Rhode Island VA Hospital Tries to Help Addicted Vets

By Greer Brigham

They served in different eras. The opioid epidemic reached them all the same. Now, they’re fighting for a way out.

Paul, 59, of Lincoln, RI has a kind demeanor and speaks with a thick Rhode Island accent. He arrived in Lebanon in 1983 soon after a suicide bomber killed 241 U.S. servicemen in their barracks. As a corpsman in the Navy, he treated the wounded from the explosion and developed Post-Traumatic Stress Disorder (PTSD) from the experience.

Once he returned home, he suffered a series of physical injuries. He initially hurt his back lifting a obese woman onto a gurney while working as an EMT for the Navy in Newport, RI. “I saw stars,” Paul said, recalling the pain. He further injured himself in a car accident in Las Vegas, which led to three surgeries to his back between 1998 and 2005.

Doctors gave him opiates following the surgeries. “Oh they were giving them out like nuts back then,” he said. Paul began to abuse the painkillers in order to dull his back pain and his PTSD. As his addiction grew, Paul started using heroin, vicodin, and benzodiazepines. At the Providence VA Medical Center, Paul said that they prescribed him fentanyl patches. “Like a good addict, I wouldn’t put them on my arm. I’d put them in my mouth and chew them up.” At one point, doctors had to put Paul into a 10 day medically-induced coma to keep him alive.

Matthew, 33, of Glocester, RI is a thoughtful man with an intensity behind his eyes. He served as a specialist with the U.S. Army in Afghanistan, leading his squad on missions to break the Taliban stronghold in local communities. Matthew fought in over a dozen firefights during his 13-month tour. He loved combat, but also encountered some scarring scenes on the battlefield.

On one mission, a local man ran out to Matthew’s squad screaming while holding up his daughter and begging for help. A kerosene fire had burned the girl from the shoulders down. Matthew’s medic told his lieutenant that they would need to medevac the girl out, but the lieutenant refused saying that it would give away their position and ruin the mission. The man and his daughter left, and a minute and a half later Matthew heard three gunshots ring out. The man had mercy-killed his own daughter.

“Stuff like that is probably what sticks with me and I think led to PTSD, more so than combat itself,” Matthew said, “being on a personal level with the locals -- I think that’s what makes it tough. We were trying to help them.” He says that he didn’t know how to productively cope with PTSD and depression at the time and started to self-medicate with opioids. The drugs gave him a sense of security and control. Percocets quickly turned into heroin.

As veterans bear the brunt of the opioid epidemic, stories like Paul’s and Matthew’s play out again and again across the country. According to US Secretary of Veterans Affairs Robert Wilkie, veterans are twice as likely as civilians to die from an opioid overdose. Given the sensitivity of the topic, we have agreed with the Providence VA Medical Center to identify these veterans only by their first names.

Resul Cesur, a professor at the University of Connecticut who studies the relationship between military service and opioid addiction, says that the physical combat injuries and PTSD commonly suffered by veterans leave them particularly predisposed to develop an opioid addiction. The culture of the military also contributes to these problems. “In this environment, people don’t want to look weak because if they reveal their weakness they may lose their job or people will look down on them,” Cesur said.

Matthew agrees. One day while he was on patrol with his squad, an IED exploded about 50 feet from his position. The blast sent Matthew flying and knocked him out. Two of his men who were closer to the blast had to be medevaced out. But Matthew kept quiet about his own injury.

“If you go to an officer that's a medic and you say, ‘oh I got blown up,’ they're going to evaluate you and the next thing you know you’re going to get sent home.” He later learned that he had suffered a Traumatic Brain Injury (TBI), which researchers find are associated with a threefold increase in the risk of opioid overdoses compared with veterans without such an injury.

Paul felt the same pressure to keep quiet when he suffered his first back injury as an EMT in Newport. He feared that he would be thrown out of the Navy if he complained too much so he dealt with it on his own.

Today, Matthew and Paul wage their battle against addiction side by side at the Providence VA Medical Center through its Collaborative Addiction & Recovery Services (CARS) program. For those in the program, it’s a constant fight. Paul takes one film of suboxone in the morning and one in the afternoon every day.

According to Brandon Marshall, a professor of epidemiology at Brown University, suboxone prevents cravings for opioids by blocking the receptors in the brain that opioids normally bind to. Methadone works in a similar fashion, by binding to these receptors and preventing other drugs from doing so. Matthew takes methadone every day, which for him has worked like an off switch; he says that he no longer feels any cravings whatsoever for opioids.

Paul also attends group meetings with other veterans suffering from addiction. The groups are specialized in areas such as stress, resentment and wellness. Three times a week, he arrives at the VA and sits in a conference room with eight or nine other veterans as they go around the room and talk about how they are doing in one of these specific areas. “Almost like an AA meeting, but it’s not,” said Paul.

At his last meeting, Paul told the group about the stress he feels from overspending. He has played guitar ever since he picked it up at Cumberland High School and says that he has recently been buying more guitars than he needs. These meetings make Paul feel grounded, and he believes that he would not be alive without them.

Both Paul and Matthew also regularly have one-on-one meetings with clinicians. Matthew meets personally with Jay Billingsley, the Opioid Treatment Program Director for CARS. He uses their weekly sessions to discuss his depression and make sure that he does not fall back into old habits.

Billingsley said that the current program differs greatly from how it looked in the past. As the number of veteran deaths skyrocketed during the opioid epidemic, the VA changed its approach to addressing pain, opioids and addiction overall.

When patients refused to follow the treatment plan provided by the VA, they used to be discharged from the program, according to Billingsley. Today, “the one mandate is that you show up.” The VA now focuses mostly on harm reduction. “One of the main things we’re looking at is keeping people alive. If you’re alive, you can change your life,” Billingsley said. “There’s not much changing going on after you die.”

For now, it does not seem like the demand for VA services will abate anytime soon, even with the end of the Iraq War and the winddown of the War in Afghanistan. According to Cesur, the scars from TBIs and PTSD stay with veterans long after their service ends and can drive continued opioid abuse. “It would be naive to say that, ‘oh the war is over, now the epidemic will go down.’”

But for Matthew and Paul, there is hope. Matthew said that he is currently drug-free and his life has almost taken an 180° turn. While street drugs had previously stopped him from caring about his bigger goals, he is now studying at the New England Institute of Technology to fulfill his dream of becoming an architect. “It’s almost like a fog has been lifted,” he said.

At the time of our interview, Paul had been sober for 8 months and was grateful for the services at CARS. “This place saved my life -- more than once,” he said. His children are back in his life and he has rediscovered his passion for music. Once a week he plays guitar for a local band he started, jamming out to tunes by Chuck Berry and Keith Richards.

In the conference room at the RI VA hospital, Paul wore a T-shirt with a parody of the U.S. Marine Corps’ Rifleman’s Creed written across it.

This is my guitar.
There are many like it,
But this one is mine.
My guitar is my best friend.
It is my life. I must master it
As I must master my life.