Inside the Appalachian Opioid Epidemic Part 2: Veterans, Chronic Pain & Alternative Treatment


It’s been about 20 years since the opioid epidemic started. Appalachia has been called ground zero for this crisis, and the Mountain State leads the country in drug overdose deaths. This episode of Inside Appalachia explores how the epidemic is affecting veterans, who are twice as likely to become addicted to opioids than the general, or civilian, population. 

Earlier this year, The Center for Ethics and the Rule of Law at the University of Pennsylvania (CERL) released a report that concludes there is a causal link between post-traumatic stress disorder and becoming addicted to drugs and alcohol.

So how did we get here? According to a report by the U.S. National Library of Medicine National Institutes of Health, nearly 10 years ago, in 1999, the Veterans Health Administration launched an initiative to add pain as the fifth vital sign. This required doctors to use a pain intensity rating for all patient visits.

This wasn’t unique to the VA — in the 1990s, several medical associations across the United States made similar shifts to treating pain as the fifth vital sign, as we heard in our episode last week.

About 60 percent of military personnel returning from deployments in the Middle East and half of older veterans from previous deployments suffer from chronic pain nationwide, according to a report that was released earlier this year from the Center for Ethics and the Rule of Law at Pennsylvania State.

In 2013, the Center for Investigative Reporting found that since the 9/11 terrorist attacks, the number of opiate prescriptions by the U.S. Department of Veterans Affairs has skyrocketed.

The investigation showed that prescriptions for opiates to veterans surged by 270 percent from 2001 to 2012.

Some of the highest rates of opioid prescriptions were given to Veterans in southern West Virginia.

According to data West Virginia Public Broadcasting obtained from the Veterans Administration, in 2012 one out of every four veterans who visited the VA in Beckley, West Virginia, was prescribed opioid painkillers, much higher than the national average of all veterans.   

Since 2012, the number of opioids prescribed at VAs in West Virginia, and the country, has decreased.

But is it ethical to take pain medication away? This has become a huge debate throughout the medical community in recent years, and with good reason, after all, there are still a lot of veterans suffering with chronic pain.

So how do doctors help these patients get the treatment they need without causing further harm by creating addiction? 

For the past three years, the VA has begun implementing new pain management recommendations for treating veterans who have chronic pain. In 2013 the VA released a new set of guidelines called The Opioid Safety Initiative, which concluded that opioids are not the best treatment for most types of chronic pain. Instead, VA doctors are encouraged to prescribe alternative therapies, like yoga, physical therapy and chiropractic care.  

How are veterans reacting when they’re prescribed yoga or physical therapy to treat their pain? Listen to the episode to find out.

Music in this episdoe was provided by Creeks Don’t Rise with “White Coat Man”, Dinosaur Burps, Marisa Anderson, Larry Dowling, Ben Townsend,  and Heroes are Gang Leaders.