VA uses tranquilizers on over 30 percent of veterans with PTSD despite clinical warnings against their use
by: J. D. Heyes
Doctors and medical professionals at the Veterans Affairs are handing out dangerous tranquilizers such as Xanax and Valium to military service members diagnosed with Post Traumatic Stress Disorder though they have been repeatedly advised not to do so because of the potential the drugs could cause more harm than good.
According to a report in NextGov.com, the VA is prescribing tranquilizers to more than 30 percent of veterans with PTSD, though clinical practice guidelines issued in 2010 by the VA's National Center for PTSD, among others, has warned against it.
Under the guidelines, which also apply to the Department of Defense, warned providers against using benzodiazepine to manage the condition because of "the lack of efficacy data and growing evidence for the potential risk of harm," the center said in the March edition of quarterly research publication.
Let's addict them, then take the pills away and see what happens
Data indicate that treatment of PTSD with benzodiazepine drugs "may interfere with the extinction of fear conditioning or potentiate the acquisition of fear responses, actually worsening recovery from trauma," the center said. That, in turn, could interfere with "first-line" treatment like exposure therapy, in which trained personnel help veterans relive traumatic events so they can learn to effectively handle them.
The center noted that more than half of all combat vets diagnosed with PTSD also suffer from substance abuse and alcoholism, adding that treatment with benzodiazepine can very often lead to addiction.
Military figures indicate the number of vets with PTSD that are being treated by the VA nearly tripled from 171,000 in 1999 to 498,000 a decade later, as troops who served in Iraq and Afghanistan entered the VA's oft-marginal healthcare system. Meanwhile, at the same time, benzodiazepine prescriptions for vets who have been diagnosed with PTSD fell from 37 percent in 1999 to 30 percent 10 years later, as the VA began using SSRIs - selective serotonin re-uptake inhibitors - such as Zoloft and Paxil to treat the condition.
Despite the reduction, the VA told NextGov.com last summer that it had bought $72 million worth of benzodiazepine from Oct. 1, 2001, through March 31, 2012.
At that, the PTSD center advised the VA to continue cutting back use of benzodiazepine for PTDS treatment.
"The decrease in benzodiazepine prescribing to 30 percent is encouraging yet the frequency of use remains high and suggests that minimizing benzodiazepine exposure is a vital policy issue for the VA," the report said.
Current warning matches earlier ones
The report's advice matches that of the Army surgeon general, who issued a policy last April warning regional medical commanders to refrain from using benzodiazepines to treat PTSD.
"The Army determined, like VA this month, that treatment of PTSD with benzodiazepines could intensify rather than reduce combat stress symptoms and lead to addiction," NextGov.com reported.
Others have also issued similar warnings, some more strongly.
In September 2011, for instance, the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury strongly urged against benzodiazepine, emphasizing in bold-face type on its website: "There is evidence against the use of benzodiazepines in PTSD management as it may cause HARM. Strongly recommend against the use of benzodiazepines for treatment of PTSD."
The PTSD center ended its report on benzodiazepine by advising the VA to find alternatives for PTSD treatment, adding that "mounting evidence suggests that the long-term harms imposed by benzodiazepine use outweigh any short-term symptomatic benefits in patients with PTSD."
Just say 'no'
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