12th Annual Rx and Illicit Drug Summit

Congressman Rogers, good morning. It’s a painful day for Kentucky, and our nation … another mass shooting. Please accept my condolences. Know that our hearts go out to the families and friends of those lost, to those suffering, and to the heroic law enforcement officers injured or killed in the line of duty. Sir, thank you for your service in uniform, and your years of legislative leadership—leadership that’s helped catalyze the nation to combat the opioid crisis and come to terms with complexities of this emergency.

Nancy [Hale], good morning. Thank you for bringing every ounce of your Appalachian “grit and faith” to this decades-long fight against opioids and illicit drugs.

Let me also acknowledge Congressman Cartwright, Congressman Carter, Congressman Trone—it’s good to see you again … so inspirational, your family’s great strength and courage, turning the tragic loss of your nephew into hope for so many others. And Congressman Clyde, thank you for your courageous service in the Navy. 

Dr. Delphin-Rittmon, good morning, and Dr. Gupta—thanks to you and your team, we have a North Star on this journey—the 2022 National Drug Control Strategy. Thank you.

And my deep thanks to all of you for being here: Heroes of Hope—as Nancy rightly describes you—from first responders to social workers, educators, advocates, community leaders; the families and caregivers who struggle to support your Veterans, your family members through Substance Use Disorder, too often struggling yourself; the many community based organizations—like Hope Manor whom I just visited on the West Side of Chicago last Thursday—who are supporting Vets in every community in the country;  and the strongest among us—the families who’ve suffered loss, and those of you in recovery.

You inspire us, give all of us so much hope. Working together, we can and will beat the opioid crisis. On behalf of all the Vets you serve, that we serve at VA, and their families, caregivers, and survivors, thank you.

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Where are the Vets? Please stand—in body or mind, as you’re able—and be recognized. Thank you. Let me tell you about one of your brothers-in-arms—Sergeant Dustin Atwell, an Indiana Hoosier.

Back in 2006, Dustin signed up to serve,  and to honor a quiet commitment he’d made when he was just 15 years old, when he saw those towers in New York come down. Dustin was an excellent soldier—Honor Grad of his Basic Course. And he deployed to war from Fort Bragg to Bahrain, where he pinned on his sergeant chevrons—a non-commissioned officer, the backbone of the military.

When Dustin got back, things started to fall apart when his brother, Marine Sergeant Bradley Atwell, died in combat in Afghanistan. Dustin went from leading soldiers to struggling with Substance Use Disorder to a criminal defendant.

That didn’t happen overnight. Substance Use Disorder results from interconnected, complex struggles. Perhaps it’s post-traumatic stress, Traumatic Brain Injury, chronic pain from injuries, depression, or other health challenges. Perhaps it’s financial challenges, legal problems, justice involvement, incarceration … a broken relationship, the loss of a loved one, or a toxic combination of many of these factors.

For Dustin, the devastating loss of his brother—and an array of other challenges—sent him into deep depression, depression that led to drugs—including opioids—that spiraled out of control until he was standing before a judge.

Dustin hated what he’d become. He’d forgotten who he was. And he was in a fight for his life.

From 2010 to 2019, the rate of drug overdose death among Vets jumped by over 50%, by 73% for Vets Dustin’s age, by 97% for older Vets, and an astounding 167% for our oldest Vets.

Let’s remember what is happening to drive up these heartbreaking overdose numbers. Easily & cheaply produced, easily and cheaply imported, deadly fentanyl that’s meeting an increased demand that comes from untreated mental health issues. So while we still lose too many Vets to prescription drug overdoses, fentanyl is finding its way into other drugs, like counterfeit pain medication and recreational drugs.

I want to be very clear—in this environment and with these odds, Substance Use Disorder can find any one of us. Any of us. Though Dustin was up against this terrible trend, thankfully, he wasn’t alone in his fight.

Because when someone like Dustin—like many of you—sign-up to serve our country in the military, we make you a promise. If you take care of us, we will take care of you when you come home. Our country as a whole makes that promise. And at VA, keeping that promise is our job. Meeting Vets like Dustin where they are, it’s our duty, and our solemn obligation.

VA met Dustin through our Veterans Justice Outreach program—his door to VA. His health care team diagnosed him with PTSD and Substance Use Disorder and lined him up with a Peer Specialist and the individualized care he needed to recover—the care he’d earned, and deserves.

Today, Dustin’s two years into recovery. A month ago, he graduated Veterans Treatment Court. He’s halfway through his Associate’s Degree. And he’s getting care at VA.

That’s what’s possible when we get Vets to VA. Because as complex as that downward spiral may be, it’s often a unique solution that gets Vets on the path to hope, and recovery … more meaningful, more fulfilling lives.

And we’re fighting like hell to help Vets do just that.

But listen. We know our Substance Use Disorder treatment has not always been patient-centric, Veteran-centric, like it has to be. We were too program-centric, leaving Vets to adopt program-defined goals for their recovery: “our way or the highway.”

No more. Today, we honor Vets’ autonomy in finding their recovery goals, and our providers support them—will support you in helping Vets—with evidence-based expertise and experience. So, I’ll touch on a few ways we’re helping Vets through the dual challenges of prescription and illicit drugs.

Our efforts likely reflect many of yours—addressing opioid safety in light of the fact that prescription opioids were the leading cause of opioid overdose deaths, and expanding efforts to address harm reduction and illicit substance use, including both opioid and stimulant use—the main drivers of overdose deaths. 

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Now, because of the sacrifices they have made for us, many Vets suffer from chronic pain, pain resulting from severe battlefield injuries, from training injuries, from spinal cord injuries, amputations and prosthetic use, Traumatic Brain Injury, or a combination. Nearly 60% of Vets who came home after fighting our wars in Central Command—in Iraq and Afghanistan, like Congressman Clyde—and over 50% of the older Vets we serve live with chronic pain. 

They’re incredibly tough. But that can put them at increased risk for substance use and overdose. So when opioids are used for pain management, our clinicians are committed to safe, responsible practices—a reflection of our long-standing Opioid Safety Initiative.

And we’ve come a long way. You may remember the tragic day back in August 2014 when Marine Veteran Jason Simcakoski died at Tomah VA Medical Center … a result of mixed drug toxicity. Jason’s dad, Marvin Simcakoski, has been holding us accountable—and we’re grateful for that—and that is making us better.

Today, VA emphasizes a whole-person approach to pain management—providing individualized care like Dustin’s based on the unique needs of each Vet, providing a breadth of services beyond meds to help Vets live their best lives. VA researchers in Connecticut, affiliated with Yale School of Medicine, are working on new ways to help Vets who may have previously misused opioids better manage chronic pain.

And we’re integrating providers who are experts with addictive medicine—an approach that aligns with both the National Drug Control Strategy and our own work to expand Veteran access to evidence-based treatments. It’s a stepped approach to care that matches intensity of the treatment to the intensity of Vets’ needs.

One step. Treat Vets who are at risk of Substance Use Disorder, or those Vets with less severe Substance Use Disorder, with brief interventions and medicine management in our primary care or general mental health clinics.

Another step. Treat Vets with more severe Substance Use Disorders or more complex medical challenges, psychological challenges, psychosocial challenges, or a combination of those in specialty Substance Use Disorder treatment programs. That means intensive services. That means withdrawal management, evidence-based psychosocial treatments. It means Substance Use Disorder medications, case management, and relapse prevention at our inpatient, residential, or outpatient programs.

And in all this, and more, we’re not working alone. We work closely with our inter-agency partners like the Department of Health and Human Services, Department of Energy, Justice, Housing and Urban Development, among others.

We’re joined at the hip with Secretary Austin and his Department of Defense clinicians—using the same guidelines for managing Substance Use Disorders that we developed, together, a joint effort.

We’re incorporating Oak Ridge National Laboratory data into predictive models for targeted prevention programs, so we can better identify Vets with the greatest challenges to recovery and get them the additional support they need.

Thanks to our work with JJR Solutions in Dayton—a Service-Disabled Veteran-Owned Small Business—we know that VA provider education sessions on opioid safety practices leads to more effective treatment for Vets in primary care … and fewer overdoses.

And in Portland, VA researchers working with the Oregon Health Sciences University are examining better ways to remove the barriers for medical treatment for rural Vets with Opioid Use Disorder. They’re 37% less likely than urban Vets to receive the meds they need—especially crucial since the opioid crisis has disproportionately impacted people in rural areas. We’re going to find better ways to serve them.

And we do need Congress’s continued support. In particular, we need help clarifying VA’s national telehealth authority for prescribing and renewing controlled substance prescriptions in-state, and across state lines for Vets who need them.

How important is that?

Just this past year, that telehealth authority’s meant buprenorphine prescriptions for over 2,300 Vets who’ve needed it. This authority is especially critical for rural Vets who need access to Opioid Use Disorder medications.

And, let me add, President Biden’s proposed budget [FY24] includes $1.3 billion for our work—providing safe, recovery-focused care for Vets with—or at risk for—Substance Use Disorder, and for Vets already on the road to recovery.

Here’s the point. None of us can do this alone. Progress—lives saved and made better—requires a unified, collaborative, and cooperative whole-of-government effort, a whole-of-nation effort.

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Still, in 2019, we lost over 3,000 Vets to opioid overdose. That’s why access to Medications for Opioid Use Disorder is a main effort, across VA, available to Vets in a variety of clinical settings so Vets have this life-saving treatment at their preferred point of care. 

Along with the increase in the number of Vets we’ve lost, there’s been a troubling increase in the number of overdose deaths from stimulants in recent years—stimulants that often include opioids. So we’re increasing our evidence-based treatments and distribution of Naloxone for stimulant use disorders. And I’m really proud of what our clinicians have achieved using Contingency Management to treat stimulant use disorder.

We’re the first to use Contingency Management on such a wide scale—with really promising results, and it’s the most effective evidence-based treatment for stimulant use disorder that there is. Contingency Management incentivizes recovery by providing immediate rewards to Vets whose abstinence is verified by drug testing, like a urinalysis. Over about 12 weeks of Contingency Management, Vets come to the clinic twice a week and provide a urine sample for immediate drug-testing—typically for methamphetamines, amphetamines, cocaine, or cannabis.

Now, when the drug test is negative—when the Vets abstained from using stimulants—they get an incentive, a reward. The incentive increases the longer they abstain. So, the reward, isn’t just for the recent success, verified by that day’s negative test, but for their consistent abstinence, over time. At VA, incentives are coupons the Vet can use to purchase merchandise from our canteen, cafeteria, or coffee shop. So far, over 6,200 Vets have enrolled in the Contingency Management Program in their recovery. And those Vets have been more than 90% successful on their drug tests for stimulants we check for.

Vets tell us it’s life-changing, making a positive difference in their quality of life by building confidence in their ability to remain abstinent and motivating them to stay in treatment, reviving their mental and physical health, all leading to improvements across many aspects of their lives and health.

One Vet said, “I’m still sober, and it is all because of [Contingency Management].” Another Vet said she’d “recommend the Contingency Management program to any Vet having a difficult time committing to a drug free life.” After 12 weeks in the Contingency Management Program, another Vet said he “learned how to live … instead of just exist.”

And VA researchers in Arkansas—affiliated with the University of Arkansas—are working to build an automated system that leverages our data to better identify Vets at risk of stopping treatment, so we can offer additional support, before a Vet may stop treatment.

That’s what we’re after. Because we want to help Vets do more than just survive. We want to help them learn how to thrive.

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And when it comes to helping Vets get to thriving, our Peer Specialists are on the very front line, meeting Vets exactly where they are.

We have 1,300 Peer Specialists, all Vets themselves. They welcome Vets, embrace them, and walk right beside them on that road to recovery. They’re embedded in specialty care, primary care, pain management clinics. They’re in our emergency departments and in general mental health clinics. They’ve all recovered from their own incredible substance use challenges and struggles. And their lived experiences help their fellow Vets reconnect, find a sense of belonging, and access all of VA’s benefits and services. Like nobody else can, VA’s peer specialists bring empathy and wisdom to this fight.

I’m thinking of Vets like Tony Hedges down at the Ralph H. Johnson VA in Charleston. Tony comes from a family with a long tradition of service. He served in the Navy, aboard the USS Ticonderoga, flagship of his battle group. After Tony left service, anxiety and depression caught up with him … led to alcohol and drug use.

He lost everything. His daughter was born while he was in prison. He was on the path of self-destruction. When he woke up at VA after a suicide attempt, he told the nurse, “You need to give up on me.”

She said, “That’s not an option. That’s not what we do.”

VA, he says, saved his life. After recovery, Tony got his degree in health services, and came back to VA. One his most memorable moments—when a Vet told him, “You saved my life.” That Vet, Brien—one of so many Tony’s helped—put it like this: “[Tony] spoke so much life into me,” Brien said. “He don’t care what color you are, what you’ve done, what you believe. He cares about you. He knows what the struggle is about, he made it, and he’s bringing you along with him.”

A while back, I met Mike out in Los Angeles. Mike’s another great peer specialist, a Vietnam Vet. For over three decades after leaving Vietnam, Mike says, he was “strung out on heroin, meth, marijuana, alcohol” … spent his last two years before recovery living in a refrigerator box, in an alley, in the San Fernando Valley, expecting to die with a needle in his arm.

Well, 15 years ago last month, Mike’s girlfriend found him and got him to his first 12-step meeting. And he’s never turned back. Today, being a peer specialist is part of his own recovery … showing other Vets their way out.

Vets helping Vets, long after they take off the uniform. There’s nothing better than that.

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Another important way we’re beating substance use disorder is by changing our culture, by embracing proven, evidence-based Harm Reduction initiatives so we can embrace even more Vets, every Vet—Vets using drugs, Vets struggling with Substance Use Disorder.

You know, President Biden’s 2022 National Drug Control Strategy is the first to champion harm reduction. And at VA, we’re all in. We do not deny Vets access to care because they use a substance. Too many people with Substance Use Disorder—Vets included—face prejudice, stigma, and discrimination when they seek treatment.

One Vet said, “I’ve avoided health care, because I’m treated like dirt as soon as they see my arms.” But stigmatizing Vets—or anyone else, for that matter—does nothing to help them. So we’re working to reduce harm, to reduce the stigma, to make sure Vets know—we can help them when they’re ready.

It’s how we can begin to build trust, trust that can lead to treatment, treatment that can save lives.

To reduce harm to Vets who use drugs, we’re increasing their access to Naloxone. We’re teaching them how to prevent opioid overdose. We’re teaching them how to recognize overdose, and how to rescue those who do overdose, teaching our staff and Vets’ family members how to use it—and providing it to them, just in case. In just the past year, we’ve equipped over 70,000 Vets with this lifesaver, put nearly one million Naloxone prescriptions in Vets’ hands since 2014 when we launched our Overdose Education and Naloxone Distribution Initiative—leading to more than 3,700 overdose reversals.

Congressman Carter, you know how important that kind of harm reduction is. Thank you for championing access to Naloxone. Your advocacy made a difference—for Vets, and all Americans. Soon, Naloxone will be within reach—over-the-counter—for people who use drugs, for their families, friends … for everyone who cares. And Vets who need it can still get it at VA. Free. That’s more lives saved.

And we’re so grateful for the kind of Harm Reduction collaborations we have with community partners like Hope & Help and the Brevard Veterans Council down in Orlando, and with the Comer Family Foundation, the Network for Public Health, the Phoenix Center, and the Dept of Public Health up in Illinois.

And we’re expanding syringe services programs. It’s helping us engage Vets who might not come to VA otherwise. It’s helping us get Vets to VA so we can screen them—and then treat them—for HEP-C, for HIV, for sexually transmitted infections, or whatever their health care needs are. By welcoming them and treating them and all Vets with the same humanity, dignity, and support we owe one another we keep building that trust.

So VA clinicians are designing safe and effective syringe service programs and helping Vets enroll in your community programs where we don’t offer them. We’re also offering Vets who use our syringe service programs referrals—to social services, to mental health services, and to any other service they need.

Now, I know that for some people harm reduction practices like syringe service programs are controversial because they fear those programs encourage people to use drugs. In fact, though, people who inject drugs and use syringe services programs are five times more likely to enroll in substance use disorder treatment than those who don’t. And that’s five times more Veterans’ lives saved.

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Now, I know Congressman Rogers and I understand this conference—his brainchild—is a gathering place for people who are taking action to end this epidemic of Substance Use Disorder.

So, here are four more ways we can use your help.

First, if you’re with law enforcement, let’s get together. We’re partnering with police forces in Coatesville, Pennsylvania; Wilmington, Delaware; Cincinnati and Dayton, Ohio, and other communities to help Vets like Dustin Atwell. We want to partner with you to help get Veterans who need care, into care, rather than into jail. Reach out to your local VA medical center, and let’s see what we can build, together.

Second, please know that all our medical centers offer Same Day Services for Vets with urgent needs—whether they’re in mental health crisis, or they’ve hit rock bottom and are ready to take that first step on a journey to recovery.

Help us find them. VA partnered with the Ad Council on the “Don’t Wait, Reach Out” campaign, and it’s making a tremendous impact helping Vets find VA, and helping normalize coming to VA for help with Substance Use Disorder and other concerns.

Just visit VA.Gov/REACH to learn more.

Third, a Vet and advocate up in New York City told us that a lot of Vets who left the military under other than honorable conditions think they cannot access VA health care. That’s not exactly right. If you’re a Vet with an Other than Honorable Discharge because of drug use or for any other reason—or if you know or are working with a Veteran in that situation—get with VA.

Vets with Other Than Honorable discharges may still be able to access VA benefits and health care. So call MyVA411, 800-698-2411, 24/7. [Visit Other Than Honorable (OTH) Discharge. (va.gov)]. We don’t want any Vets to self-select away. We don’t want well-meaning advocates or peers to discourage them.

And fourth, if you encounter a Veteran in your work, a Vet at rock bottom, a Vet ready for help, a Vet in crisis—and I mean any kind of crisis from homelessness to food insecurity to Substance Use Disorder—help get them to VA.

Just Dial 988 and then Press 1, day or night, 24/7.

You’ll be hooked-up with a qualified, caring, Veteran Crisis Line responder who can make it happen. Our VA clinicians know Veterans. In many cases our clinicians are Veterans. And we know that Vets who get their care at VA do better.

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Everybody, thank you for the work you do, for instilling hope in so many, for helping build trust with so many whose trust has been battered and bruised time after time, over days, months, years, sometimes even decades.

They’re putting their trust in your hands. And in your hands, their trust is so well-placed.

Thank you for your partnership, and for helping VA serve Vets as well as they have served us. Let’s keep it up.

God bless our Vets, their families, caregivers, and survivors. And may we always give them our very best.