Advocates are working to ensure that veterans are not overlooked as Congress and the Trump administration push to address the opioid epidemic.
They say two sweeping opioid bills passed in recent years is a good start, but that the programs they cover need dedicated funding to ensure success.
Veterans groups are also pushing lawmakers for a greater focus on mental health issues, which they say make opioid addiction particularly difficult to address with veterans. They want Congress to ensure that so-called parity laws, which prohibit health plans from charging more or denying claims for mental health and substance abuse, are strictly enforced.
Federal officials have been struggling in recent years to stem the epidemic of opioid overdoses.
In September 2017, synthetic opioid overdose deaths for the past year were estimated at almost 29,000. In March 2018, past-year synthetic opioid overdose deaths were estimated at more than 30,000, according to the Centers for Disease Control and Prevention.
That nationwide crisis has had a devastating toll on veterans. Advocates cite federal data showing that veterans are twice as likely as nonveterans to die from an accidental opioid overdose.
“It’s such a massive crisis,” said Torie Keeton, a research and advocacy adviser for the Kennedy Forum, a mental health advocacy organization.
It’s also a unique challenge for advocates who say that mental health programs are essential to addressing the danger opioids pose to veterans.
According to the Wounded Warrior Project, veterans often suffer from what they call “invisible wounds” accompanying chronic pain.
Veterans who return with devastating injuries need opioids to address the physical pain. But often those prescriptions can also increase the risk for substance abuse among veterans who suffer from emotional distress, the organization said.
President Trump has declared the opioid epidemic a public health emergency, and last month he signed into law sweeping bipartisan legislation intended to curb the growing crisis.
The Support for Patients and Communities Act includes some targeted provisions for veterans, such as allowing doctors at the Department of Veterans Affairs (VA) to better track opioid prescriptions in the hopes of better identifying patterns of abuse.
Even though most of the legislation is focused on other areas in need of reform, experts said it will still be an important move for veterans because it changes how the health system deals with opioid addiction, through better tracking of prescriptions, lifting restrictions on addiction treatments and making it easier for Medicaid funds to go to treatment.
“It does matter for veterans that H.R. 6 passed,” said Heather O’Beirne Kelly, who directs veterans and military health policy for the American Psychological Association. “The majority of veterans get their care outside the VA, so whatever we do for larger community will serve veterans.”
Still, advocates say there were some blind spots and more needs to be done.
For example, Keeton notes that the legislation did not address broader issues of mental health and wellness or ensure mental health parity. She said her group, the Kennedy Forum, has been tracking instances of health insurance plans denying claims for treatment related to mental health and substance abuse disorder.
“Parity is important to veterans’ health coverage. Wrongful denials of mental health and substance abuse disorder claims, they can hit the vets first,” Keeton warned.
One particular provision of the Support Act would have increased enforcement of federal parity laws, but it was not included in the final version, Keeton said.
“That was left out, and we were disappointed. [The law] would have been a lot stronger. ... It would have helped get veterans the care they need.”
And advocates across the board are pushing for more dedicated funding for addiction treatment and mental health programs.
Keeton said veterans are involved in all the conversations her organization has with lawmakers and other stakeholders about mental health and wellness. Her group and others are working to raise awareness about the effect of the opioid epidemic on the nation’s veterans.
One bright spot has been the VA, which advocates say has been a leader in recognizing the issue of chronic pain in veterans and addressing opioid abuse. In particular, they say the agency’s Opioid Safety Initiative has been successful in decreasing the number of veterans being prescribed opioids.
“VA is really the forefront of opioid safety, and they’re leading the way for what the private sector is doing,” said Kelly.
Stephanie Mullen, research director for the Iraq and Afghanistan Veterans of America, said 23 percent of the group’s members have been prescribed or are currently taking opioids for service-connected injuries. Thirty-eight percent report chronic pain from a service-connected injury.
“Overall, VA, with the support of Congress and both past and current administrations, have significantly decreased the number of veterans prescribed opioids within the VA system,” Mullen said.
But Mullen said the department can do more to bring innovative new therapies to veterans.
“We believe there is more work to be done in exploring alternative therapies and treatments for pain and other conditions that opioids are used to treat,” Mullen added.
Kelly said there was work ahead, but that overall support among lawmakers for caring and treating veterans with addiction and mental health issues has come a long way.
“It feels very different now than it did 20 years ago in the general public and on [Capitol Hill],” Kelly said.
“It’s one of the few issues that gets overwhelming support. [Members] proactively ask for input on mental health, suicide prevention,” she continued.
“It’s not a hard sell anymore.”