Veteran Opioid Use, Policies, and Rehab Treatment Centers

Opioid drugs continue to be prevalently used and misused throughout the country. As a medication, opioid painkillers are commonly prescribed to manage severe pain, although opioids are also widely abused or used illegally.¹ Abusing opioids can involve taking them in larger amounts than prescribed, taking them when they haven’t been prescribed to you, combining them with other drugs or alcohol to increase the effects, using them to get high, or taking them in a different way than prescribed, such as chewing or crushing the pills and snorting, smoking, or injecting the powder.^{1, 2}

Veterans, just like other members of the population, are vulnerable to opioid abuse and addiction. Luckily, there is a range of opioid treatment centers that can help veterans find recovery from opioid abuse and addiction.

What Are Opioids and Opiates?

The terms opioids and opiates are often used somewhat interchangeably, though there are some distinctions. In some instances, the term opiates will be reserved to describe the naturally-derived opiate alkaloids such as morphine and codeine, while opioids may additionally refer more broadly to semi-synthetic drugs that are manufactured from these precursors as well as fully lab-made synthetic drugs.^1,3

In their various formulations, prescription opioids may be used to treat moderate to severe pain, reduce cough, stop diarrhea, and induce sleep.^{1, 3} These drugs interfere with how the body transmits signals and sensations that indicate pain.^{3, 4} Their use is also associated with increased activity of a brain chemical known as dopamine, which can result in a rewarding euphoria, thus increasing the potential for abuse and addiction in some people.^{2, 3} In addition to their therapeutic pharmacological activity, opioids may have some side effects, including:^{1, 2}

• Drowsiness.
• Confusion.
• Nausea and vomiting.
• Constipation.
• Depressed breathing, which can cause brain damage or death in severe cases.

Opioid Use in Veterans

Veterans may be prescribed opioids to manage pain resulting from a variety of issues. While many veterans safely take opioids for limited periods of time under medical supervision, others may find opioid use problematic for several reasons. Opioid use to manage many chronic pain has become less widespread, as there may be safer and more effective pain management strategies in some of these situations.^{5, 6} Chronic opioid use increases several health risks, and makes tolerance to the effects of opioids much more likely. Over time, a progression from taking opioids as prescribed to needing ever-increasing amount of the medication for it to continue to manage pain can lay the groundwork for problematic patterns of misuse.⁵

Since opioids stimulate the reward centers of the brain, misuse of these medications can dramatically reinforce their continued use—ultimately contributing to the development of an addiction.² As opioid use escalates in some instances, people may begin to seek cheaper or easier to obtain opioid alternatives, such as heroin. ^{2, 4}

Causes and Risks

Veterans may be at greater risk of developing substance use disorders (SUDs) than the general population.⁷ A range of factors can contribute to this higher risk. In some cases, opioid use disorders (OUDs) develop in veterans for whom prescription opioids were initiated for injuries sustained during deployment that later result in chronic pain.^{5, 7} Substance use disorders are also quite prevalent among veterans who struggle with mental health issues, such as depression or post-traumatic stress disorder (PTSD).⁷ It can be challenging for veterans to reintegrate into civilian life after military service; this can be another contributing factor to the development of SUDs as well.⁷ Overall, while the causes and risks of developing an opioid addiction vary depending on one’s circumstances, opioid addiction remains a prescient and growing problem for veteran populations.

Impacts on Veterans

Opioid and other substance misuse can have major short- and long-term impacts on a veteran’s life. Veterans with substance use disorders are may be several times more likely to receive a diagnosis of PTSD or depression. These mental health issues themselves are additionally associated with other issues such as sleep disturbances and relationship violence.⁷ Veterans with co-occurring SUD and PTSD may also be more likely to experience additional mental and physical health issues, such as HIV, liver disease, anxiety, and schizophrenia.^{7, 8}

Homelessness is another issue that affects veterans who struggle with substance abuse. Not having stable housing can make it difficult to access treatment. Furthermore, it’s estimated that in 2011, nearly one in five veterans attending substance abuse treatment were homeless.⁷ Overdose is a major issue that can potentially be fatal, even after a single use.¹ Veterans are at increased risk for unintentional opioid overdoses.⁷

Additionally, suicide amongst veteran populations seems to be associated with the use of prescription pain medications. In 2017, a VA study of over 100,000 veterans found that those who were taking high doses of opioids for chronic pain were nearly twice as likely to commit suicide. However, the data is still being examined, and it’s unclear if the opioids were a cause of the suicide, or if the underlying, unresolved chronic pain was the bigger factor in the deaths.⁷

Signs of Opioid Use Disorder

While taking opioids under a doctor’s supervision can be safe, misuse in excess of prescribed guidelines can increase the risk of developing an opioid use disorder.^{5, 7} Opioid use disorders involve patterns of problematic opioid use that persist despite negative consequences in one or more areas of life. Experiencing at least 2 of the following symptoms within a one-year period may indicate an opioid use disorder:^{8, 9}

• Cravings to use opioids, which can be overwhelming.
• Cutting back or quitting important activities as a result of opioid use.
• Developing a tolerance, so that the same amount of opioids no longer have the same effect.
• Inability to cut back or stop using, even if you genuinely want to.
• Loss of control over your opioid use, including the amount of the drug you take and for how long.
• Not being able to stop using opioids even after knowing that they have caused or worsened a physical or mental health condition.
• Spending a significant portion of time getting, using, or getting over the effects of opioids.
• Struggling to complete tasks at home, school, or work as a result of opioid use.
• Taking opioids in situations that can be dangerous, such as when driving or operating machinery.
• Using opioids even after knowing that they have caused or worsened issues with personal or social relationships.
• Withdrawal symptoms occur when you stop using opioids.

Other warning signs that a person may be abusing or addicted to opioids might include:^{8, 9}

• Buying opioids illegally.
• Running out of medication early.
• Claiming that the prescription medication has been lost or stolen.
• Visiting multiple doctors, hospitals, or pharmacies to obtain opioid prescriptions.
• Constantly complaining of medical issues that require opioid medication, even with no evidence.
• Changes in eating or sleeping habits.
• Frequent drowsiness.
• Getting arrested for possession or sales of drugs, theft, or driving under the influence.
• Isolating from family and friends, or spending time with a completely different group of friends.

Will Opioid Use or Rehab Affect My Veteran Benefits?

There is always the possibility that opioid misuse can make it more difficult or even impossible to access veteran disability and health benefits, but this occurs only in specific situations. As a veteran, attending opioid treatment programs will not affect your receipt of benefits in any way.

However, receiving a dishonorable discharge from the military, such as for committing a felony or engaging in willful misconduct, will disqualify you for veteran benefits.^{10, 11} If you are injured while under the influence of drugs or alcohol and it is determined to be willful misconduct, you will not be eligible for disability benefits through the Department of Veterans Affairs (VA) for the injuries sustained while under the influence of substances.^{12, 13}

In the military, willful misconduct means knowingly doing something you shouldn’t be doing and not worrying about the outcome.^{12, 14} Just taking opioids in the military isn’t necessarily considered to be willful misconduct. But misusing prescribed opioids, using them to get high, taking illegal opioids, or purchasing prescription opioids illegally is considered willful misconduct.^{12, 13} Using opioids in these ways can bar you from receiving any types of veterans benefits, including disability and VA healthcare benefits.^{11, 13}

VA Policies & Guidelines for Opioid Prescriptions

In recognition of the opioid crisis, the VA has dramatically changed opioid prescribing practices within the last decade.^{7, 15} The Opioid Safety Initiative has changed how VA physicians treat pain among veterans, incorporating non-opioid pain management strategies to either replace or supplement opioid medications and better address the pain that veterans are facing.¹⁵ Efforts such as these have contributed to a 64% reduction in prescription opioid use in VA patients between 2012 and 2020, lowering long-term opioid use by 70% and decreasing the risk of opioid overdose.¹⁵

The VA has begun to incorporate a range of both alternative and evidence-based approaches to complement ongoing pain management strategies, including:^{5, 16}

• Self-care: Building social supports, maintaining proper sleep and diet, engaging in some type of physical activity, participating in hobbies, smoking cessation, and meditation.
• Strategies to reduce pain: Improving posture; weight loss; engaging in gentle activities such as yoga, tai chi, and stretching; practicing deep breathing or relaxation; heating and icing areas that are painful; pain management classes; support groups.
• Non-pharmacological therapies: Acupuncture, chiropractor visits, transcutaneous nerve stimulation, physical and occupational therapy, and behavioral therapies such as cognitive behavioral therapy and biofeedback to help you adjust your responses to pain.
• Non-opioid medications: Topical treatments that can be applied to the skin; anti-inflammatory medications; antidepressants that can improve muscle, bone, and nerve pain; and anticonvulsant medications that can improve nerve pain.
• Specialized treatments that can address specific issues, such as injections to manage pain in one area.

Opioid Rehab and Treatment for Veterans: When is it Time?

If opioids are interfering with your ability to function in daily life, you may want to reassess your patterns of use.  If you’ve read through the list of signs used to diagnose an opioid use disorder and identified at least 2 in yourself, it could be time to seek help. The best course of action would be to reach out to a medical professional or to your local VA representative.

Several resources are available to veterans who want to learn more about finding opioid or opiate addiction treatment centers. Some places you can start include:

• Speak with your medical provider. They can conduct an assessment and guide you towards treatment, even offering a referral if needed.
• Contact your local VA office or hospital. They can provide more information about available services and direct you to your primary care provider at the VA. If you don’t already have VA healthcare benefits, you may need to first apply for them.
• Call the VA’s general information hotline at 1-800-827-1000. You can speak to someone who can answer some questions you may have, such as where your nearest VA office/hospital is and whether there is a VA opioid treatment program near you. There is also an online search tool that you can access here to find a VA substance use program near you.

Is Opioid Treatment Covered by the VA or Other Veteran Benefits?

Opioid rehab is covered by VA healthcare resources. Government-funded insurance programs like Medicare, Medicaid, and TRICARE can also help veterans cover the cost of opioid addition.^{7, 17} Federal health insurance programs like Medicare and Medicaid also generally cover treatment for opioid use disorders.^{18, 19}  While facilities and programs may cover a wide range of services—including detox, inpatient treatment, residential treatment, outpatient services, medication-assisted treatment, behavioral therapy, family counseling, and more—it is important to check with your specific healthcare system and/or insurance provider.^{7, 20} Coverage of specific services and facilities may vary depending on your unique needs and healthcare plan.