Chronic pain is an experience that many Veterans know all too well, and the devastating effects that it can introduce into a Veteran’s life can have drastic consequences. Recently, the Ralph H. Johnson VA Medical Center hosted a special live broadcast panel with ABC News 4 aboard the USS Yorktown to discuss the opioid epidemic and alternative therapy options for pain management.
According to a study completed by the National Institutes of Health, 65.6% of Veterans reported having pain over a three-month period, with 9.1% having severe pain. Severe pain was 40% greater in Veterans than non-Veterans, especially among those who served in recent conflicts.
One of the Veterans featured in the recent panel, Darryl Gadsden, has battled with painkillers since his service in the Army in the mid-80s. His life is a testament to how even the strongest soldiers can succumb to addiction and substance abuse in the face of chronic pain.
Gadsden suffered a debilitating back strain due to the heavy toll of training with a 65-pound kit during a 13-mile march for field exercises. The pain he felt that day was so excruciating he was transported by medevac from the field to the local hospital with what medics thought was a heart attack.
“It felt like someone had driven a sword through my back,” Gadsden explained. “Like they had shattered my ribcage. I was afraid to breathe, because every time I would inhale pain would stretch from my back into my chest like my ribcage was caving in.”
When he reached the hospital, doctors told Gadsden he had scoliosis that was aggravated by the heavy load he was carrying. They treated his pain with morphine and a prescription for oxycodone.
That began his treacherous trek with prescription painkillers. After taking orders to Alaska, Gadsden continued to use painkillers to combat his chronic pain.
“I thought maybe the change to Alaska would do me some good; it didn’t,” he said. “The climate really changed me, and the pain was so bad some days that I wanted to end my life so that I wouldn’t have to feel it anymore.”
Gadsden decided to push through the pain, and eventually left the Army to go back home to South Carolina. He took a job with the Department of Transportation for the state and continued to self-medicate with painkillers.
“I became my own doctor,” he said. “I started mixing the pills with alcohol and got to the point where I would take them even when I didn’t need them.”
After a few years, Gadsden realized a dream to become a firefighter and used that motivation to cut back on the pills while he trained to get ready. His application to the fire department was accepted, and Gadsden quickly proved his worth when he saved an apartment from a dangerous fire within the first six months on the job. In fact, he was even nominated for fireman of the year his first year on the job.
Even though his dreams were realized, Gadsden just couldn’t shake the pull of addiction, and the heavy strain the physicality of his new career took on his body made matters worse.
“It was a haunting feeling,” he explained. “It was like my addiction was pulling me. I couldn’t shake it.”
Gadsden said he felt like he was out of control, and he became so worried that he might cost someone their life while he was high on painkillers that he decided to quit the job he worked so hard to get. That became the first step in a downward spiral that led him to rock bottom.
“My motto was to just push through it,” he said. “I pushed, and I pushed until I became a full-blown addict. I lost everything. My job, my car, my family, and all my money. I was homeless, and I just kept wondering, ‘How did I get here?’”
For the next two decades, Gadsden struggled with his addiction and homelessness, battling to survive on the streets while remaining detached from the life he had before his downward spiral. He frequently fell out of touch with his daughter, Roshina, whom he had after a casual relationship shortly after leaving the Army. He said that his disconnection from her was one of his biggest regrets from his struggle with addiction.
“I never wanted her to see me at my low point,” Gadsden explained. “So, I stayed in touch, but I never really got too involved.”
After years of falling into the daily trap of substance and alcohol abuse, Gadsden finally decided to try out some VA programs he had heard about. Using group meetings and the rehabilitation program, he was finally able to get sober long enough to find a plan for his pain management.
“I made a choice that I wanted to live,” he said. “I checked myself into rehab at the VA and started doing the work to get plugged into the program and work with doctors to get rid of my dead weight. I was finally able to deal with the trauma that I went through.”
Part of his process led him to realize that opioid painkillers were not compatible with his addiction. Gadsden worked with the pain management team and Homeless Patient Aligned Care Team Physician Dr. Elizabeth Call to find a pain management plan that worked for his recovery.
“Through alternatives to opioid pain medication and treatment for depression, Mr. Gadsden achieved control over his pain,” Dr. Call said. “He is a changed man! Although he still copes with daily pain, I am so proud of his ability to focus on living and enjoying his life. He was able to use the whole health services available and placed faith in his providers who truly care about him. He reminds me of why I chose to become a physician.”
Gadsden has been able to use alternative treatments, such as yoga, mindfulness, and acupuncture, to remain clean and sober for the past four years now. As part of his process of recovery, Gadsden was even able to reconnect with his daughter and his now 9-year-old granddaughter and create the family he once lost to addiction.
““I gave myself the chance and did the work,” he said. “For us to be in the place we are now, as close as we are, is a blessing. I can’t turn back the time we lost, but we can make it up now.”
Through his addiction, Gadsden lost his dream job, the love of his life, and the chance to be the father his daughter needed. In recovery, he has been able to rekindle that relationship, and build the connection with his granddaughter that he never could with his daughter.
Veterans struggling with addiction and homelessness can find assistance and resources through VA’s Homeless Program or by calling the Charleston Community Resource and Referral Center at 843-789-6804.
Scott Pauley is a public affairs specialist at the Ralph H. Johnson VA Medical Center in Charleston, SC.
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The VA hasn’t fully acknowledged its role in the alarming opiate addiction rates among veterans, which are approximately twice the national average (which is astonishingly high). In my opinion, it is criminal that the VA/Federal Government has refused to incorporate cannabis as a safer, more effective tool in managing pain, but has no problem prescribing a potentially lethal prescription cocktail of opioids, anti-psychotics, benzodiazepines, antidepressants, and stimulants. A study in the Journal of the American Medical Association (2012) showed that veterans with mental health disorders and PTSD were three times more likely to receive opioids for pain diagnoses than other veterans (Levine, 2017). In Huntington, West Virginia where 28 people overdosed from heroin in a four-hour period last year, the local VA prescribes take-home opiates to approximately 18% of its patients—a rate that’s about 230% higher than the national average for all adult male patients (Levine, 2017). According to Dr. Andrew Kolodny, co-director of Brandeis University’s Opioid Policy Research Collaborative, “these are iatrogenic—medically caused—addictions by the VA.
Recent Department of Defense (DoD) reports on medication use among active duty service members (ADSMs) indicate potentially problematic use of central nervous system (CNS)-acting drugs; nearly a third of all ADSM received one or more prescriptions for opioids, CNS depressants, or stimulants during the fiscal year 2010 (Collett, Song, Jaramillo, Potter, Finley, & Pugh 2016). According to the Army Institute of Public Health, 46% of those who completed suicides, 90% of those who attempted suicide, and 87% of those with suicidal ideation received a CNS-acting prescription the year preceding the event (Collett, Song, Jaramillo, Potter, Finley, & Pugh 2016). CNS polypharmacy (defined as 5 or more CNS-acting medications) among VA patients is not uncommon; 10% of all Veterans with PTSD received medications from three or more classes of medications that induce sedation in 2004, a rate that increased to 12% by 2011 (Collett, Song, Jaramillo, Potter, Finley, & Pugh 2016). CNS polypharmacy was significantly associated with both overdose and suicide-related behavior (SRB).
In the report, “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research,” an expert, ad hoc committee of the National Academies of Sciences, Engineering, and Medicine presents nearly 100 conclusions related to the health effects of cannabis and cannabinoid use. They state that there is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment for chronic pain in adults; and there is no or insufficient evidence to support or refute a statistical association between cannabis use and death due to cannabis overdose (National Academies, 2017).
References
Collett, G.A., Song, K., Jaramillo, C.A., Potter, J.S., Finley, E.P., & Pugh, M.J., (2016). Prevalence of Central Nervous System Polypharmacy and Associations with Overdose and Suicide-Related Behaviors in Iraq and Afghanistan War Veterans in VA Care 2010– 2011. Drugs – Real World Outcomes 3(1): 45-52. https://doi.org/10.1007/s40801-015- 0055-0
Levine, A., (2017). How the VA fueled the national opioid crisis and is killing thousands of veterans. Newsweek. Retrieved on 8.10.19 from https://www.newsweek.com/2017/10/20/va-fueled-opioid-crisis-killing-veterans- 681552.html
National Academies of Sciences, Engineering, and Medicine (2017). The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Retrieved on 8.10.19 from http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2017/Cannabis-Health- Effects/cannabis-conclusions.pdf
Once more you voided my comments, no wonder your killing 22 a day.
Great story of not fixing the CAUSE OF PAIN, masking it , dealing with it by changing your abilities so as not to aggravate it isnt the correct answer. Im my case your pain pills have now caused heart problems thhat as usuall the VAhasnt addressed. 43 years and a relative easy knee replacement would have solved my problems. Instead VA chose over and over to ignore it causing a life of hellish conditions. Recently i wrote Sec.of Va hoping to get the IG investigation thats needed, ZERO investigation, not even a lousy phone call. Somethings never change. Its no wonder 22 kill themselves each day .Smoke and mirrors not talking to vets the system has failed. Quit patting yourselves on your back and answer the damn questions.
I have chronic pain in my back and I try to go 4 days a week… it helps a lot but isn’t a cure…
For Scott Pauley:
Your piece on “Charleston Veteran battles chronic pain” unfortunately perpetuates the mythology that short-term medical exposure to medical opioids is automatically addicting. For all except a possible 0.5%, this is clearly untrue and published medical literature proves beyond doubt that it is untrue. As demonstrated by Schatman, Singer and Sullum, today’s addict is almost never yesterday’s chronic pain patient.
A significant mechanism for vulnerability to substance abuse may be faulty expression of the A118G gene, affecting mu-receptor action in the brain. Patient Gadsden may be one of the unfortunate 0.5%. We cannot generalize from his experience. Go look it up in medical literature. Articles by Thomas Kline, MD PhD on Medium.com also explain the mechanism in layman terms. See https://medium.com/@ThomasKlineMD/opioid-facts-are-we-getting-the-whole-picture-a-physicians-perspective-67cc7e3b0d2e
Also highly pertinent are the following papers demonstrating that rates of chronic prescribing or diagnoses of substance use disorder in post-surgical patients are significantly less than 1%.
Gabriel A Brat, Denis Agniel, Andrew Beam, Brian Yorkgitis, Mark Bicket, Mark Homer, Kathe P Fox, Daniel B Knecht, Cheryl N McMahill-Walraven, Nathan Palmer, Isaac Kohane, “Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study”, BMJ 2018;360:j5790
http://www.bmj.com/content/360/bmj.j5790.long
Eric C. Sun, Beth D. Darnall, Laurence C. Baker, Sean Mackey, “Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period”, JAMA Internal Medicine 2016;176(9):1286-1293.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2532789
Do you have any information regarding ALS…recovery, longevity, etc?
Thanks for sharing my friend, I am just about the same situation! After reading your story, I am going to try Accupuncture!Thank you for your service to our great country.