Military's drug policy threatens troops' health, doctors say - Nextgov

[Guest guest]

http://www.nextgov.com/nextgov/ng_20110118_8944.php?oref=spotlight

Military's drug policy threatens troops' health, doctors say

By Bob Brewin 01/18/2011



This is the first story in an ongoing series.

Army leaders are increasingly concerned about the growing use and abuse of

prescription drugs by soldiers, but a Nextgov investigation shows a U.S. Central

Command policy that allows troops a 90- or 180-day supply of highly addictive

psychotropic drugs before they deploy to combat contributes to the problem.

The CENTCOM Central Nervous System

â Drug formulary includes drugs like Valium and Xanax, used to treat

depression, as well as the antipsychotic Seroquel, originally developed to treat

schizophrenia, bipolar disorders, mania and depression.

Read the entire Broken Warriors series.

Although CENTCOM policy does not permit the use of Seroquel to treat deploying

troops with these conditions, it does allow its use as a sleep aid, and allows

deployed troops to be provided with a 180-day supply, even though the drug has

been implicated in the deaths of two Marines who died in their sleep after

taking large doses of the drug.

The Army endorsed Seroquel as a sleep aid in the May 2010 report of its Pain

Management Task Force, which, among other things, called for a reduction in the

number of prescription drugs given to troops. An appendix to that report

recommended taking Seroquel in either 25- or 50-milligram doses for sleep

disorders.

A June 2010 internal report from the Defense Department's Pharmacoeconomic

Center at Fort Sam Houston in San showed that 213,972, or 20 percent of

the 1.1 million active-duty troops surveyed, were taking some form of

psychotropic drug: antidepressants, antipsychotics, sedative hypnotics, or other

controlled substances.

Dr. Grace , a former Navy psychiatrist, told Nextgov she resigned her

commission in 2002 " out of conscience, because I did not want to be a pill

pusher. " She believes psychotropic drugs have so many inherent dangers that " the

CENTCOM CNS formulary is destroying the force, " she said.

Dr. Greg , who runs the Los Angles-based Comprehensive Pain Relief Group,

which treats chronic pain and prescription drug abuse through an integrative

medical approach called the Nutrition, Emotional/Psychological, Social/Financial

and Physical program, said he was shocked by CENTCOM's drug policy for deployed

troops. " If I was a commander I'd worry about what these troops would do, " as a

result of their medications, said.

Dr. Breggin, an Ithaca, N.Y., psychiatrist who testified before a House

Veterans Affairs Committee last September on the relationship between medication

and veterans' suicides, said flatly, " You should not send troops into combat on

psychotropic drugs. " Medications on the CENTCOM CNS formulary can cause loss of

judgment and self-control and could result in increased violence and suicidal

impulses, Breggin said.

The Army implicated prescription drugs as contributing to suicides in a July

2010 report, which said one-third of all active-duty military suicides involved

prescription drugs.

When the suicide report was released, Gen. Chiarelli, the Army's vice

chief of staff, said the service needed to develop better controls for

prescription drugs. " Let's make sure when we prescribe that we put an end date

on that prescription, so it doesn't remain an open-ended opportunity for

somebody to be abusing drugs, " Chiarelli said.

But when it comes to the CENTCOM CNS formulary -- which for some drugs allows a

180-day supply when troops deploy, followed by a 180-day refill in theater,

according to an October 2010 update to the psychotropic drug policy -- neither

the Army nor CENTCOM sees a need for change.

In an e-mailed statement to Nextgov, Col. Stasinos, chief of

â addiction medicine for the Army surgeon general, and Col. Carol Labadie,

pharmacy program manager in the Directorate of Health Policy and Services for

the surgeon general, said soldiers are supplied with up to 180 days of

medications because they " serve in remote areas without easy access to

pharmacies. It is important that soldiers on chronic medications do not run out

of them during combat operations, because not taking the medications can be as

dangerous as taking too much medication. "

Abuse of prescription drugs, Stasinos and Labadie said, can be prevented by

improved communication among health care providers, soldiers and commanders.

Comprehensive reviews of soldiers' medication profiles by pharmacists are

another way to prevent abuse, they said.

The statement from Stasinos and Labadie added that it is possible that troops

could receive a 180-day supply of more than one psychotropic medication.

Navy Lt. Cmdr. Speaks, a CENTCOM spokesman, echoed comments from the

Army. He said the drug-supply policy for deployed troops was " established to

ensure personnel who required these medications had an adequate supply before

deployment to last through pre-deployment activities and training as well as

travel to theater and initial deployment phase. "

He added, " Some of these medications can cause duty-limiting side effects if

they are withdrawn abruptly [i.e. if the individual runs out]. This policy

prevents that from occurring. "

Speaks said, " Abuse is always a possibility the prescribing clinician must

consider ... demonstration of clinical stability, medication quantity limits and

in-theater review of prescriptions reduces the potential for abuse. "

Suicide and Drug Abuse

The Army's suicide report drew a link between a significant increase in

prescription drug use among troops and the service's rising suicide rate. It

also raised serious concerns about troops trafficking in prescription drugs.

, the former Navy psychiatrist, now has a civilian practice in

Greensboro, N.C. She said at least one drug on the CENTCOM formulary --

Depakote, an anticonvulsant, which military doctors prescribe for mood control

-- carries serious physical risks for troops. Depakote is toxic to certain

cells, including hair cells in the ears, and can lead to hearing loss. Troops in

a howitzer battery who already run the risk of hearing loss should not take

Depakote, she said.

The medication also can cause what she calls " cognitive toxicity, " also known as

Depakote dementia, impairing a person's ability to think and make decisions.

said that while Depakote has been investigated as an adjunct therapy for

cancer, its use has been limited due to the drug's effects on cognition.

The antidepressant Wellbutrin, also on the CENTCOM formulary, likely poses a

long-term risk of Parkinson's disease, especially for older troops, said

, author of Drug-Induced Dementia: A Perfect Crime (AuthorHouse, 2009).

and Breggin both expressed deep concerns about Xanax, perhaps the most

addictive of all benzodiazepines, a class of depressant medications used to

treat anxiety, on the CENTCOM formulary.

Breggin, author of Medication Madness: The Role of Psychiatric Drugs in Cases of

Violence, Suicide and Crime (St. 's , 2009), called Xanax " solid

alcohol " and said all the benzodiazepines on the CENTCOM formulary " amount to a

prescription for abuse. " He also said there is no rationale for prescribing

multiple psychotropic drugs to troops.

said he was " flabbergasted " that military doctors prescribed Seroquel as a

sleep aid, as the Food and Drug Administration has not approved such a use and

other drugs are more effective. Breggin agreed, calling Seroquel " very

dangerous, expensive and not proven to be more beneficial than other drugs. "

noted Seroquel has the addictive potential of opioids, such heroin.

CENTCOM's allowance of Seroquel as a sleep aid also seems to fly in the face of

a high-level Defense policy set in November 2006. In a memo titled " Policy

Guidance for Deployment Limiting Pyschiatric Conditions and Medications, "

Winkenwerder, then assistant secretary of Defense for health affairs,

said psychotropic medications that would prohibit troops from deployment

included those used to treat chronic insomnia.

Asked if prescribing Seroquel to aid sleep violated this policy, Stasinos and

Labadie said in an e-mail, " Seroquel is not prescribed for chronic insomnia.

Lower doses have been used to aid soldiers with troubled sleep for

anxiety-related nightmares. " They added while other sleep medications are on the

CENTCOM formulary, none appears to relieve nightmares as effectively as

Seroquel.

Woodin, a spokeswoman for the U.S. division of London-based AstraZeneca,

which makes Seroquel, said the drug is not approved by the FDA as a sleep aid or

to treat post-traumatic stress disorder. But, she added, mental health

professionals often prescribe it to treat conditions not approved by the FDA.

" Like patients, we trust doctors to use their medical judgment to determine when

it is appropriate to prescribe medications, " Woodin said.

Nightmare

Stan White, a retired high school teacher who lives in the small town of Cross

Lanes, W.Va., has observed the effects Seroquel can have. When his son

returned from a tour in Iraq with the Marine Reserve 4th Combat Engineer

Battalion in 2007, he was diagnosed with post-traumatic stress disorder and was

prescribed three psychotropic drugs, including Seroquel, by the Huntington

Veterans Affairs Medical Center, White said.

VA started on 25 milligrams of Seroquel a day and upped the dose to 1,600

milligrams a day (the CENTCOM-approved dose is 25 milligrams a day).

White died in his sleep Feb. 12, 2008, six months after seeking help.

White said was so befuddled by his drug cocktail, which included

Klonopin, a benzodiazepine, and hydrocodone, an opiate, that his wife, Shirley,

had to dole them out for. White said Seroquel did not diminish 's

nightmares at even such a high dosage.

While talk therapy is widely viewed as one of the most effective treatments for

some mental health problems, including PTSD, White said had only a few

such sessions, primarily with a local veterans' peer therapy group. It was not

until the week died that a VA psychiatrist decided to begin intensive

sessions with him.

Stan White says his mission in life today is to expose the dangers of Seroquel.

The drug, he said, " turns people unto zombies. I cannot imagine going into

battle on Seroquel. "

Sent via BlackBerry by AT & T

[Guest guest]

http://www.nextgov.com/nextgov/ng_20110118_8944.php?oref=spotlight

Military's drug policy threatens troops' health, doctors say

By Bob Brewin 01/18/2011



This is the first story in an ongoing series.

Army leaders are increasingly concerned about the growing use and abuse of

prescription drugs by soldiers, but a Nextgov investigation shows a U.S. Central

Command policy that allows troops a 90- or 180-day supply of highly addictive

psychotropic drugs before they deploy to combat contributes to the problem.

The CENTCOM Central Nervous System

â Drug formulary includes drugs like Valium and Xanax, used to treat

depression, as well as the antipsychotic Seroquel, originally developed to treat

schizophrenia, bipolar disorders, mania and depression.

Read the entire Broken Warriors series.

Although CENTCOM policy does not permit the use of Seroquel to treat deploying

troops with these conditions, it does allow its use as a sleep aid, and allows

deployed troops to be provided with a 180-day supply, even though the drug has

been implicated in the deaths of two Marines who died in their sleep after

taking large doses of the drug.

The Army endorsed Seroquel as a sleep aid in the May 2010 report of its Pain

Management Task Force, which, among other things, called for a reduction in the

number of prescription drugs given to troops. An appendix to that report

recommended taking Seroquel in either 25- or 50-milligram doses for sleep

disorders.

A June 2010 internal report from the Defense Department's Pharmacoeconomic

Center at Fort Sam Houston in San showed that 213,972, or 20 percent of

the 1.1 million active-duty troops surveyed, were taking some form of

psychotropic drug: antidepressants, antipsychotics, sedative hypnotics, or other

controlled substances.

Dr. Grace , a former Navy psychiatrist, told Nextgov she resigned her

commission in 2002 " out of conscience, because I did not want to be a pill

pusher. " She believes psychotropic drugs have so many inherent dangers that " the

CENTCOM CNS formulary is destroying the force, " she said.

Dr. Greg , who runs the Los Angles-based Comprehensive Pain Relief Group,

which treats chronic pain and prescription drug abuse through an integrative

medical approach called the Nutrition, Emotional/Psychological, Social/Financial

and Physical program, said he was shocked by CENTCOM's drug policy for deployed

troops. " If I was a commander I'd worry about what these troops would do, " as a

result of their medications, said.

Dr. Breggin, an Ithaca, N.Y., psychiatrist who testified before a House

Veterans Affairs Committee last September on the relationship between medication

and veterans' suicides, said flatly, " You should not send troops into combat on

psychotropic drugs. " Medications on the CENTCOM CNS formulary can cause loss of

judgment and self-control and could result in increased violence and suicidal

impulses, Breggin said.

The Army implicated prescription drugs as contributing to suicides in a July

2010 report, which said one-third of all active-duty military suicides involved

prescription drugs.

When the suicide report was released, Gen. Chiarelli, the Army's vice

chief of staff, said the service needed to develop better controls for

prescription drugs. " Let's make sure when we prescribe that we put an end date

on that prescription, so it doesn't remain an open-ended opportunity for

somebody to be abusing drugs, " Chiarelli said.

But when it comes to the CENTCOM CNS formulary -- which for some drugs allows a

180-day supply when troops deploy, followed by a 180-day refill in theater,

according to an October 2010 update to the psychotropic drug policy -- neither

the Army nor CENTCOM sees a need for change.

In an e-mailed statement to Nextgov, Col. Stasinos, chief of

â addiction medicine for the Army surgeon general, and Col. Carol Labadie,

pharmacy program manager in the Directorate of Health Policy and Services for

the surgeon general, said soldiers are supplied with up to 180 days of

medications because they " serve in remote areas without easy access to

pharmacies. It is important that soldiers on chronic medications do not run out

of them during combat operations, because not taking the medications can be as

dangerous as taking too much medication. "

Abuse of prescription drugs, Stasinos and Labadie said, can be prevented by

improved communication among health care providers, soldiers and commanders.

Comprehensive reviews of soldiers' medication profiles by pharmacists are

another way to prevent abuse, they said.

The statement from Stasinos and Labadie added that it is possible that troops

could receive a 180-day supply of more than one psychotropic medication.

Navy Lt. Cmdr. Speaks, a CENTCOM spokesman, echoed comments from the

Army. He said the drug-supply policy for deployed troops was " established to

ensure personnel who required these medications had an adequate supply before

deployment to last through pre-deployment activities and training as well as

travel to theater and initial deployment phase. "

He added, " Some of these medications can cause duty-limiting side effects if

they are withdrawn abruptly [i.e. if the individual runs out]. This policy

prevents that from occurring. "

Speaks said, " Abuse is always a possibility the prescribing clinician must

consider ... demonstration of clinical stability, medication quantity limits and

in-theater review of prescriptions reduces the potential for abuse. "

Suicide and Drug Abuse

The Army's suicide report drew a link between a significant increase in

prescription drug use among troops and the service's rising suicide rate. It

also raised serious concerns about troops trafficking in prescription drugs.

, the former Navy psychiatrist, now has a civilian practice in

Greensboro, N.C. She said at least one drug on the CENTCOM formulary --

Depakote, an anticonvulsant, which military doctors prescribe for mood control

-- carries serious physical risks for troops. Depakote is toxic to certain

cells, including hair cells in the ears, and can lead to hearing loss. Troops in

a howitzer battery who already run the risk of hearing loss should not take

Depakote, she said.

The medication also can cause what she calls " cognitive toxicity, " also known as

Depakote dementia, impairing a person's ability to think and make decisions.

said that while Depakote has been investigated as an adjunct therapy for

cancer, its use has been limited due to the drug's effects on cognition.

The antidepressant Wellbutrin, also on the CENTCOM formulary, likely poses a

long-term risk of Parkinson's disease, especially for older troops, said

, author of Drug-Induced Dementia: A Perfect Crime (AuthorHouse, 2009).

and Breggin both expressed deep concerns about Xanax, perhaps the most

addictive of all benzodiazepines, a class of depressant medications used to

treat anxiety, on the CENTCOM formulary.

Breggin, author of Medication Madness: The Role of Psychiatric Drugs in Cases of

Violence, Suicide and Crime (St. 's , 2009), called Xanax " solid

alcohol " and said all the benzodiazepines on the CENTCOM formulary " amount to a

prescription for abuse. " He also said there is no rationale for prescribing

multiple psychotropic drugs to troops.

said he was " flabbergasted " that military doctors prescribed Seroquel as a

sleep aid, as the Food and Drug Administration has not approved such a use and

other drugs are more effective. Breggin agreed, calling Seroquel " very

dangerous, expensive and not proven to be more beneficial than other drugs. "

noted Seroquel has the addictive potential of opioids, such heroin.

CENTCOM's allowance of Seroquel as a sleep aid also seems to fly in the face of

a high-level Defense policy set in November 2006. In a memo titled " Policy

Guidance for Deployment Limiting Pyschiatric Conditions and Medications, "

Winkenwerder, then assistant secretary of Defense for health affairs,

said psychotropic medications that would prohibit troops from deployment

included those used to treat chronic insomnia.

Asked if prescribing Seroquel to aid sleep violated this policy, Stasinos and

Labadie said in an e-mail, " Seroquel is not prescribed for chronic insomnia.

Lower doses have been used to aid soldiers with troubled sleep for

anxiety-related nightmares. " They added while other sleep medications are on the

CENTCOM formulary, none appears to relieve nightmares as effectively as

Seroquel.

Woodin, a spokeswoman for the U.S. division of London-based AstraZeneca,

which makes Seroquel, said the drug is not approved by the FDA as a sleep aid or

to treat post-traumatic stress disorder. But, she added, mental health

professionals often prescribe it to treat conditions not approved by the FDA.

" Like patients, we trust doctors to use their medical judgment to determine when

it is appropriate to prescribe medications, " Woodin said.

Nightmare

Stan White, a retired high school teacher who lives in the small town of Cross

Lanes, W.Va., has observed the effects Seroquel can have. When his son

returned from a tour in Iraq with the Marine Reserve 4th Combat Engineer

Battalion in 2007, he was diagnosed with post-traumatic stress disorder and was

prescribed three psychotropic drugs, including Seroquel, by the Huntington

Veterans Affairs Medical Center, White said.

VA started on 25 milligrams of Seroquel a day and upped the dose to 1,600

milligrams a day (the CENTCOM-approved dose is 25 milligrams a day).

White died in his sleep Feb. 12, 2008, six months after seeking help.

White said was so befuddled by his drug cocktail, which included

Klonopin, a benzodiazepine, and hydrocodone, an opiate, that his wife, Shirley,

had to dole them out for. White said Seroquel did not diminish 's

nightmares at even such a high dosage.

While talk therapy is widely viewed as one of the most effective treatments for

some mental health problems, including PTSD, White said had only a few

such sessions, primarily with a local veterans' peer therapy group. It was not

until the week died that a VA psychiatrist decided to begin intensive

sessions with him.

Stan White says his mission in life today is to expose the dangers of Seroquel.

The drug, he said, " turns people unto zombies. I cannot imagine going into

battle on Seroquel. "

Sent via BlackBerry by AT & T

[Guest guest]

http://www.nextgov.com/nextgov/ng_20110118_8944.php?oref=spotlight

Military's drug policy threatens troops' health, doctors say

By Bob Brewin 01/18/2011



This is the first story in an ongoing series.

Army leaders are increasingly concerned about the growing use and abuse of

prescription drugs by soldiers, but a Nextgov investigation shows a U.S. Central

Command policy that allows troops a 90- or 180-day supply of highly addictive

psychotropic drugs before they deploy to combat contributes to the problem.

The CENTCOM Central Nervous System

â Drug formulary includes drugs like Valium and Xanax, used to treat

depression, as well as the antipsychotic Seroquel, originally developed to treat

schizophrenia, bipolar disorders, mania and depression.

Read the entire Broken Warriors series.

Although CENTCOM policy does not permit the use of Seroquel to treat deploying

troops with these conditions, it does allow its use as a sleep aid, and allows

deployed troops to be provided with a 180-day supply, even though the drug has

been implicated in the deaths of two Marines who died in their sleep after

taking large doses of the drug.

The Army endorsed Seroquel as a sleep aid in the May 2010 report of its Pain

Management Task Force, which, among other things, called for a reduction in the

number of prescription drugs given to troops. An appendix to that report

recommended taking Seroquel in either 25- or 50-milligram doses for sleep

disorders.

A June 2010 internal report from the Defense Department's Pharmacoeconomic

Center at Fort Sam Houston in San showed that 213,972, or 20 percent of

the 1.1 million active-duty troops surveyed, were taking some form of

psychotropic drug: antidepressants, antipsychotics, sedative hypnotics, or other

controlled substances.

Dr. Grace , a former Navy psychiatrist, told Nextgov she resigned her

commission in 2002 " out of conscience, because I did not want to be a pill

pusher. " She believes psychotropic drugs have so many inherent dangers that " the

CENTCOM CNS formulary is destroying the force, " she said.

Dr. Greg , who runs the Los Angles-based Comprehensive Pain Relief Group,

which treats chronic pain and prescription drug abuse through an integrative

medical approach called the Nutrition, Emotional/Psychological, Social/Financial

and Physical program, said he was shocked by CENTCOM's drug policy for deployed

troops. " If I was a commander I'd worry about what these troops would do, " as a

result of their medications, said.

Dr. Breggin, an Ithaca, N.Y., psychiatrist who testified before a House

Veterans Affairs Committee last September on the relationship between medication

and veterans' suicides, said flatly, " You should not send troops into combat on

psychotropic drugs. " Medications on the CENTCOM CNS formulary can cause loss of

judgment and self-control and could result in increased violence and suicidal

impulses, Breggin said.

The Army implicated prescription drugs as contributing to suicides in a July

2010 report, which said one-third of all active-duty military suicides involved

prescription drugs.

When the suicide report was released, Gen. Chiarelli, the Army's vice

chief of staff, said the service needed to develop better controls for

prescription drugs. " Let's make sure when we prescribe that we put an end date

on that prescription, so it doesn't remain an open-ended opportunity for

somebody to be abusing drugs, " Chiarelli said.

But when it comes to the CENTCOM CNS formulary -- which for some drugs allows a

180-day supply when troops deploy, followed by a 180-day refill in theater,

according to an October 2010 update to the psychotropic drug policy -- neither

the Army nor CENTCOM sees a need for change.

In an e-mailed statement to Nextgov, Col. Stasinos, chief of

â addiction medicine for the Army surgeon general, and Col. Carol Labadie,

pharmacy program manager in the Directorate of Health Policy and Services for

the surgeon general, said soldiers are supplied with up to 180 days of

medications because they " serve in remote areas without easy access to

pharmacies. It is important that soldiers on chronic medications do not run out

of them during combat operations, because not taking the medications can be as

dangerous as taking too much medication. "

Abuse of prescription drugs, Stasinos and Labadie said, can be prevented by

improved communication among health care providers, soldiers and commanders.

Comprehensive reviews of soldiers' medication profiles by pharmacists are

another way to prevent abuse, they said.

The statement from Stasinos and Labadie added that it is possible that troops

could receive a 180-day supply of more than one psychotropic medication.

Navy Lt. Cmdr. Speaks, a CENTCOM spokesman, echoed comments from the

Army. He said the drug-supply policy for deployed troops was " established to

ensure personnel who required these medications had an adequate supply before

deployment to last through pre-deployment activities and training as well as

travel to theater and initial deployment phase. "

He added, " Some of these medications can cause duty-limiting side effects if

they are withdrawn abruptly [i.e. if the individual runs out]. This policy

prevents that from occurring. "

Speaks said, " Abuse is always a possibility the prescribing clinician must

consider ... demonstration of clinical stability, medication quantity limits and

in-theater review of prescriptions reduces the potential for abuse. "

Suicide and Drug Abuse

The Army's suicide report drew a link between a significant increase in

prescription drug use among troops and the service's rising suicide rate. It

also raised serious concerns about troops trafficking in prescription drugs.

, the former Navy psychiatrist, now has a civilian practice in

Greensboro, N.C. She said at least one drug on the CENTCOM formulary --

Depakote, an anticonvulsant, which military doctors prescribe for mood control

-- carries serious physical risks for troops. Depakote is toxic to certain

cells, including hair cells in the ears, and can lead to hearing loss. Troops in

a howitzer battery who already run the risk of hearing loss should not take

Depakote, she said.

The medication also can cause what she calls " cognitive toxicity, " also known as

Depakote dementia, impairing a person's ability to think and make decisions.

said that while Depakote has been investigated as an adjunct therapy for

cancer, its use has been limited due to the drug's effects on cognition.

The antidepressant Wellbutrin, also on the CENTCOM formulary, likely poses a

long-term risk of Parkinson's disease, especially for older troops, said

, author of Drug-Induced Dementia: A Perfect Crime (AuthorHouse, 2009).

and Breggin both expressed deep concerns about Xanax, perhaps the most

addictive of all benzodiazepines, a class of depressant medications used to

treat anxiety, on the CENTCOM formulary.

Breggin, author of Medication Madness: The Role of Psychiatric Drugs in Cases of

Violence, Suicide and Crime (St. 's , 2009), called Xanax " solid

alcohol " and said all the benzodiazepines on the CENTCOM formulary " amount to a

prescription for abuse. " He also said there is no rationale for prescribing

multiple psychotropic drugs to troops.

said he was " flabbergasted " that military doctors prescribed Seroquel as a

sleep aid, as the Food and Drug Administration has not approved such a use and

other drugs are more effective. Breggin agreed, calling Seroquel " very

dangerous, expensive and not proven to be more beneficial than other drugs. "

noted Seroquel has the addictive potential of opioids, such heroin.

CENTCOM's allowance of Seroquel as a sleep aid also seems to fly in the face of

a high-level Defense policy set in November 2006. In a memo titled " Policy

Guidance for Deployment Limiting Pyschiatric Conditions and Medications, "

Winkenwerder, then assistant secretary of Defense for health affairs,

said psychotropic medications that would prohibit troops from deployment

included those used to treat chronic insomnia.

Asked if prescribing Seroquel to aid sleep violated this policy, Stasinos and

Labadie said in an e-mail, " Seroquel is not prescribed for chronic insomnia.

Lower doses have been used to aid soldiers with troubled sleep for

anxiety-related nightmares. " They added while other sleep medications are on the

CENTCOM formulary, none appears to relieve nightmares as effectively as

Seroquel.

Woodin, a spokeswoman for the U.S. division of London-based AstraZeneca,

which makes Seroquel, said the drug is not approved by the FDA as a sleep aid or

to treat post-traumatic stress disorder. But, she added, mental health

professionals often prescribe it to treat conditions not approved by the FDA.

" Like patients, we trust doctors to use their medical judgment to determine when

it is appropriate to prescribe medications, " Woodin said.

Nightmare

Stan White, a retired high school teacher who lives in the small town of Cross

Lanes, W.Va., has observed the effects Seroquel can have. When his son

returned from a tour in Iraq with the Marine Reserve 4th Combat Engineer

Battalion in 2007, he was diagnosed with post-traumatic stress disorder and was

prescribed three psychotropic drugs, including Seroquel, by the Huntington

Veterans Affairs Medical Center, White said.

VA started on 25 milligrams of Seroquel a day and upped the dose to 1,600

milligrams a day (the CENTCOM-approved dose is 25 milligrams a day).

White died in his sleep Feb. 12, 2008, six months after seeking help.

White said was so befuddled by his drug cocktail, which included

Klonopin, a benzodiazepine, and hydrocodone, an opiate, that his wife, Shirley,

had to dole them out for. White said Seroquel did not diminish 's

nightmares at even such a high dosage.

While talk therapy is widely viewed as one of the most effective treatments for

some mental health problems, including PTSD, White said had only a few

such sessions, primarily with a local veterans' peer therapy group. It was not

until the week died that a VA psychiatrist decided to begin intensive

sessions with him.

Stan White says his mission in life today is to expose the dangers of Seroquel.

The drug, he said, " turns people unto zombies. I cannot imagine going into

battle on Seroquel. "

Sent via BlackBerry by AT & T

[Guest guest]

http://www.nextgov.com/nextgov/ng_20110118_8944.php?oref=spotlight

Military's drug policy threatens troops' health, doctors say

By Bob Brewin 01/18/2011



This is the first story in an ongoing series.

Army leaders are increasingly concerned about the growing use and abuse of

prescription drugs by soldiers, but a Nextgov investigation shows a U.S. Central

Command policy that allows troops a 90- or 180-day supply of highly addictive

psychotropic drugs before they deploy to combat contributes to the problem.

The CENTCOM Central Nervous System

â Drug formulary includes drugs like Valium and Xanax, used to treat

depression, as well as the antipsychotic Seroquel, originally developed to treat

schizophrenia, bipolar disorders, mania and depression.

Read the entire Broken Warriors series.

Although CENTCOM policy does not permit the use of Seroquel to treat deploying

troops with these conditions, it does allow its use as a sleep aid, and allows

deployed troops to be provided with a 180-day supply, even though the drug has

been implicated in the deaths of two Marines who died in their sleep after

taking large doses of the drug.

The Army endorsed Seroquel as a sleep aid in the May 2010 report of its Pain

Management Task Force, which, among other things, called for a reduction in the

number of prescription drugs given to troops. An appendix to that report

recommended taking Seroquel in either 25- or 50-milligram doses for sleep

disorders.

A June 2010 internal report from the Defense Department's Pharmacoeconomic

Center at Fort Sam Houston in San showed that 213,972, or 20 percent of

the 1.1 million active-duty troops surveyed, were taking some form of

psychotropic drug: antidepressants, antipsychotics, sedative hypnotics, or other

controlled substances.

Dr. Grace , a former Navy psychiatrist, told Nextgov she resigned her

commission in 2002 " out of conscience, because I did not want to be a pill

pusher. " She believes psychotropic drugs have so many inherent dangers that " the

CENTCOM CNS formulary is destroying the force, " she said.

Dr. Greg , who runs the Los Angles-based Comprehensive Pain Relief Group,

which treats chronic pain and prescription drug abuse through an integrative

medical approach called the Nutrition, Emotional/Psychological, Social/Financial

and Physical program, said he was shocked by CENTCOM's drug policy for deployed

troops. " If I was a commander I'd worry about what these troops would do, " as a

result of their medications, said.

Dr. Breggin, an Ithaca, N.Y., psychiatrist who testified before a House

Veterans Affairs Committee last September on the relationship between medication

and veterans' suicides, said flatly, " You should not send troops into combat on

psychotropic drugs. " Medications on the CENTCOM CNS formulary can cause loss of

judgment and self-control and could result in increased violence and suicidal

impulses, Breggin said.

The Army implicated prescription drugs as contributing to suicides in a July

2010 report, which said one-third of all active-duty military suicides involved

prescription drugs.

When the suicide report was released, Gen. Chiarelli, the Army's vice

chief of staff, said the service needed to develop better controls for

prescription drugs. " Let's make sure when we prescribe that we put an end date

on that prescription, so it doesn't remain an open-ended opportunity for

somebody to be abusing drugs, " Chiarelli said.

But when it comes to the CENTCOM CNS formulary -- which for some drugs allows a

180-day supply when troops deploy, followed by a 180-day refill in theater,

according to an October 2010 update to the psychotropic drug policy -- neither

the Army nor CENTCOM sees a need for change.

In an e-mailed statement to Nextgov, Col. Stasinos, chief of

â addiction medicine for the Army surgeon general, and Col. Carol Labadie,

pharmacy program manager in the Directorate of Health Policy and Services for

the surgeon general, said soldiers are supplied with up to 180 days of

medications because they " serve in remote areas without easy access to

pharmacies. It is important that soldiers on chronic medications do not run out

of them during combat operations, because not taking the medications can be as

dangerous as taking too much medication. "

Abuse of prescription drugs, Stasinos and Labadie said, can be prevented by

improved communication among health care providers, soldiers and commanders.

Comprehensive reviews of soldiers' medication profiles by pharmacists are

another way to prevent abuse, they said.

The statement from Stasinos and Labadie added that it is possible that troops

could receive a 180-day supply of more than one psychotropic medication.

Navy Lt. Cmdr. Speaks, a CENTCOM spokesman, echoed comments from the

Army. He said the drug-supply policy for deployed troops was " established to

ensure personnel who required these medications had an adequate supply before

deployment to last through pre-deployment activities and training as well as

travel to theater and initial deployment phase. "

He added, " Some of these medications can cause duty-limiting side effects if

they are withdrawn abruptly [i.e. if the individual runs out]. This policy

prevents that from occurring. "

Speaks said, " Abuse is always a possibility the prescribing clinician must

consider ... demonstration of clinical stability, medication quantity limits and

in-theater review of prescriptions reduces the potential for abuse. "

Suicide and Drug Abuse

The Army's suicide report drew a link between a significant increase in

prescription drug use among troops and the service's rising suicide rate. It

also raised serious concerns about troops trafficking in prescription drugs.

, the former Navy psychiatrist, now has a civilian practice in

Greensboro, N.C. She said at least one drug on the CENTCOM formulary --

Depakote, an anticonvulsant, which military doctors prescribe for mood control

-- carries serious physical risks for troops. Depakote is toxic to certain

cells, including hair cells in the ears, and can lead to hearing loss. Troops in

a howitzer battery who already run the risk of hearing loss should not take

Depakote, she said.

The medication also can cause what she calls " cognitive toxicity, " also known as

Depakote dementia, impairing a person's ability to think and make decisions.

said that while Depakote has been investigated as an adjunct therapy for

cancer, its use has been limited due to the drug's effects on cognition.

The antidepressant Wellbutrin, also on the CENTCOM formulary, likely poses a

long-term risk of Parkinson's disease, especially for older troops, said

, author of Drug-Induced Dementia: A Perfect Crime (AuthorHouse, 2009).

and Breggin both expressed deep concerns about Xanax, perhaps the most

addictive of all benzodiazepines, a class of depressant medications used to

treat anxiety, on the CENTCOM formulary.

Breggin, author of Medication Madness: The Role of Psychiatric Drugs in Cases of

Violence, Suicide and Crime (St. 's , 2009), called Xanax " solid

alcohol " and said all the benzodiazepines on the CENTCOM formulary " amount to a

prescription for abuse. " He also said there is no rationale for prescribing

multiple psychotropic drugs to troops.

said he was " flabbergasted " that military doctors prescribed Seroquel as a

sleep aid, as the Food and Drug Administration has not approved such a use and

other drugs are more effective. Breggin agreed, calling Seroquel " very

dangerous, expensive and not proven to be more beneficial than other drugs. "

noted Seroquel has the addictive potential of opioids, such heroin.

CENTCOM's allowance of Seroquel as a sleep aid also seems to fly in the face of

a high-level Defense policy set in November 2006. In a memo titled " Policy

Guidance for Deployment Limiting Pyschiatric Conditions and Medications, "

Winkenwerder, then assistant secretary of Defense for health affairs,

said psychotropic medications that would prohibit troops from deployment

included those used to treat chronic insomnia.

Asked if prescribing Seroquel to aid sleep violated this policy, Stasinos and

Labadie said in an e-mail, " Seroquel is not prescribed for chronic insomnia.

Lower doses have been used to aid soldiers with troubled sleep for

anxiety-related nightmares. " They added while other sleep medications are on the

CENTCOM formulary, none appears to relieve nightmares as effectively as

Seroquel.

Woodin, a spokeswoman for the U.S. division of London-based AstraZeneca,

which makes Seroquel, said the drug is not approved by the FDA as a sleep aid or

to treat post-traumatic stress disorder. But, she added, mental health

professionals often prescribe it to treat conditions not approved by the FDA.

" Like patients, we trust doctors to use their medical judgment to determine when

it is appropriate to prescribe medications, " Woodin said.

Nightmare

Stan White, a retired high school teacher who lives in the small town of Cross

Lanes, W.Va., has observed the effects Seroquel can have. When his son

returned from a tour in Iraq with the Marine Reserve 4th Combat Engineer

Battalion in 2007, he was diagnosed with post-traumatic stress disorder and was

prescribed three psychotropic drugs, including Seroquel, by the Huntington

Veterans Affairs Medical Center, White said.

VA started on 25 milligrams of Seroquel a day and upped the dose to 1,600

milligrams a day (the CENTCOM-approved dose is 25 milligrams a day).

White died in his sleep Feb. 12, 2008, six months after seeking help.

White said was so befuddled by his drug cocktail, which included

Klonopin, a benzodiazepine, and hydrocodone, an opiate, that his wife, Shirley,

had to dole them out for. White said Seroquel did not diminish 's

nightmares at even such a high dosage.

While talk therapy is widely viewed as one of the most effective treatments for

some mental health problems, including PTSD, White said had only a few

such sessions, primarily with a local veterans' peer therapy group. It was not

until the week died that a VA psychiatrist decided to begin intensive

sessions with him.

Stan White says his mission in life today is to expose the dangers of Seroquel.

The drug, he said, " turns people unto zombies. I cannot imagine going into

battle on Seroquel. "

Sent via BlackBerry by AT & T