Michael, a 43-year old veteran of the Gulf War, is a man of few words. He doesn’t talk about what he saw during his tour in Iraq, or whether he suffered from post-traumatic stress disorder (PTSD). While he says he began using opioids after he injured his left knee, he doesn’t mention how he hurt it. He did, however, tell Human Rights Watch researcher Megan McLemore that he uses heroin “now and again.”
But Michael was willing to talk about one part of his life as he walked through the streets of his Queens, New York neighborhood with Megan. Each day, together with his friend Juan, a veteran who had overcome a serious drug problem, Michael volunteers with the New York Harm Reduction Educators. They do outreach in the streets of Harlem and the Bronx, handing out clean needles to prevent HIV and hepatitis. They also offer information about veteran support groups, and – especially important – about naloxone, a medication that can reverse a heroin overdose. He is trying to help other veterans stay alive. He knows too well how they got there, to the streets, to drug use, to homelessness.
In a new report, No Time to Waste, Human Rights Watch shows how alcohol and drug dependence among veterans is strongly associated with homelessness, as well as mental health problems – including PTSD and depression – that affect 40 percent of Iraq and Afghanistan veterans in the care of the Department of Veterans Affairs (VA). It’s estimated that more than one million US veterans take prescription opioids – synthetic opiates – for pain, and nearly half of them use the drugs chronically, or for more than 90 days. Drugs or alcohol are involved in one out of every three Army suicides, and the VA estimates that 22 veterans commit suicide each day.
While the VA has taken some steps to reach drug-dependent vets, Human Rights Watch found that more needs to be done. Drug-dependence treatment needs to be expanded, and more housing needs to be made available to chronically homeless veterans. The VA should also expand the availability of naloxone, which is safe, easy to use, and approved in many states for distribution by trained volunteers to people who are at high risk of overdose. The death rate by accidental overdose among VA hospital patients is nearly double that reported in the US as a whole.
Michael claims he only uses heroin “now and then.” For years, he has lived in transitional housing – one step away from homelessness. The city-run housing program does not require abstinence from drugs or alcohol, which is good, or he might lose the roof over his head.
As trained volunteers with New York Harm Reduction Educators, Michael and Juan know where people who use drugs hang out. They go to those street corners at all hours of the night, helping anyone in need, but keeping a special lookout for veterans. Each time someone approaches them for help, one of them asks, “Hey, are you a vet?” They focus their efforts on those who say yes, and they have been able to create a small network of veterans who help each other stay alive.
If the vets tell them they’re using pain killers, heroin, or other opioids, Michael and Juan make sure to give them naloxone kits to carry with them in case of overdose.
Michael was inspired to work with New York Harm Reduction Educators by his friend Leon, who did two tours in Iraq and who lived with him in transitional housing. By day, his friend would beg on the street, holding up a cardboard sign asking for money. At night, he often did heroin. Michael gave him naloxone to carry with him. “It just might save his life,” he said.
Michael even helped found the organization’s official veteran outreach program, and about 10 to 20 people attend their meetings on a regular basis. Some of the veterans who show up are getting VA services, and some aren’t.
Michael doesn’t have access to VA services because he received a dishonorable discharge after going AWOL for 180 days. He didn’t elaborate on what happened, except to say that he’s appealing his discharge. The high rate of dishonorable discharges is problematic due to the prevalence of PTSD, Traumatic Brain Injury, and related substance abuse among active military members.
Human Rights Watch is working to make sure that everyone, including veterans like Michael, receives the necessary support to deal with pain, drug dependence and homelessness.
