The VA's Opiate Problem: A Whistleblower Speaks Out

Thursday, February 27, 2014

As American service members have returned from Iraq and Afghanistan over the last few years, the Center for Investigative Reporting (CIR) has discovered a growing problem. 

Veterans who seek treatment for pain are prescribed opiates, which are highly addictive pain pills like hydrocodone, oxycodone, methadone and morphine. According to CIR, VA prescriptions for opiates increased by 270 percent between 2001 and 2012, far outpacing the increase in patients, who now have a fatal overdose rate of nearly double the national average.

CIR staff reporter Aaron Glantz has investigated this story for months. As one retired Marine, Tim Fazio, told him, "I thought the painkillers were OK because the doctors were prescribing them to me. If the doctor's giving this to me, I'm going to take it...If it makes me feel good, I'm going to take 15 of them, know what I mean?"

CIR's reporting has prompted several Congressional hearings, including one at the House Committee on Veterans' Affairs this week. There Dr. Robert Pretzel, Under Secretary for Health at the Department of Veterans Affairs, told the Committee, "15 years ago, it was felt that pain was under-managed and pain medications were pushed; you need to get rid of the pain. That has obviously led—and I'm not talking about the VA but medicine in general—that has led to a problem in this country of the overuse of opiates in managing pain. And the VA is very seriously addressing that problem."

Now, Dr. Basimah Khulusi, a former Veterans Affairs physician, has come forward as a whistleblower on this issue. She says the VA forced her out because patients complained that she wouldn't prescribe high doses of opiates. She's now in private practice in Los Angeles, and the VA has refused to comment on her case.

Dr. Khulusi told CIR and its co-investigator on this story, ABC News, that the majority of the veterans she saw were addicted to opiates, that some veterans received up to 900 narcotic pain pills a month and 1,000 milligrams of morphine a day—10 times the level she considered safe. According to internal data obtained by CIR, the number of opiate prescriptions at the Kansas City VA increased by 173 percent between 2001 and 2012.

Watch a video of ABC's report below. To see an interactive map of CIR's findings, click here.


ABC Entertainment News|ABC Business News

Guests:

Aaron Glantz and Dr. Basimah Khulusi

Produced by:

Jillian Weinberger

Editors:

T.J. Raphael

Comments [14]

J. Patrick Gilligan from Bullhead City, AZ

I'm a 65 year old veteran who suffers chronic severe pain. There is no cure, only pain management, but the problem I have is VA doctors, and private physicians as well are being harassed about prescribing too many opiates because of some who abuse these medications. I hate to complain continually that my meds aren't strong enough, but if I don't I'll be forced to endure pain so severe I can't function. I switched clinics over a year ago and even though I had been able to get acceptable pain relief on the same dosage for several years, my new doctor decided to reduce the dosage. I am an intelligent adult and I do not have an addiction problem - I have a pain problem. If by some miracle I no longer had pain I would cease taking opiates and that would be that.

Sep. 21 2014 01:57 PM
Mark from MD

Has there been a curee for opiate withdrawal for over 30 years that has been covered up in the name of profit? Did 2 doctors discover this by accident and approach the Australian government over 30 years ago and instead of being praised for the cure, they were treated hostilyl and told that if this gets out it will shut down half of the rehabs in the country and to many jobs would be lost? Is there a place to go to find out what this suppressed secret is? Yep!!! www.NoMoreOpiateWithdrawal.weebly.com

May. 24 2014 12:32 AM
Ed Orr from Lynden, Washington

I am not addicted to the pain medications but AM addicted to having the pain reduced to a level where I can function. Every veteran has a duty to themselves to always research ANY medication the VA doctors prescribe them. The VA Hospital where I go has absolutely no mechanism for the pharmacy to check for contraindications of prescribed medications from the VA physicians. Once I was sent nitroglycerine and I have no heart problems! That is the tip of the iceberg. One VA physician asked me to sig an opiate contract (which is illegal and unenforceable).
I said to him Ok I will sign yours if you will sign mine which clearly states that if the VA misses or is late in sending out my prescribed medications then the "contract(s)" would be null and void. This contract madness is NOT VA policy and I know the VA's Opiate manual very well and use it against those doctors who use their RX pad as a weapon for their own personal bias. I have been denied medications for a service connected disability from but one injury I received in Vietnam. Not only am I suing the doctor himself (a contractor at the VA) individually but the hospital as well for deliberate infliction of pain plus other forms of VA misconduct and substandard care for a veteran like myself who is 100% service connected permanent and totally disabled. I have a 100% for PTSD and another 100% for various other service connected injuries. Of course the VA only pays for 100% for one injury or a combination of other injuries also totaling another 100%.

Apr. 01 2014 08:26 PM
CAROLINE from NJ USA

Believe me! It isn't just VA docs over prescribing opiates. I had a broken leg and had little pain, but was given very strong medication at the hospital by a nurse who just couldn't get it thru her head that I didn't feel any pain. She was soooo sure I'd have pain, that I began believing her, and the leg had not been set . . . however was set before she got back with med. The setting did hurt like heck, but it was over quickly. I took the med anyway thinking she knew more than me. Spent the next sever hours dizzy and throwing up due to over medication. I did need pain meds the day after my surgery. I needed something a bit strong so I could sleep at night, but I was given far to much medication. Cutting oxycodone in half, and then quarters got me thru the first week at home or 2nd week after surgery.

Since my experience I've suggested to friends that they can cut their medication into smaller pieces if they don't want such a strong dose. Also, ask your doctor for slow release. Stretching as directed by physicians can also diminish pain.

Opiates are also being prescribed for mental disorders - also a very bad idea!

Mar. 05 2014 01:08 PM
moderniste from San Francisco

What I see as troubling is the very dogmatic tendency in pain management to either over-prescribe opiates, or not prescribe them at all. Also, not once it this broadcast did I hear the term "DEPENDENCE", as opposed to addiction. I am a current chronic pain patient in treatment by a chronic pain specialist who works in conjunction my other doctors. Over the past 8 years, I've taken a constant dose of opiate medications, so I am now physically DEPENDENT upon opiates, a medical condition that is very different than addiction. It's very important to distinguish between the two. Patients who start to display addictive behavior must be treated differently, and I am NOT referring to these type of patients in this comment.

When I take my opiate medications, I do not feel euphoria, or experience a "high"; I'm not "stoned", which is an insulting term I did hear during this report. Furthermore, when I started down this road, I educated myself about opiate use and realized that my body would become dependent upon the drugs, meaning that I would experience withdrawal symptoms upon reducing or stopping their use. This is very different than addiction, which joins physical dependence with the unhealthy emotional need for the drugs; a craving, that drives the patient to display drug-seeking behaviors and negatively affects their quality of life. I have experienced complete withdrawal several times during my treatment, and while some of the withdrawal symptoms were unpleasant, I did NOT have the emotional component of craving my medication.

Opiate medication is far from the ONLY tool that my doctors use to treat my pain problem, and pain patients who only sit around and pop pills are indeed a major problem, and this is behavior that that no good pain doctor should allow. In addition to the opiates, I'm prescribed Ibuprofen, Lamictal, a drug useful for the nerve aspect of my pain, and Effexor, a SNRI that is useful for chronic pain and anxiety, which most pain patients experience to varying degrees. I see a therapist for talk therapy. I also do a large amount of daily physical therapy that includes traditional exercises and a yoga program that is specifically tailored to pain patients with my specific condition. Lastly, I use meditation and visualization relaxation therapy.

My pain program would not be nearly as effective without mind/body techniques, and I am very religious about using them daily. My point is that a holistic style of treatment that combines opiates with mind/body techniques is MUCH more efficient and effective than those two modalities taken separately.

Of course patients who display addictive tendencies need to be treated differently than those who are merely dependent, but doctors need to put the work in to identify those tendencies in their patients rather than apply dogmatic, universal policies like lowering or eliminating ALL opiates because they have a negative effect on SOME patients.

Feb. 27 2014 04:07 PM
Bill from Long Island

Hi all,

I have a painful bladder syndrome for which I was prescribed a fentanyl pain patch. I have tried to manage without this on multiple occasions in the last 7 years but could not function with my constant badder discomfort. I am taking the 25 ugram hour. level, which is low. I am concerned that it will become even more difficult to get palliative care, if there is a political overreaction. For the record, the Mylan Fentanyl product never makes me "high"... I had been through that with hydrocodone i had before the Fentanyl and do not want that sort thing. But I had an experience with a "pain doctor" who wanted to sell me an implant that disrupts pain. I did not want that and was subsequently *terminated* as his pain patient. This *termination* made it impossible to get another "Pain Doctor" to accept me as a patient. Fortunately I have a great primary care physician who I trust and has trusted me. I have went through the withdrawal process 4 times to get off this opiate, and it is REALLY disruptive to endure the withdrawal as well as the emerging pain. I was told that the beauty of Fentanyl is that it is a pain blocker, that does not make one high. My experience is that this accurately describes the action of fentanyl and I am so grateful that this option is available to me. In general, there are worse things in life (like never ending misery from pain) than mild drug dependency and I would urge common sense and moderation, before reactive decisions are made.

Feb. 27 2014 03:31 PM

Many TBI cases resolve to CPS/CNPS [central pain syndrome/central neural pain syndrome]. CPS is an under-diagnosed condition common to closed-head injuries, stroke victims and other neurological cases. CPS is the perception of pain where there are no underlying physical reasons. Part of the reason is because unlike motor neurons that STOP sending signals, pain neurons keep cranking up the "perceive pain" message. It results in the perception of severe burning, crushing or freezing or stabbing. Opiates are DEFINITELY NOT EFFECTIVE for these cases. High doses of Neurontin/gabapentin and other anti-convulsives give some relief but nothing makes it go away.

Feb. 27 2014 03:19 PM
John Doe from New York City, NY

I'm a former patient of Dr. Khulusi and when I first saw her I was on high dosages of Opiates. Sure they took care of my pain but they also had me in a fog all day as well. I also felt pretty damn good, a nice high I might say. Dr. Khulusi educated me on the dangers of not allowing the body's natural pain killers do their job while at the same time using less opiates. She was concerned with MY well being and health, to think otherwise would be wrong. Most Pharmas have re-formulated opiates to disallow the high people were feeling when taking their drugs. That in itself may drive some veterans to street drugs, after all, why buy the drugs on the street when the VA will give them to you for nothing. There is a line that has to be drawn in the amount of opiates patients take per day, otherwise we will see more and more accidental deaths due to abuse. Opiates were never meant to be a permanent fix for pain anyway and most civilian physicians will prescribe a lot less opiates than the VA. The more opiates you take, the more you need to maintain pain control and/or the euphoria you feel after taking them. I'm on Dr. Khulusi's side on this issue and I'm in chronic pain and have been for years. I've learned to live with it safely with fewer opiates. 6 to 8 opiate tablets per day should be sufficient OR a pain patch. Either way it's still dangerous and to slay a physician because he or she is concerned about your health is stupid and selfish. Dr. Khulusi wouldn't receive any more compensation if she prescribed more opiates or less. Her job was to ensure your pain was taken care of by any means possible and that doesn't mean strictly narcotics.

Feb. 27 2014 12:58 PM
Larry Fisher from Brooklyn, N.Y.

The pink elephant is in the room..
1. Was Doctor Basimah Khulusi a victim of sexism and racism? Are other Doctors who believed in rehabilitation also fired?
2. Did Doctors in V.A. treat new Vets differently than Vietnam Vets. The comments from other listeners of The Takeaway suggest that policy on opiates differed than The Takeaway's report.
3.Is there a lawsuit against the V.A. from Dr. Basimah Khulusi?
4. The numbers clearly indicate an increase of prescribed opiates. What's going on with some Vets not getting a slight increase and others getting pushed over the edge?

Feb. 27 2014 12:53 PM

John, I hope you can find a Medicare or Medicaid pain management doctor like my brother's [tho good luck with the ACA in place]. Read my comment above. Sour notes, indeed. Let her live with PTSD & a back that's disintegrating.

Feb. 27 2014 12:27 PM
Kay Merkel Boruff from Dallas

My Viet-Nam veteran brother Frederic found a Medicare pain management doctor who finally made the last three years of his life comfortable with opiates. He lived with PTSD, Agent orange, Hep C, post polio, a degenerative spine from 200+ Airborne jumps, & a 40 feet fall resulting in an ankle with bone grafts & metal pins. Are people with diabetes or heart problems "addicted" to their medicines? Thank God for legal opiates and pain management doctors who care for their patients with compassion.

Feb. 27 2014 12:19 PM
Hardtman from Portland, OR

I'm a patient of the VA medical center in Portland, OR. I've had very aggravating (and harmful) experiences with the VA's pain control policies. Here's a MAJOR sub-issue: if a vet has the word "marijuana" ANYWHERE in their medical record, forget getting a strong pain-killer for ANY condition, including the OCCASIONAL flair-up of a diagnosed, service-connected injury. (Even in a pot-firendly state like OR, WA, and CO)

Feb. 27 2014 12:14 PM
constance a roustom from monument beach ma, 02553

hearing so much about the crimea i was reminded of alfred lord tennyson'Charge of the Light Brigade, then i read Tears,IdleTears by same and they were so much more beautiful than the actual sordid events.
constance a roustom,
cape cod, ma

Feb. 27 2014 11:29 AM
John Farley from Rual, PA

The doctor claims 1000 mgs. a day for VA dosage of chronic pain management! I've been one of those patients since the Vietnam war, and at that rate I'd be taking 100 pills a day and probably would have been good and dead a long time ago. I've argued with VA doctors for twenty years trying to get an increase in dosage from 30 to 40 mgs. a day: from 3 pills to 4 pills. For me it's the difference in being able to shop in a supermarket for myself. Chronic pain wrecks my life every day.
You guys got this all wrong. The VA doctors aren't playing loose with the pill pads. Try asking some vets. The only whistle that lady is blowing has a pretty sour note.

Feb. 27 2014 09:41 AM

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