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Does off-label prescribing of high-risk drugs contribute to soldiers’ suicides?

REUTERS/Goran Tomasevic
The suicide rate among both active-duty military personnel and military veterans has hit record highs this year; experts are trying to determine why.

As has been widely reported, the suicide rate among both active-duty military personnel and military veterans has hit record highs this year.

Here are some of the troubling statistics from a recent article in the the Army Times:

  • More American active-duty service members killed themselves in the first six months of 2012 than in the first six months of any of the previous 11 years.
  • For every service member who dies in battle in Iraq or Afghanistan, 25 veterans take their own lives.
  • A military veteran commits suicide every 80 minutes.
  • Only 1 percent of Americans have served in Iraq or Afghanistan, but veterans of those wars represent 20 percent of suicides in the U.S..

Earlier this year, two scholars reported that the U.S. military suicide rate is now likely double or triple what it was during the horrifically bloody and traumatizing American Civil War.

Those same scholars, psychologist B. Christopher Frueh and American historian Jeffrey A. Smith, both of the University of Hawaii, note that the reason the military suicide rate has climbed so high remains a mystery.

“The ‘true’ explanation,” they wrote in Time magazine last August, “is probably multifactorial: a combination of general military stressors, combat trauma, economic stressors, societal stressors, and changes in recruitment standards. We also need to examine whether recent increases are related to changes in military esprit de corps, aggressive use of prescription medications [by] military physicians that may deregulate emotions and cognitive functioning, and even reduced psychological hardiness in society in general.”

‘Never been more medicated’

Paul John Scott, a health writer based in Rochester, Minn., has written a terrific and disturbing article on one of those possible factors — the aggressive prescribing of medications by military physicians — in the current (December) issue of Men’s Journal magazine.

“American soldiers (active soldiers as well as retired) have never been more medicated than they are now,” he writes.

In 2010, more than 213,000 service members (roughly 20 percent of active-duty military) were taking medications the military considered “high risk” — from epilepsy drugs to psychiatric pills like Seroquel.

But what’s more incredible is that Seroquel and other antipsychotics are expensive (as much as $10 a dose) and not proven to be effective in treating the very conditions for which the military and VA most often prescribe them: insomnia and [post-traumatic stress disorder]. But that didn’t prevent their use by the military from increasing tenfold between 2001 and 2009.

The spike in prescriptions, as well as the growing chorus of concern within the military, prompted a high-level memo from Gen. Jonathan Woodson, M.D., assistant secretary of defense for health affairs, cautioning military personnel about the use of atypical antipsychotics, specifically Seroquel.

“Providers should use caution,” he wrote in February 2012, “when these agents are used as sleep aids in service members struggling with substance-use disorders.… Providers should offer service members the lowest risk medication and non-medication therapy options for their symptoms.”

But many military doctors do not seem to be getting that message. Here’s just one example from Scott’s article:

In a single visit, a VA doctor put [Iraq veteran John] Keith on Seroquel and the antidepressants Trazodone and Zoloft, all of which come with suicide warnings. He woke from a blackout to learn he had temporarily lost his mind. “I called my doctor up and said, ‘I just threw my friend’s furniture off a third-story balcony.’ She said, ‘Well, just cut the new pills in half.’”

We shouldn’t be surprised, says Scott, that military doctors are overprescribing these drugs.

Doctors do not practice in a vacuum; they are fed a consistent stream of misinformation from the drug companies promoting these medicines. As [British psychiatrist Dr. David] Healy argues in his book “Pharmageddon,” physicians learn about drugs through a closed, proprietary clinical-trial system in which manufacturers fund, design, manipulate, and own the vast majority of drug trials — trials they can alternately choose to hide or promote as they wish.

Dr. Robert Rosenheck, who has worked extensively with the Department of Veterans Affairs, describes off-label use in the VA as “quite high.” “The rules around truth-in-marketing have allowed drug companies to publish scientific articles saying various thins,” he says. “They can hand out articles that encourage doctors to believe things the FDA does not approve.”

The DOD could fix the problem by banning off-label prescribing, but it won’t. “Off-label use of psychotropic medications is common, legal, and within the standard of care,” says Capt. Michael Colston, M.D., in an email. The Institute of Medicine, a branch of the National Academy of Sciences, which advises the federal government, sees it differently. “If airline travel were like health care,” its panel wrote, “each pilot would be free to design his or her own preflight safety check, or not to perform one at all.”

Unfortunately, Scott’s article isn’t available online. You’ll have to find it on the newsstands or in your local library.

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Comments (1)

  1. Anonymous Submitted by Anonymous on 12/04/2012 - 08:51 am.

    Healy, in particular, has suggested something like a 20 year cycle for psychiatric drugs:

    For the first few years articles begin to appear touting a new miracle drug; prescribing begins, then intensifies. After about 10 years problems that were known to drug companies but suppressed begin to pop up. After 15 years these problems become better known, but drug companies still deny them, and prescribing continues. At 20 years the problems become too prevalent to ignore. At that time the drug is probably off patent, and miracle! a new drug has been “invented” to replace the now discredited drug, which is abandoned in favor of the new drug.

    Wash, rinse, repeat.

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