July 18, 2014

The Department of Veterans Affairs has gotten  bad press lately, but it is about to make the drug overdose medication naloxone available to its patients nationwide. This time the VA is on the right track, but overdose prevention and effective treatment remain out of reach for tens of thousands of US veterans.   

Unprecedented numbers are struggling with drug dependence and affected by mental health issues, suicide, and homelessness. A recent study estimates that nearly 1 million VA patients are taking prescription painkillers -- half of them chronically, or beyond 90 days.

I interviewed dozens of veterans who use drugs for a new report  that pulls together information about the issue from the government, academics and other sources.

Donald, a 60 year old Vietnam veteran, told me that using drugs helps him and other veterans cope with their wartime experiences.  “How can I just ‘step up’ and stop when I have voices in my head, anxiety and anger?” he said. 

Dr. Elizabeth Oliva, the director of the Overdose Education and Naloxone Distribution initiative at the Department of Veterans Affairs, told me the VA is now making naloxone available to patients at high risk of overdose, mostly those in its residential drug treatment programs. It will make naloxone available to patients nationwide by the end of the year.

 This is an important step. But millions of veterans are not engaged with the VA health system. The VA should give naloxone kits and training to vets and their families at Vet Centers, community sites where veterans gather for information, support and social events. The VA should also work with correctional facilities to reach veterans who need overdose prevention and ongoing health care.

VA drug treatment programs also remain out of reach for many veterans.  Although the prescription drugs methadone and buprenorphine are proven to be effective for treating people dependent on opioids such as Oxycontin, Vicodin, or heroin, many drug dependent people in the US, including veterans, don’t have access to them. Only one of three patients at the VA who need methadone or buprenorphine is getting it, as demand for these programs has outpaced supply.  Also, some doctors at the VA resist medication-assisted therapy, considering it to be “substituting one addictive drug for another.” This ignores the evidence of lives restored, and overdoses prevented, by this treatment.

Another Department of Veterans Affairs program provides essential services to veterans struggling with drugs or alcohol. The “HUD-VASH” program, a partnership with the Department of Housing and Urban Development, has secured permanent housing for nearly 60,000 veterans since 2008. In recent years, HUD-VASH has dropped a requirement that veterans be “housing ready,” usually through abstinence from drugs or alcohol, before they receive housing.  The new approach provides housing as the first step and then surrounds the person with supportive services.

VA evaluations show that the “Housing First” approach saves money for health care and allows the VA to reach the most vulnerable veterans – those who combine alcohol and drug dependence with serious mental health issues.  They live under bridges, in doorways and in parks of towns all over America. A Housing First approach brings them inside.

The Department of Veterans Affairs has responded to drug dependence with three programs whose effectiveness has been proven and that make good financial sense. But barriers to evidence-based treatment need to be removed, and there is no time to waste.

Gary is a 29-year-old Iraq War veteran. Before finding an apartment through HUD-VASH, he lived in the New York City subway. “If it weren’t for HUD-VASH, I would probably be dead,” he told us.