The wars fought by this generation are different from the previous ones, and have left a different kind of disabled veteran: Lots of concussive brain injuries from homemade bombs, along with lots of Post Tramautic Stress Disorder from unpredictable combat conditions.
The combination has produced a new crop of veterans in chronic pain, while PTSD has lowered their thresholds for pain.
The result is a group of people especially vulnerable to pain pill addiction, said David Shulkin, the undersecretary of health for the Department of Veterans Affairs.
Shulkin - who moved to the VA from his earlier post as the head of Morristown Medical Center - returned to the state Monday to join the U.S. Surgeon General and both New Jersey senators to talk about the crisis of opioid addiction.
How bad is the problem?
Surgeon General Vivek Murthy told the group he now devotes half his time to the topic. An estimated two million Americans struggle with pain-pill addiction.
He likened his agency's new focus on pain pill addiction to its 1964 report on tobacco, which ushered in a change in thinking about cigarettes and health.
Shulkin shared startling statistics with a standing-room crowd of clinicians at St. Barnabas Medical Center in Livingston Monday:
The VA has managed to reduce its opioid prescriptions by a third, but Shuklin cautioned it was essential to have an effective alternative for the patient. Simply refusing to renew a prescription with produce resentment, he said.
Vets in chronic pain can meet with a pharmacist to discuss alternatives, and are issued a pre-paid envelope in which to return their unused medications to keep someone else from using them.
Murthy, the Surgeon General, said that while there has been a growing realization that many cases of addiction begin with a legitimate opioid prescription to treat legitimate pain, most doctors lack any formal training in addiction. That means they are unlikely to spot the signs of addiction among their patients, and know little about how to treat addiction.
That needs to change, he said, so that understanding substance abuse addiction would be on par with understanding high blood pressure or high insulin levels - something that would be any every doctor's basic understanding of human health.
"Every clinician needs to be trained in the basics about diagnosing and treating substance abuse," he said.
Murthy said he soon will be sending an old-fashioned letter to 2.3 million physicians to highlight his concern about the problem, which continues to worsen despite attempts to tackle it.
Both of New Jersey's senators talked about the general shortage of treatment slots for addicts who are ready to tackle their problem.
"I can't tell you the number of people who have said to me, 'I can't get my son or daughter into a treatment program,'" said U.S. Sen. Robert Menendez (D-NJ).
Fellow Sen. Cory Booker agreed, talking about the first-hand knowledge his office has of the depth of the problem: "For us, they're not statistics. They're people we know. They are people who are desperate who reach out to our office."
Asked by the moderator if he felt Congress was doing enough to address the problem, he answered, "I think the technical term would be, 'Hell no.'"
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