Veterans' deaths alter prescribing of pain pills
By JEB PHILLIPS | The Columbus Dispatch, Ohio | Published: September 29, 2013
COLUMBUS, Ohio — Scott McDonald survived Army deployments to Bosnia, Afghanistan and Iraq.
It was the pills that killed him as he lay on his couch in Reynoldsburg. He was 35.
An autopsy found that McDonald’s death was caused by the combined effect of five drugs: two antidepressants, an anti-anxiety medicine, an anti-convulsant and a narcotic painkiller. McDonald was prescribed the drugs at the Chalmers P. Wylie Veterans Affairs Ambulatory Care Center in Columbus, said Heather McDonald, his wife.
She had become worried that he was being over-prescribed in the months after he started going to the center in 2011. She was concerned that, instead of figuring out how to heal McDonald’s physical and psychological pain, doctors decided to treat him by medicating him.
He had chronic shoulder and back pain and numbness in his hands, and post-traumatic stress disorder had been diagnosed.
He received oxycodone, the painkiller, the day before he died. Mrs. McDonald found her husband asleep on the couch that night. When she tried to wake him to get him into bed, he was “loopy,” she said. She asked him if he’d taken too much of his medicine.
“I took what they told me,” he said to her.
He was dead the next morning, Sept. 13, 2012.
The Fairfield County coroner’s chief investigator ruled the death an accidental overdose. He also noted that many pills were unaccounted for. Among the missing were nine oxycodone pills; an instruction on the bottle indicated that McDonald should have only taken one before he died.
Another instruction about the maximum per-day dosage, though, could have led McDonald to believe “he could take nine to relieve the pain,” the investigator wrote.
Mrs. McDonald, 31, told her story in her attorney’s office at Easton Town Center last week. She is considering legal action against the U.S. Department of Veterans Affairs.
For now, she wants to tell people that this happens: Troops come home, they are prescribed a lot of medicine, and sometimes they die from taking it.
“I feel incredibly obligated now to bring this forward,” she said.
Statistics seem to back her up. From 2002 through 2008, Ohio averaged 35 unintentional veteran deaths per year that involved at least one prescription opiate, according to data from the state Department of Health. There were 53 in 2009 and 59 in 2010.
Data provided by the Wylie Veterans Affairs center in Columbus show that, from 2002 to 2011, the number of patients treated there increased by 72 percent. But the number of painkiller prescriptions increased by 237 percent.
Veterans medical centers, along with the wider medical community, treated pain a certain way during that decade, said Dr. Edward Bope, chief of primary care at the Columbus VA center.
He would not talk specifically about McDonald’s case, but he talked about the mindset during those years: “If a patient is having pain, we give them medicine to relieve the pain.”
That medicine was often powerful, short-acting and best suited for the kind of acute pain that people might feel after surgery. It was being prescribed, though, for chronic pain, Bope said.
Over the past couple of years, the medical community has changed course, he said. The problems with short-acting narcotic medicine, such as oxycodone, became obvious. Patients found themselves on a pain roller coaster — free of it for a while but waiting for it to come back to take another pill.
Patients could lose track of how many pills they had taken, which could lead to an unintentional overdose, he said. Not to mention issues with addiction, or the possibility that patients were supplying others with their pills.
Gov. John Kasich talked about the problem of over-prescription last May, and about the importance of changing doctors’ attitudes, when he announced new state guidelines that make it more difficult for some patients to obtain painkillers.
In the same vein, the Columbus VA center began an initiative to change pain management in December, Bope said. All patients were assessed to see whether they even needed the pain medicine they had been prescribed. Chronic-pain sufferers were gradually switched from short-acting medicine to longer-acting drugs. Those patients have less of a pain roller coaster, and they have an easier time keeping track of doses, he said.
The rate of narcotic prescriptions in 2013 is now closer to 2002 levels, according to statistics from the Columbus VA center. About 70 percent of pain-pill prescriptions used to be short-acting; now it’s 30 percent.
All of this was too late for Scott McDonald. Since her husband’s death, Heather McDonald has heard from others who believe that their loved ones are taking too much VA-prescribed medicine.
Military families realize they can lose people in battle. But when the troops come home, the danger is supposed to be over. Heather McDonald cries when she talks about it.
“I could have accepted it if he had died overseas,” she said.