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Old 01-29-2011, 13:27   #1
SouthernDZ
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The General's Drug Problem

This was in USA Today as well. It's a long article but well worth the read. Apparently the medical establishment still does not have a handle on pain management and the aftermath.



The General's Drug Problem

TAMPA - Standing before a packed hall of 700 military doctors and medics here, the deputy commander of the nation's elite special operations forces warned about an epidemic of chronic pain sweeping through the U.S. military after a decade of continuous war.

Be careful about handing out narcotic pain relievers, Lt. Gen. David Fridovich told the audience last month. "What we don't want is that next generation of veterans coming out with some bad habits."

What Fridovich didn't say was that he was talking as much about himself as anyone."I was fighting the pain. And I was fighting the injury. And I was fighting the narcotics."

For nearly five years, the Green Beret general quietly has been hooked on narcotics he has taken for chronic pain - a reflection of an addiction problem that is spreading across the military. Hospitalizations and diagnoses for substance abuse doubled among members of U.S. forces in recent years. This week, nurses and case managers at Army wounded care units reported that one in three of their patients are addicted or dependent on drugs.

In going public about his drug dependency during interviews with USA TODAY, Fridovich, 59, echoes the findings of an Army surgeon general task force last year that said doctors too often rely on handing out addictive narcotics to quell pain.

An internal Army investigation report released Tuesday revealed that 25 percent to 35 percent of about 10,000 soldiers assigned to special units for the wounded, ill or injured are addicted or dependent on drugs, according to their nurses and case managers. Doctors in those care units told investigators they need training in other ways to manage pain besides only using narcotics.

"I was amazed at how easy it was for me or almost anybody to have access and to get medication, without really an owner's manual," says Fridovich, deputy commander of the nation's roughly 60,000 Green Berets, Army Rangers, Navy SEALS and secretive Delta Force teams.

For such a high-ranking military officer, publicly acknowledging drug dependency was unprecedented.

More...

http://www.theleafchronicle.com/arti...roblem-w-VIDEO
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Old 01-29-2011, 14:10   #2
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Doctors prescribe that stuff way to much IMO. When I was in you could get anything you wanted from the Bn Doc.
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Old 01-29-2011, 14:23   #3
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I understand that there was a similiar problem after the Civil War with wounded Veterans who experienced morphine for the first time.
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Old 01-29-2011, 20:34   #4
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Old 01-29-2011, 20:45   #5
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The pain medicine of choice during the Civil War era was Laudanum. Laudanum was a opium alcohol mixture that was potent, very effective, and readily available. Not only was it the drug of choice for pain relief for Civil War Veterans, it was widely used by civilians. Narcotic addiction was very high in the immediate post Civil War period. There was a a letter titled, "Confessions of a Young Lady Laudanum-Drinker" dated 1889 by an unknown author http://www.druglibrary.org/schaffer/...y/laudlady.htm, written to a doctor describing her troubles with Laudanum. It is still available today by prescription. It was not until the 1914 Harrison Narcotic Tax Act that narcotics became regulated and subject to control.

There are many that deal with moderate to severe chronic pain every day, from a variety of causes. Using long acting narcotics is effective in dealing with such pain; however, it is not without drawbacks. All previous major armed conflicts have wrestled with this problem, and today we have a specialty that can address chronic pain management. A system that seems to offer the best hope are multidisciplinary approaches. This includes providers from General Medicine, Surgery, Orthopedics, Anesthesia, Psychiatry, and Physical Medicine. This combined approach may well be able to tailor an approach that reduces the need for narcotic use long term. Every major war brings advances in medicine. Perhaps we can see some advance in the chronic pain issue that has haunted us since before our Civil War. It is very difficult to look a wounded war veteran in the eye and say no to the request for pain meds that are clearly needed; perhaps that is why the problem has lasted so long.

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Correct on Laudanum, my father was offered it during the final weeks of his life while he was dying of cancer but he refused it.

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Old 01-29-2011, 20:52   #6
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have lots of friends with hiatal hernias (serious acid reflux) from all of the Motrin team guys used like aspirin.
They say serious pain killers are one of the most adictive things going.
Frido, from my experiences with him, is a very straight shooter...glad we have guys like him being successful. I watched him chew an 06 Inf type a new asshole when he was an LTC SF controller @ NTC. The 06 was the division ops officer and totally disregarded the SF intel until they got waxed...it was great to see. I admired his directness and honesty.
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Old 01-29-2011, 22:01   #7
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Could it be that a number servicemembers actually carry the gene for addiction but never had problems with it because they never used opiates until they were seriousely wounded? They start taking them for the pain and then they become addicted. Happens to a number of otherwise ordinary people. I read a book and then watched the movie about a female undercover narcotics officer who in her work had to occasionally use small amounts of cocaine. It turns out that she carried the gene, became addicted, and then had to go through rehabilitation and leave the narcotics field.

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Old 01-30-2011, 00:59   #8
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have lots of friends with hiatal hernias (serious acid reflux) from all of the Motrin team guys used like aspirin.
They say serious pain killers are one of the most adictive things going.
Frido, from my experiences with him, is a very straight shooter...glad we have guys like him being successful. I watched him chew an 06 Inf type a new asshole when he was an LTC SF controller @ NTC. The 06 was the division ops officer and totally disregarded the SF intel until they got waxed...it was great to see. I admired his directness and honesty.
In the late 60's no way did you get narcotics after the morphine, then initial debridgement. Within two days after that they were ripping clotted blood bandages off one to keep the infection out. The next time narcotics came around was after surgery for primary /delayed closure.. That was two days max for GSW's in the upper and lower leg even with a shattered bone. I will never forget when they took that short leg walker off in late July 69. I about screamed every step to the car. I went to the Smoke Bomb Hill Club. Drank plenty.

Now, I think these men are getting some different kinds of wounds these days? I certainly am no expert nor anyone's judge as every wound is different. I could not imagine a man I respected being burned terribly by WP.
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Old 01-30-2011, 06:53   #9
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Using long acting narcotics is effective in dealing with such pain; however, it is not without drawbacks.
Great post RF1 - I am sure you are well versed in pain management from your medical field. For chronic pain (read - not acute on chronic) - do you feel methadone is underused? Extremely effective and long acting with minimal abuse potential. Titrating up the dose does take time, but gives a long steady state once you get there.

We tend to wait to use methadone for end-of-life care in my field (and our pediatric palliative team seems to support this practice).

(I hope this post isn't seen as a hijack.)
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Old 01-30-2011, 08:01   #10
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One of the best MDs I ever worked with was the ER Physician at Womack back in the mid-70s. He developed a case of nephrolithiasis and self-treated with oral morphine, became addicted, was rehab'd and lost his license to prescribe controlled meds.

I saw far too many get hooked on pain or other meds.

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Old 01-31-2011, 11:25   #11
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Old 01-31-2011, 21:28   #12
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Old 02-01-2011, 01:06   #13
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Old 02-01-2011, 07:25   #14
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Part of the problem with a lot of the pain meds out there is that the user develops a "tolerance" to the meds effectiveness, so like any other type of addiction, more is needed to get the same effect.
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Old 02-02-2011, 00:24   #15
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Part of the problem with a lot of the pain meds out there is that the user develops a "tolerance" to the meds effectiveness, so like any other type of addiction, more is needed to get the same effect.
Pain is what the patient says it is. Having said that, not everyone seems to accurately convey their pain level. High level of pain should cause stress and manifest physiologically. Talking on the phone with regular heart rate, BP, and respiration rate are not indicative of 8/10 to 10/10 pain...so *shrugs*

I see first hand the problem just about every day. I often feel the healthcare personnel are converting patients to drug seeker . I do admire those who display true grit and gut it out to the point of being unable to sleep/woken up/in tears. Then I had to encourage their taking it as it's hindering the healing process.

Hats off to the good general for raising awareness.
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