30 July 2010

Noel Koch was right about one thing...

Last month, Noel Koch, the former head of the Army's Wounded Warrior program, guest-blogged at Tom Ricks' The Best Defense.  Koch's article described, among other things, rampant drug abuse in the Army's Warrior Transition Units, exacerbated by physicians who haphazardly prescribe painkillers.

I am in a room with 35 soldiers. The one first in front of me is glassy-eyed, staring into the middle distance, and I have to raise my voice to get his attention. Wilson, what are you doing here?

"I'm schizophrenic, sir." How old are you? "Nineteen, sir." You haven't been downrange, have you, son? "No, sir."

Smith, why are you here? "I'm bi-polar, sir." How old are you? "Twenty, sir." Have you deployed? "No, sir."  Same glassy-eyed look....

...About the glassy-eyed look? Here's a snapshot from another WTU session. A visibly agitated soldier tells me, "A lot of times I run out of my meds when the dispensary is closed and I can't get a refill when I need it."

I ask him what he is taking, and he tells me Percocet. I ask him how many he takes that he can't time his refills with the dispensary schedule. He says he has a jar of the stuff that he takes when he needs it. This turns out to be a common problem, and an uncontrollable one in the WTUs.

In Vietnam the enemy turned our war fighters into drug addicts. Today, their caregivers are doing it.
Although Koch received a rebuttal from Brigadier General Gary Cheek, the Commanding General of the US Army's Warrior Transition Command, it's worth noting that Brig. Gen. Cheek actually acknowledged that drug abuse was, indeed, a problem within the WTUs (see the comment section).

The US Army's recently-released study on suicide only confirms the serious drug problems within the Warrior Tranistion Units.  (Page 64 in the PDF file)

[Soldiers in the WTUs] can be considered at-risk – almost all Soldiers in WTUs populate one or more of the outer rings in the “Army Population at Risk” maze shown in Figure 12. The prevalence of illicit drug use in WTUs is illustrative of this risk. Illicit drug use during FY 2009 within the seven WTUs surveyed for this report were 2.9 times the FY 2009 overall Army average; of the 5,385 WTU Warriors tested for drugs, 4.8% were positive, compared to the overall Army average of 1.67%.

The prescription of opiate, antidepressant and anti-anxiety drugs is an important aspect of treatment provided to WTU Soldiers. The use of these medications is legitimate when they are taken in compliance with medical direction. When these drugs are used illicitly, however, Army policy requires that offenders be referred for counseling and disciplinary action as appropriate. The enforcement of these standards has been made problematic because of inadequate detection systems. The high number of WTU Soldiers on medication compounds this problem and increases the opportunities for abuse.

There are three key gaps in Army policy with regard to detecting potential prescription drug abuse. First, the Medical Review Officer (MRO) will excuse a positive urinalysis for a drug if the Soldier has a prescription for the drug, regardless of the date of prescription. Data surveyed from seven WTUs indicated that the MRO “clearance rate” (the percentage of excused positive tests) for Warriors was 90% during CY 2009.  Second, levels of drugs found by urinalysis tests do not utilize specific concentrations other than to confirm the existence of the drug. This is important because it prevents the MRO from determining if the Soldier was using the drug for therapeutic reasons, since the samples of substance abusers would reveal much higher levels. Finally, the percentage of Soldiers in WTUs that are actually tested is unknown, which prevents an accurate determination of the magnitude of the drug problem.

WTU leadership recognized these issues and took several affirmative steps to combat prescription drug abuse; including limiting the length and quantity of medication dispensed per prescription and requiring that Warriors receive their prescriptions from a single provider. While these measures serve to mitigate the problem, the gaps in detection systems “mask” the full extent of potential illicit prescription drug use in WTUs. Current data cannot show prescription drug abuse of Soldiers who have expired prescriptions for the drug or are taking the drug in excess of prescribed amounts. The effects of these detection gaps, together with the failure to test any Soldiers in a significant portion of WTUs, prevent WTU Commanders from effectively managing their at-risk populations.
Additional links:  Elisabeth Bumiller reports at the New York Times.

No comments: