Susan Samples, Target 8 investigator -
GRAND RAPIDS, Mich. (WOOD) -- Andrew Lapres had a tough time finding family pictures to share with Target 8.
"I realized there's not a whole lot of pictures of me with the kids because I'm always the one holding the camera, not the one playing," the 34-year-old husband and father from Rockford said.
That's been especially true in the last year, since the U.S. Department of Veterans Affairs cut off his access to opioids.
"It helped," Lapres said of the hydrocodone VA doctors had prescribed him up until June, 2016. "I hated the fact that I needed to take it, but it afforded me the ability to play with my kids a bit, go fishing, go to the park."
Lapres was prescribed 5 mg hydrocodone/325 mg acetaminophen to be taken four times a day. But routine drug tests showed the opioid levels in his system didn't match his prescription. Lapres said that's because he took the hydrocodone only as needed for the pain he has endured since he was injured between deployments to northern Iraq.
"(I) injured my neck in training in a gunnery range," Lapres recalled.
The veteran, a tanker in the Army, had his head in the gunner primary site when the tank's driver locked the brakes while going uphill.
"The veteran states his body lurched forward while his head remained stationary in the gun sight," a doctor wrote in Lapres' VA medical record.
The whiplash injury, further aggravated during Lapres' second tour in Iraq, has led to a constant battle with pain.
"It fluctuates in levels," Lapres explained to Target 8. "Feels like somebody's got me by the base of the neck, holding onto my spine and just kind of crushing with burning pain along with it."
The hydrocodone, explained Lapres, provided him with just a little freedom.
"It helped me to know that they're there," Lapres said of the hydrocodone, which is sold under brand names like Norco and Vicodin. "I don't need to take them, but knowing that they're there, I have some control, knowing that I'm not helpless, was kind of a big deal."
Now, Lapres said the VA has taken away that control.
"Since they took me off of it, I haven't been able to do things, live," he said. "I have an 11-year-old son who likes playing football. I can't play catch with him. I can't pick up my daughter."
What he can do is speak out about the VA's crackdown on prescribing opioids.
"This is not street drugs. These are not people trying to get high," Lapres said of veterans suffering from chronic pain. "These are people who have long histories, plenty of records showing the problems they have, and (the VA) is taking the tools to manage that pain away from veterans.">>A Killer Among Us: Pain patients also victims in war on opioid epidemic
PROGRAM WORKS TO REDUCE OPIOID PRESCRIPTIONS
The U.S. Department of Veterans Affairs was one of the first agencies to identify the nation's overdose crisis. Since 2000, fatal overdoses in America have quadrupled and now outpace car crashes as the leading cause of accidental death. In 2014, overdoses killed 18,893 Americans.
Veterans, who suffer from higher rates of chronic pain, have been especially vulnerable. According to a spreadsheet the VA provided Target 8, the agency saw 67,828 patients nationwide for "opioid use disorder" in the last year alone, including 2,330 in Michigan.
In 2012, the VA prescribed an opioid medication to 17.2 percent of the 9 million veterans receiving benefits nationwide. In 2017, that percentage dropped to 11.1.
That's in large part due to the agency's launching of an Opioid Safety Initiative, which is aimed at reducing the number of veterans on opioids while providing alternative "whole-body" pain management services. Since 2014, when the initiative was launched, the VA has reduced the number of veterans prescribed opioids nationwide by 27 percent.
The reduction has been even more pronounced among veterans on long-term opioid therapy. From 2012 to 2017, the VA reduced the number of vets prescribed opioids long-term by 41 percent, from 438,329 vets to 257,097.
"In a way, I'm almost worried on the other side of that that we might have stopped… a little too fast," Laurence Meyer, MD, chief officer of specialty care services with the VA, said in a phone call with Target 8."I don't want to push on reduction as the sole outcome of better therapy. I want to make sure that we give veterans the support they need, of course for their pain, but also for their mental health status, for their functional requirements."
CHANGE AFTER YEARS OF TAKING MEDICATION
When an Allegan County veteran went to pick up his oxycodone prescription at the Battle Creek VA Medical Center last month, he was shocked to see fewer pills than normal.
"There's that nasty four-letter word," the veteran said, pointing to "wean" on the label of the bottle, which held 120 pills instead of the usual 150.
"Continue to wean off this medication," read 67-year-old Bob, who Target 8 is identifying by his first name only for privacy reasons and who served in the U.S. Army stateside for a year and a half in the late 1960s.
"My doctor's nurse said, 'Bob, what you're going to have to do is instead of five a day, take four,'" he told Target 8.
"'Are you kidding me?'" he asked her.
The VA's opioid reduction program was news to Bob, who has been on oxycodone for 12.5 years to relieve back pain from a lifetime of concrete work and farm labor. At one point, VA doctors had him on 300 oxycodone a month -- 10 a day.
While he recalls getting a letter from the VA in the spring mentioning upcoming changes in opioid prescribing, he said it didn't seem urgent or imminent.
He doesn't believe it was the letter the VA sent to veterans on opioids in 2015, which he thinks he would have remembered.>>PDF: 2015 letter
Now, Bob is worried about managing not only his back pain, but also withdrawal symptoms from cutting down his opioid intake.
"Had a bad 'bout -- sweats, nausea, didn't want to eat," he listed, recalling withdrawal symptoms he suffered years ago. "This is bad. The whole country. This is a hell of a thing we've gotten into."
"I hate these (pills)," he continued. "I hate them because of what it's brought me to. The addiction. I know I'm addicted. I know I am."
WORKING TO HELP VETS MANAGE PAIN IN OTHER WAYS
Since the VA rolled out the Opioid Safety Initiative, it has made what it calls "significant progress" in reducing the opioid risk among veterans.
"Our goal is safety," Dr. Ireneo Diaz, a primary care physician who's also associate chief of staff for medical service at the Battle Creek VA Medical Center, told Target 8. "We know for a fact that the higher the dosage our patients are on, the higher the risk of side effects that they will encounter. So we want to get to safe levels and if at all possible we want to explore alternative means of dealing with chronic pain."
To that end, the VA has added or is in the process of adding on-site pain management services at health centers across the country, including:
- Chiropractic care
- Health coaching
- Mind-body therapy
- Pain classes
- Support groups
- Tai chi/Qi Gong
- Medication assisted therapy
"We're trying to hit it from all these different angles using this multi-disciplinary, multi-modal approach to chronic pain," said Bethany Grix, Ph.D., a clinical psychologist and member of the Pain Management Team at the Battle Creek VA Medical Center. "We know that imbalances in certain aspects of life, like activity level, sleep, stress management, emotional issues or mental health needs, can actually impact chronic pain and the way we experience chronic pain."
VA officials told Target 8 that they've shared information regarding the Opioid Safety Initiative through veteran town halls, on social media, on their local websites, with letters, flyers and through direct patient education.>>Online: VA on pain management
"It really does take getting the word out there on what programs we do have available," Grix said. "And that mindset shift of moving from a single treatment option to looking at the whole big pictures, which is really the best practice of pain management."
Neither Grix nor Diaz is allowed to comment on individual veterans' cases. Therefore, they could not speak to the complaints voiced by Bob and Andrew Lapres.
"Our goal is to individualize their treatment, make sure they engage with their treatment, that they have enough coping mechanisms… coping skills to work through their chronic pain," Diaz said.
Bob, who does not have a computer, usually sees a VA health care provider once or twice a year and doesn't recall discussing opioid risks specifically, though he acknowledges his memory isn't always clear.
"It's like a dead-end road," Bob said of his dependence on opioids. "You got me down this dead-end road. Somebody bring me a road map. Help me find a way out."
The VA did call Bob at Target 8's request to set up an appointment to review his case and get him additional help with pain management and weaning off oxycodone.
Meanwhile, Andrew Lapres has an appointment with a VA doctor to explore the possibility of nerve ablation, a pain treatment that uses electrical current to heat up nerve tissue and decrease pain signals from the affected area.
Lapres told Target 8 that he's willing to try anything to relieve his pain, but the only treatment he has received since the VA cut off his hydrocodone prescription a year ago is chiropractic care.
"There's a big difference between somebody who wants pain relief and somebody who wants narcotics," Lapres said. "I don't want opioids. I just don't want pain."
Lapres wife, Jessica, said it's been a "daily struggle" to find ways to adapt to life with chronic pain.
"You deserve so much more," she told her husband as they sat in an interview room at WOOD TV8. "Him and hundreds of thousands of other veterans out there who are going through the same problems. They deserve better."-----Resources provided to Target 8 by the VA:
- Educational Pain Resources for Veterans (PDF)
- VA/Department of Defense Clinical Practice Guideline for Opioid Therapy for Chronic Pain (PDF)
- Going Overboard: Be Safe with Pain Killers (PDF)
- Taking Opioids Responsibly for Your Safety and the Safety of Others (PDF)
- Battle Creek VA Medical Center program offerings (PDF)
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