Thursday, January 22, 2009

Army's drug abuse policy under fire

January 22, 2009

Army's drug abuse policy under fire

Critics say system is likely to punish troops rather than help them.

Alan Scher Zagier, The Associated Press

Fort Leonard Wood -- Spec. Jeremiah Thomson didn't know what was worse: excruciating back pain from a combat explosion in Baghdad or the prescription drug addiction he developed once home.

The Army was quick to prescribe Percocet, Vicodin, Oxycontin and similarly powerful painkillers to Thomson and other injured soldiers at Fort Leonard Wood, Thomson testified in a court-martial hearing. He's now serving a three-year sentence for illegally buying prescription drugs -- the sellers included a former commanding officer in Iraq -- and selling the pills to eight other soldiers.

As more troops return home with war injuries, the Army is prescribing more pain medication . But a military system that relies on discipline as well as treatment is drawing fire from some prominent critics, including those inside the system.

"It's a terrible problem," said Barbara McDonald, a civilian social worker and Army drug abuse counselor, describing a recent surge in prescription drug abuse and the Army's handling of the problem.

Legal painkiller use by injured troops has increased nearly 70 percent since the start of the Iraq war six years ago, according to Army records. Surveys show that more soldiers are struggling with prescription drug addiction -- and seeking help from Army doctors and counselors.

Thomson is among seven soldiers convicted by court martial in 2008 of illegal drug use or distribution who served in the installation's 5th Engineer Battalion. An additional five await trial on similar charges. A dozen have been kicked out of the Army, and two others went AWOL after being implicated .

Dr. Les McFarling, who heads the Army's substance abuse treatment program, acknowledges the increased potential for abuse.

"You can put soldiers at risk when you're managing their pain," he said.

But McDonald and other critics call the military's approach a broken system, as likely to punish or denigrate troops as to treat their addictions.

The criminal cases in Missouri, coupled with allegations of misconduct and staffing shortages in the Army Substance Abuse Program levied by McDonald and another whistleblower, caught the attention of Sen. Claire McCaskill, D-Mo. She has asked Secretary of the Army Pete Geren to investigate.

"Clearly, at Fort Leonard Wood and potentially across the military, they have not prioritized this as a health issue," McCaskill said. "The culture has traditionally looked at this as a discipline issue."

Under the Uniform Code of Military Justice, such punishments can include reductions in rank and pay, imprisonment and discharges from military service for bad conduct.

The Army says those disciplined in the Fort Leonard Wood investigation committed criminal misconduct by selling or illegally possessing drugs, as opposed to those who become dependent on narcotics prescribed for legitimate injuries.

"A soldier who steps forward is someone who should be admired, not as someone with a black mark next to their name," McCaskill said.

In a Dec. 22 response to McCaskill's inquiry, Geren indicated the Army will consider abolishing its policy that a commanding officer be notified when a soldier comes forward voluntarily for ASAP counseling.

Still, officials at Fort Leonard Wood and the Pentagon defend their approach, even as they acknowledge staffing shortages that have left ASAP nationwide nearly 90 counselors short of required employment levels. Staffing levels at the Missouri post are now above the required minimums, the Army says.

McDonald disputes that, saying at least one recently hired counselor for Fort Leonard Wood's ASAP unit lacks required mental health certification.

Army statistics provided to The Associated Press show that the number of soldiers enrolled in ASAP at Fort Leonard Wood at the end of 2008 was the highest since the start of the Iraq war six years ago.

McCaskill's office learned of the problems at Fort Leonard Wood from former ASAP counselor John Speckhals, a Vietnam veteran and former Veterans Affairs social worker now stationed in Germany. Speckhals declined an AP request for an interview.

An inquiry by the senator's office said as many as 180 cases referred to the base's ASAP unit were misclassified in what McCaskill suggested in a Nov. 12 letter to Geren were "deliberate clinical findings that soldiers who were dependent on alcohol or drugs were not dependent in order to keep the caseload down for an overwhelmed staff."

"There was an effort to give a cosmetic fix to a problem that was systemic," McCaskill said .

In his letter to McCaskill, Geren said a review of those cases and 17 others showed some record-keeping errors, but no evidence that cases were deliberately mislabeled.

McDonald, whose son is a soldier, spent 20 years as a civilian substance abuse counselor before joining the Army's fight against drug and alcohol abuse one year ago. She has filed a workplace complaint against her supervisor and faces disciplinary action she says stems from her criticisms. Army officials have not commented.

McDonald claims that some Army doctors and counselors point to drug dependency as a sign of weakness. Since McDonald's complaints surfaced, she is no longer allowed to see patients.

Lori Mullins of Idaho Falls, Idaho, said her 18-year-old daughter, Destiny, was told McDonald had quit and that McDonald was told Destiny Mullins no longer wanted treatment.

"They told (Destiny) she didn't belong in the military, that she was a shame to the uniform," the elder Mullins said. "Instead of being protected by the Army, they're blaming her for it."

Destiny Mullins received an honorable discharge in November.

Chuck Ashbrook, who oversees ASAP prevention and education efforts at Leonard Wood, maintained that counselors pay close attention to links between substance abuse, post-traumatic stress disorder and combat injuries.

He said that, thanks to medical advances, soldiers who might have returned from previous conflicts as casualties are instead surviving with injuries that may require stronger pain management.

However, Ashbrook also noted historical increases in drug dependency among soldiers during wartime.

"We've always seen these kind of problems," he said. "This is not unique."

Additional Facts
The issue at a glance
Wounded troops: Legal painkiller use by injured troops has increased nearly 70 percent since the start of the Iraq War, the Army says. As more soldiers seek help with prescription drug addiction, the Army is struggling to hire enough drug counselors to meet the increased demand.
Black market: An investigation at Fort Leonard Wood revealed a group of soldiers who illegally bought and sold Percocet, Oxycontin, Vicodin and other powerful painkillers. The investigation ensnared more than two dozen soldiers.
Congressional inquiry: A whistleblower who worked in the Army Substance Abuse Program took his concerns to Sen. Claire McCaskill, a Missouri Democrat. She has asked Army Secretary Pete Geren to investigate.
-- The Associated Press

Army's drug abuse policy under fire

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