper should be seen as a charge for policymakers to do more. If America's troops were, by their service, put uniquely at risk in the nation's drug epidemic, then it is pivotal that they receive all the help they need.