US: Unprecedented numbers of veterans affected by drug dependency, suicide & overdose.
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(New York) –The Department of Veterans Affairs (VA) should expand treatment, overdose prevention, and housing programs to aid the unprecedented numbers of veterans affected by drug dependency, suicide, and overdose, Human Rights Watch said in a report released today. An estimated more than one million USveterans take prescription opioids for pain, and nearly half of them use the drugs chronically, for more than 90 days.
The 39-page report, “No Time to Waste: Evidence-Based Treatment for Drug Dependence at the United States Department of Veterans Affairs,” compiles and analyzes findings from a wide range of sources about problems of drug dependency among veterans and the implications for treatment and assistance. Human Rights Watch found that alcohol and drug dependence are strongly associated with homelessness as well as with mental health conditions – including post-traumatic stress syndrome and depression – that affect 40 percent of Iraq and Afghanistan veterans in VA care. Drugs or alcohol are involved in one of three Army suicides, and the VA estimates that 22 veterans commit suicide each day.
“Hundreds of thousands of veterans are struggling with chronic pain, drug dependency, mental health conditions, and homelessness,” said Megan McLemore, senior health researcher at Human Rights Watch and author of the report. “The Department of Veterans Affairs has developed effective, evidence-based programs, but they urgently need to be made available to everyone who needs them.”
The report is based on interviews with dozens of veterans and their advocates, VA officials, and community service providers, as well as extensive review of government, academic, and other research. Human Rights Watch also reviewed and assessed the availability of a wide range of evidence-based programs – that is, programs that have been proven effective -- to treat dependency and address veterans’ drug-related problems.
One of the report’s findings is the need to expand the availability of naloxone, a prescription medication that can reverse overdose from opioids such as heroin. The rate of death by accidental overdose among patients of VA facilities is nearly double that reported in the US as a whole. While the VA plans to make naloxone available nationwide through VA hospitals by the end of 2014, the VA should make naloxone available to all veterans, regardless of where they get treatment, Human Rights Watch said.
“Veterans are dying every day of opioid overdose,” McLemore said. “Those most in need may not be in the VA system, so it’s critical for the VA to work with community groups to make naloxone available to all veterans who need it.”
Evidence-based drug dependency treatment programs also should be expanded. Although the prescription drugs methadone and buprenorphine are proven to be effective for treating individuals dependent on opioids such as Oxycontin, Vicodin, or heroin, many veterans do not have access to them.
Veterans told Human Rights Watch that without these programs, they would be unable to live in dignity or contribute to society. One Vietnam veteran said that “Before I started methadone, I was no more than the walking dead. Methadone gave me my life back.”
“Only one of three patients at the VA who need methadone or buprenorphine is getting it,” said McLemore. “We found that 38,000 VA patients don’t have access to the most effective treatment for their condition, and many more who are not in the VA health system also need treatment.”
The report also examines a VA program for chronically homeless veterans, many of whom struggle with alcohol and drug dependence as well as mental health conditions, including post-traumatic stress syndrome and depression. Alcohol and drug dependence are strongly associated with homelessness, both among veterans and in the general population. Nearly 60,000 veterans are homeless on a given night, and as many as 400,000 veterans may experience homelessness or unstable housing at some point each year. Female veterans are the fastest growing segment of the homeless population in the United States.
Since 2008, the “HUD-VASH” program, a partnership between the VA and the Department of Housing and Urban Development, has provided permanent housing for nearly 60,000 chronically homeless veterans. In recent years this program has changed from a model that required veterans to prove their “readiness” for housing, usually through abstinence from drugs or alcohol, to a “Housing First” model that provides housing as the first step and then surrounds the individual with a range of supportive services.
Department of Veterans Affairs reviews of the program show that the Housing First approach saves money in health care costs and allows the VA to reach the most vulnerable veterans – those who combine alcohol and drug dependence with mental health issues, Human Rights Watch said.
After pilot programs in 14 cities, the VA plans to use the Housing First model in all 100 HUD-VASH sites nationwide. Congress should ensure adequate funding to meet the demand for housing among chronically homeless veterans, Human Rights Watch said.
Under international human rights law, governments are obligated to apply proven standards, best practices, and evidence-based models to prevent disease, treat illness, and protect the right to health, which includes access to overdose prevention, effective drug dependency treatment, mental health care, and stable housing.
“The Department of Veterans Affairs has adopted these evidence-based models because they are effective,” McLemore said. “But access to these services is also key to their right to health, and to life itself.”
One veteran told Human Rights Watch that his buddy, an Iraq War veteran who regularly uses heroin, now carries his naloxone kit with him at all times. A veteran of the Iraq War said that without the HUD-VASH program, he would still be living in the subway, on the streets, or under bridges. “I’d probably be dead,” said one veteran of the Iraq war. “Now I’m in treatment and I’m doing okay.”
“Everyone has the right to effective medications for overdose prevention and drug treatment,” McLemore said. “These programs save lives and they need to be expanded without delay.”
The 39-page report, “No Time to Waste: Evidence-Based Treatment for Drug Dependence at the United States Department of Veterans Affairs,” compiles and analyzes findings from a wide range of sources about problems of drug dependency among veterans and the implications for treatment and assistance. Human Rights Watch found that alcohol and drug dependence are strongly associated with homelessness as well as with mental health conditions – including post-traumatic stress syndrome and depression – that affect 40 percent of Iraq and Afghanistan veterans in VA care. Drugs or alcohol are involved in one of three Army suicides, and the VA estimates that 22 veterans commit suicide each day.
“Hundreds of thousands of veterans are struggling with chronic pain, drug dependency, mental health conditions, and homelessness,” said Megan McLemore, senior health researcher at Human Rights Watch and author of the report. “The Department of Veterans Affairs has developed effective, evidence-based programs, but they urgently need to be made available to everyone who needs them.”
The report is based on interviews with dozens of veterans and their advocates, VA officials, and community service providers, as well as extensive review of government, academic, and other research. Human Rights Watch also reviewed and assessed the availability of a wide range of evidence-based programs – that is, programs that have been proven effective -- to treat dependency and address veterans’ drug-related problems.
One of the report’s findings is the need to expand the availability of naloxone, a prescription medication that can reverse overdose from opioids such as heroin. The rate of death by accidental overdose among patients of VA facilities is nearly double that reported in the US as a whole. While the VA plans to make naloxone available nationwide through VA hospitals by the end of 2014, the VA should make naloxone available to all veterans, regardless of where they get treatment, Human Rights Watch said.
“Veterans are dying every day of opioid overdose,” McLemore said. “Those most in need may not be in the VA system, so it’s critical for the VA to work with community groups to make naloxone available to all veterans who need it.”
Evidence-based drug dependency treatment programs also should be expanded. Although the prescription drugs methadone and buprenorphine are proven to be effective for treating individuals dependent on opioids such as Oxycontin, Vicodin, or heroin, many veterans do not have access to them.
Veterans told Human Rights Watch that without these programs, they would be unable to live in dignity or contribute to society. One Vietnam veteran said that “Before I started methadone, I was no more than the walking dead. Methadone gave me my life back.”
“Only one of three patients at the VA who need methadone or buprenorphine is getting it,” said McLemore. “We found that 38,000 VA patients don’t have access to the most effective treatment for their condition, and many more who are not in the VA health system also need treatment.”
The report also examines a VA program for chronically homeless veterans, many of whom struggle with alcohol and drug dependence as well as mental health conditions, including post-traumatic stress syndrome and depression. Alcohol and drug dependence are strongly associated with homelessness, both among veterans and in the general population. Nearly 60,000 veterans are homeless on a given night, and as many as 400,000 veterans may experience homelessness or unstable housing at some point each year. Female veterans are the fastest growing segment of the homeless population in the United States.
Since 2008, the “HUD-VASH” program, a partnership between the VA and the Department of Housing and Urban Development, has provided permanent housing for nearly 60,000 chronically homeless veterans. In recent years this program has changed from a model that required veterans to prove their “readiness” for housing, usually through abstinence from drugs or alcohol, to a “Housing First” model that provides housing as the first step and then surrounds the individual with a range of supportive services.
Department of Veterans Affairs reviews of the program show that the Housing First approach saves money in health care costs and allows the VA to reach the most vulnerable veterans – those who combine alcohol and drug dependence with mental health issues, Human Rights Watch said.
After pilot programs in 14 cities, the VA plans to use the Housing First model in all 100 HUD-VASH sites nationwide. Congress should ensure adequate funding to meet the demand for housing among chronically homeless veterans, Human Rights Watch said.
Under international human rights law, governments are obligated to apply proven standards, best practices, and evidence-based models to prevent disease, treat illness, and protect the right to health, which includes access to overdose prevention, effective drug dependency treatment, mental health care, and stable housing.
“The Department of Veterans Affairs has adopted these evidence-based models because they are effective,” McLemore said. “But access to these services is also key to their right to health, and to life itself.”
One veteran told Human Rights Watch that his buddy, an Iraq War veteran who regularly uses heroin, now carries his naloxone kit with him at all times. A veteran of the Iraq War said that without the HUD-VASH program, he would still be living in the subway, on the streets, or under bridges. “I’d probably be dead,” said one veteran of the Iraq war. “Now I’m in treatment and I’m doing okay.”
“Everyone has the right to effective medications for overdose prevention and drug treatment,” McLemore said. “These programs save lives and they need to be expanded without delay.”
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