Opioid misuse is rampant in the United States. According to the Centers for Disease Control and Prevention (CDC), the number of overdose deaths involving opioids has quadrupled since 1999 and currently, 91 Americans die daily from an opioid overdose. Unfortunately, the epidemic has hit military veterans especially hard.

“The veteran population is really a microcosm of the general population, but it’s a high-risk population,” said Anthony Dekker, DO, a physician who treats veterans with chronic pain and substance use disorders.                        

According to Veterans Health Administration officials, nearly 60 percent of returning veterans from the Middle East and more than half of older veterans in the U.S. Department of Veterans Affairs (VA) health care system live with chronic pain. Until recently, the VA treated chronic pain overwhelmingly with opioid therapy, which has resulted in misuse and addiction among many veterans as well as their caregivers.

In recent years, the VA has reduced opioid prescriptions and worked to better identify veterans struggling with substance use disorders. The CDC has also established guidelines to help better ensure that millions of physicians prescribe opioids appropriately and responsibly.

Fighting stigma

A major part of getting veterans and their caregivers the care they need is creating an environment in which they feel comfortable asking for help, said Steve Schwab, Executive Director of the Elizabeth Dole Foundation.

“The first step to fighting a stigma is raising awareness and making people feel they’re acknowledged. We need to encourage caregivers and veterans to raise their hands and seek support,” said Schwab.

To this end, Schwab said, getting veterans and caregivers in contact with peers who’ve had similar experiences is key. The Elizabeth Dole Foundation’s Hidden Heroes campaign provides an online resource that facilitates those connections.

“There are no easy answers, but I’m inspired to be part of Hidden Heroes, which is seeking solutions to the tremendous challenges and long-term needs of this too often over-looked community,” said Emery Popoloski, a military caregiver who works as the Fellows Program Coordinator at The Elizabeth Dole Foundation.

'“We want to help prevent future episodes of substance misuse and get people the evidence-based medical care for their pain conditions up front...”'

Another important approach, Dr. Dekker said, is increasing the availability of non-opioid and non-pharmacologic interventions for chronic pain. He noted that physical therapy, occupational therapy, massage, acupuncture, mindfulness and even yoga have all proved effective measures for reducing pain while preventing opioid misuse.

“The most important one is physical activity and exercise. People who receive medications and stay at home and sit on the couch are doing themselves a disservice and the provider isn’t treating the patient adequately,” Dr. Dekker said.

Reducing opioid availability

Dr. Dekker advocates discussing treatment options with patients seeking help for managing chronic pain and finding a solution that is right for the patient. “For some patients, using opioid medication to treat pain is not appropriate or needed.” Some major players in the health insurance industry are leading the way in making the drugs less pervasive.

In November 2016, Cigna, a global health services company, asked medical practices in their collaborative care organizations to sign a pledge to reduce opioid prescribing and to treat opioid use disorder as a chronic condition. So far, more than 130 medical groups, encompassing more than 60,000 physicians, have signed in support, said Douglas Nemecek, M.D., Chief Medical Officer of Cigna Behavioral Health.

“We want to help prevent future episodes of substance misuse and get people the evidence-based medical care for their pain conditions up front so they minimize the risks and don’t ever get into a situation where they’re misusing opioids. For those who already have substance use disorders, we want to make sure we get those people to the appropriate care providers,” said Dr. Nemecek.

Equally important is ensuring access to treatment. The increase in opioid overdoses may indicate those with a substance use disorder are not being diagnosed and referred to treatment. In addition to its pledge initiative, Cigna is working with nonprofit organizations, physicians, employers and other partners to tackle the opioid epidemic. That spirit of collaboration, Dr. Dekker said, is essential.

“There needs to be a cooperative approach between providers, patients and communities with regard to the appropriate evaluation of pain and the appropriate prescribing of medications,” Dr. Dekker said.

Dr. Nemecek wholeheartedly agrees with this. “This health crisis can’t be fixed with a single approach, and it can’t be fixed by a single agency or organization alone. That’s why it’s so critical for all stakeholders to work together,” he said.