Addressing Opioid Use After Service-Related Injuries

Key Takeaways

• Service-related injuries among veterans include PTSD, TBI, hearing loss, and musculoskeletal disorders, impacting their transition to civilian life.
• PTSD and TBI are prevalent psychological injuries, while musculoskeletal injuries often involve the lower back and knees.
• The enduring impact of service-related injuries on veterans includes chronic pain, emotional distress, and social readjustment challenges.
• Opioid use among veterans with service-related injuries is high, with overdose mortality rates increasing by 53% from 2010 to 2019.
• Veterans often begin using opioids for pain management, which can lead to misuse and opioid use disorder (OUD).
• Access to healthcare and utilization of Veterans Health Administration services are significant barriers for veterans with SUDs.
• Strategies to address opioid use in veterans include the Whole Health model, Medications for Opioid Use Disorder (MOUD), and community care models.
• Non-opioid pain management strategies for veterans are being explored, including multimodal opioid-sparing analgesia and new pharmacological treatments.
• Veteran support services for opioid recovery include mental health services, housing and employment programs, and crisis intervention.
• Policy recommendations for addressing opioid use in veterans focus on prevention, treatment, and support, with an emphasis on enhancing opioid safety programs and increasing access to healthcare.

Understanding the Scope of Service-Related Injuries Among Veterans

Service-related injuries encompass a broad range of physical and psychological conditions that veterans may experience as a result of their military service. These injuries can have profound effects on veterans' lives, impacting their physical health, mental well-being, and socioeconomic status. The Department of Veterans Affairs (VA) recognizes the significance of these injuries by providing disability ratings and compensation to support affected individuals. Injuries commonly classified as service-related include post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), hearing loss, and musculoskeletal disorders. These conditions not only affect veterans' quality of life but also contribute to the challenges they face when transitioning back into civilian life.

PTSD and TBI are among the most prevalent psychological injuries, often resulting from combat exposure or other traumatic events during service. Hearing loss is another significant injury, frequently caused by exposure to loud noises in military environments. Musculoskeletal injuries, such as those to the back, knees, and shoulders, are common due to the physical demands of military duties. The VA provides various forms of assistance, including disability pay and access to healthcare services, to help veterans cope with the aftermath of these injuries. For instance, veterans with a 100% disability rating can receive a basic monthly compensation rate, which is adjusted for dependents and additional factors like Aid and Attendance benefits.

Addressing the needs of veterans with service-related injuries is a multifaceted effort that involves providing equitable access to healthcare and benefits, as highlighted in the VA's 2024 Equity Action Plan. This plan aims to eliminate disparities and enhance economic security for all veterans, including those from historically underserved communities. Efforts are also made to inform veterans about their earned benefits and support them through various programs, such as the Transition Assistance Program and Vets4Warriors, which provide guidance and peer support during the transition period.

Prevalent Service-Related Injuries in Veterans

Service-related injuries among veterans are a significant concern, with musculoskeletal injuries (MSKIs) being highly prevalent. These injuries include a range of conditions affecting the muscles, bones, and joints. According to a study published in Military Medicine, the most common sites of injury are the lower back and the knee, which together account for a substantial portion of all overuse injuries. The lower back, in particular, is frequently reported as the most common injury site across the U.S. Armed Forces.

Another study from OrthoInfo indicates that strains often occur in the back or leg, notably the hamstring. Sprains and strains are typical soft-tissue injuries that can result from overexertion or accidents during service. The Cleveland Clinic adds that ankle and elbow injuries are also common, with ankle sprains being a frequent issue.

Psychological injuries are also a significant concern for veterans, with the U.S. Department of Veterans Affairs recognizing military sexual trauma (MST) as a serious issue that can lead to long-term psychological trauma. Moreover, veterans are at risk for chronic conditions such as post-traumatic stress disorder (PTSD) and other health issues related to their service, including exposure to harmful substances or environmental hazards that may lead to diseases like mesothelioma or fibromyalgia.

Overall, these injuries not only affect the physical well-being of veterans but also have a profound impact on their mental health, social functioning, and quality of life, necessitating comprehensive care and support services.

The Enduring Impact of Service-Related Injuries on Veterans

Service-related injuries have profound and lasting effects on veterans, encompassing physical, emotional, and social dimensions. The physical consequences often persist long after their military service, with many veterans experiencing chronic pain, disability, and long-term health issues, such as depression and pain that hinder recovery. Emotional impacts are equally significant, with conditions like post-traumatic stress disorder (PTSD) not only affecting the veterans but also placing a considerable strain on their families. Research from BMC Psychiatry highlights the challenges faced by spouses of veterans with PTSD, including societal discrimination and a lack of support, which can lead to disruptions in family dynamics.

Socially, the transition to civilian life can be particularly difficult for those with service-related injuries. According to a Pew Research Center survey, injured veterans are more likely to struggle with readjustment and are less satisfied with the medical care received post-service. The impacts extend to employment, with injuries often leading to job loss or reduced work capacity. Moreover, the effects of service injuries are not limited to the veterans themselves; family members, especially children, experience emotional and social repercussions, as seen in research from NCBI, which shows how children of injured veterans struggle with social participation and changes in family roles.

These multifaceted impacts necessitate a comprehensive approach to support and rehabilitation for veterans, addressing not only the physical but also the profound emotional and social challenges they and their families face.

Prevalence of Opioid Use Among Veterans with Service-Related Injuries

The prevalence of opioid use among veterans, particularly those with service-related injuries, is a critical concern. Studies reveal that the opioid overdose crisis has significantly impacted U.S. military veterans, with overdose mortality rates climbing by 53% from 2010 to 2019. This alarming trend underscores the need for comprehensive understanding and intervention ( Bennett et al., 2022 ). Veterans often begin using opioids as a treatment for acute and chronic pain resulting from service-related injuries, with many underestimating their risk of overdose despite having a risk profile comparable to those diagnosed with opioid use disorder (OUD) ( Teeters et al., 2018 ).

Co-occurring substance use disorder (SUD) and mental illness are prevalent among veterans, with 1.1 million (5.6%) aged 18 or older experiencing both. Young veterans aged 18 to 25 are particularly vulnerable, with nearly two in five suffering from SUD or any mental illness ( SAMHSA, 2021 ). The intersection of mental health concerns, such as PTSD, depression, and the experience of military sexual trauma, with physiological pain from injuries creates a complex risk environment for veterans, potentially leading to self-medication with opioids and subsequent addiction ( Bennett et al., 2022 ).

Despite the high prevalence of SUDs among veterans, access to healthcare and utilization of Veterans Health Administration services remain significant barriers. Community care models and overdose prevention resources that incorporate veterans' perspectives and experiences are crucial in addressing this issue. The integration of mental health support with SUD treatment is also highlighted as a necessary approach for effective intervention ( Teeters et al., 2017 ).

Understanding Opioid Prescription Among Veterans with Service-Related Injuries

Veterans with service-related injuries often face acute and chronic pain, leading to the prescription of opioids as a pain management solution. Opioids are powerful pain relievers that can effectively manage the severe discomfort that comes from physical injuries sustained in the line of duty. However, the use of opioids carries the risk of developing use disorders due to their addictive nature. Research indicates that opioid use among veterans is sometimes initiated iatrogenically, meaning it is a consequence of medical treatment, especially when managing service-related injuries.

Additionally, opioids may be used by veterans to self-medicate for various reasons beyond physical pain, including to alleviate psychological distress such as anxiety, depression, or post-traumatic stress disorder (PTSD). For instance, some veterans use prescribed opioids to help with sleep or to reduce anxiety, which can lead to misuse and increased risk behaviors. The complexity of treating service-related injuries, both physical and psychological, makes pain management a challenging issue within the veteran community.

Access to healthcare and consistent follow-up are critical for veterans who rely on opioids for pain management. The Department of Veterans Affairs (VA) has acknowledged the need for comprehensive solutions that are effective, efficient, and evidence-based to combat opioid misuse among veterans. Initiatives such as reducing opioid prescriptions, implementing alternative pain management techniques, and providing support services are part of ongoing efforts to address this public health concern. Studies have shown that a multifaceted approach considering physiological, psychological, and social factors is essential in understanding and addressing opioid use among veterans.

Health Risks and Social Consequences of Opioid Use Among Veterans

The opioid crisis has significantly affected U.S. military veterans, especially those with service-related injuries, leading to a dramatic increase in drug overdose mortality rates. From 2010 to 2019, overdose deaths among veterans surged by 53%. The consequences of opioid use extend beyond the risk of overdose; they include the potential for opioid use disorder (OUD) and the exacerbation of mental health issues such as depression, post-traumatic stress disorder (PTSD), and the effects of military sexual trauma. Research indicates that veterans with a history of military sexual trauma are at a 50% higher risk of having an OUD diagnosis.

Veterans who do not utilize Veterans Health Administration (VHA) services are particularly vulnerable. Community care models and outreach programs, such as those in New York City, are crucial for reaching veterans who are socially isolated or reluctant to seek traditional substance use services. The VHA's Overdose Education and Naloxone Distribution Program and interventions like Operation Opioid SAFE, which offers overdose prevention training and naloxone, represent proactive measures against the opioid crisis. However, the co-use of opioids with other substances and unmonitored dose escalation remain significant risks for misuse and overdose.

Additionally, the opioid crisis has broader social consequences, including reduced labor force participation and increased healthcare costs. Efforts to address these issues include federal policy responses, the expansion of complementary and integrative health interventions, and virtual care models to improve treatment access. Despite these efforts, barriers to comprehensive care and uneven access to services persist, underscoring the need for continued attention and improvement in managing opioid use among veterans.

Strategies to Address Opioid Use in Veterans with Service-Related Injuries

Veterans with service-related injuries are at an increased risk for opioid use due to chronic pain management, mental health disorders, and the prevalence of substance use disorders (SUDs). The opioid crisis has significantly affected this population, with opioid-related deaths remaining high despite efforts such as the Opioid Safety Initiative (OSI). To combat this, a multifaceted approach is necessary, focusing on the biopsychosocial framework, which includes physiological, psychological, and sociological aspects of veterans' lives.

Interventions to reduce opioid reliance among veterans include the implementation of the Whole Health model, which emphasizes personalized, proactive, and patient-driven care. Research highlights the importance of incorporating veterans' experiences into overdose prevention strategies, and community care models have shown promise for those not connected to Veterans Health Administration services.

Moreover, the availability of Medications for Opioid Use Disorder (MOUD) is critical, and education is key to improving access. Initiatives like the Veteran Community Partnership (VCP) aim to improve interventions for opioid use disorder. For veterans outside the VA system, risk mitigation principles and outreach programs that provide low-threshold services are essential. Programs like Overdose Education and Naloxone Distribution are vital for risk reduction.

Additionally, addressing the high prevalence of military sexual trauma and its link to opioid use disorder is crucial. Specialized SUD treatment and gender-tailored care can increase treatment engagement, especially among female veterans. Finally, policy recommendations must focus on improving healthcare access, enhancing MOUD availability, and integrating veterans' voices in the design of prevention resources.

Non-Opioid Pain Management Strategies for Veterans

For veterans with service-related injuries, managing pain without relying on opioids is a critical concern. Recent research has identified several non-opioid pain management techniques that can be effective. One approach is the use of multimodal opioid-sparing analgesia, which includes a combination of nonpharmacologic strategies, local and regional anesthesia techniques, nonopioid analgesics, and opioids only when necessary. This method emphasizes the importance of individualized pain management plans that may incorporate various therapies to achieve pain relief.

Another promising area of research is the development of new non-opioid pharmacological treatments. A molecule that targets neuropathic pain by binding to a specific protein involved in pain signaling has shown long-lived effects in reducing hypersensitivity in animal trials. This discovery, funded in part by the National Institutes of Health, points to the potential for new drug therapies that can provide pain relief without the risks associated with opioids.

Additionally, there are various non-medication based interventions such as Transcutaneous Electrical Nerve Stimulation (TENS), which may offer relief for certain types of pain, although evidence supporting its effectiveness varies. Other non-opioid medications, like NSAIDs, acetaminophen, antidepressants, and anticonvulsants, also play a role in pain management. More invasive procedures like radiofrequency ablations and sympathetic nerve blocks are used for specific pain conditions and have varying levels of evidence supporting their use.

These findings underscore the importance of exploring and integrating a wide range of pain management options for veterans, aiming to alleviate pain while minimizing reliance on opioids.

Veteran Support Services for Opioid Recovery

Veterans grappling with opioid use have access to a multifaceted network of support services designed to facilitate recovery and reintegration into civilian life. The Department of Veterans Affairs (VA) plays a pivotal role in providing mental health services, including counseling and crisis intervention, tailored to veterans' unique experiences and needs. These services are crucial for addressing not only substance abuse but also co-occurring mental health conditions such as PTSD, depression, and anxiety.

Comprehensive support extends beyond mental health care, with programs like the Supportive Services for Veteran Families (SSVF) and the Homeless Veterans Reintegration Program (HVRP), which aim to secure housing and employment for veterans, thereby stabilizing key aspects of life that can be disrupted by substance use. U.S.VETS offers individualized support services including case management and aftercare, emphasizing the importance of tailored approaches to veteran care.

For immediate assistance, veterans can contact the Veterans Crisis Line or explore community resources such as the National Alliance on Mental Illness (NAMI). These services provide a lifeline for veterans, ensuring they are not alone in their journey to recovery. For those seeking help, it's encouraged to reach out to the nearest VA medical center or utilize online resources like the National Resource Directory to connect with the appropriate support systems.

Strategic Policy Recommendations for Addressing Opioid Use in Veterans

Effective policy recommendations are crucial for addressing the opioid crisis among veterans who suffer from service-related injuries. To mitigate this issue, a multi-pronged approach is necessary, focusing on prevention, treatment, and support. Research indicates that policies should aim to reduce opioid-related deaths, overprescribing, and opioid use disorder (OUD) through improved funding, expanded research, and the identification of best practices.

• Enhanced Opioid Safety Programs: Initiatives like the VA's Opioid Safety Initiative (OSI) have shown promise by reducing the number of veterans dispensed opioids. Further expansion and refinement of such programs are recommended.
• Comprehensive Pain Management: The VA/DoD Clinical Practice Guidelines advocate for evidence-based recommendations in managing chronic pain without sole reliance on opioids. Policies should support these guidelines and encourage alternative pain management techniques.
• Increased Access to Healthcare: Addressing barriers to healthcare access and utilization, especially within the VA system, is vital for veterans at high risk of overdose due to complex clinical conditions.
• Overdose Prevention Training: Programs like Operation Opioid SAFE, which offer overdose prevention training and naloxone distribution, should be widely implemented to reduce the risk of opioid overdose among veterans.
• Support for Mental Health: Given the high prevalence of mental health issues such as PTSD and depression among veterans, policies should ensure integrated mental health services and support for those with a history of military sexual trauma, who are at increased risk of OUD.
• Low-Threshold Services: Outreach programs that provide low-threshold services and risk reduction information are essential for veterans who may not utilize VA services.
• Medications for Opioid Use Disorder (MOUD): Increased provision of MOUD and holistic approaches to treatment should be a cornerstone of veteran healthcare policy.

Implementing these policy recommendations requires collaboration between government agencies, healthcare providers, and veterans' support organizations to create a comprehensive response to the opioid crisis among veterans.

For veterans grappling with addiction and co-occurring mental health disorders, the VA’s services stand ready to assist. The first step towards recovery is reaching out for help today.

Orlando Recovery Center is a proud member of the VA Community Care Network and are equipped to accept VA health benefits. Our Veteran Advocates are poised to assist you or a cherished veteran in navigating the VA approval process, ensuring you receive the vital help you deserve. Call us today and ask for a dedicated Veteran Advocate to assist you.