Editor's note: This story was produced by The Center for Investigative Reporting.
A new study claims that since the 9/11 terrorist attacks, the U.S. Department of Veterans Affairs, charged with helping veterans recover from war, instead masks their pain with potent drugs, feeding addictions and contributing to a fatal overdose rate among VA patients that is nearly double the national average.
Prescriptions for four opiates – hydrocodone, oxycodone, methadone and morphine – have surged by 270 percent in the past 12 years, according to data that the Center for Investigative Reporting obtained through the Freedom of Information Act.
CIR's analysis for the first time exposes the full scope of that increase, which far outpaced the growth in VA patients and varied dramatically across the nation.
The data shows the agency has issued more than one opiate prescription per patient, on average, for the past two years. In interviews, advocates and experts said the skyrocketing prescription rate confirmed their worst fears: that the agency is overmedicating its patients as it struggles to keep up with their need for more complex treatment, CIR reports.
"Giving a prescription, which they know how to do and are trained to do, is almost a default," said Dr. Stephen Xenakis, a psychiatrist and retired brigadier general who served as commanding general of the Army's Southeast Regional Medical Command.
The problem, Xenakis said, is that opiates hurt more veterans than they help.
Senior VA officials declined to be interviewed by CIR about the prescription epidemic. Instead, the agency produced a written statement saying it was engaged "in multiple, ongoing efforts to address prescription drug abuse among veterans seen in our health care system."
The agency long has been aware of the problem. In 2009, new VA regulations required clinicians to follow an "integrated approach" to helping veterans in pain, including a stronger focus on treating the root causes of pain rather than using powerful narcotics to reduce symptoms.
But despite the regulations, VA doctors are prescribing more opiates than ever and the data suggests that adoption of the regulations varies wildly.
Wave of Opiates in Oklahoma
No VA hospital system has prescribed more opiates per patient since 9/11 than the Jack C. Montgomery VA Medical Center in Muskogee. Over the past decade, the hospital and its clinic in Tulsa issued 1.6 opiate prescriptions per patient.
The results can be seen in Tulsa's jail and in its criminal courthouse, which has called a special docket for veteran offenders every Monday since December 2008.
Observers say geography is a contributing factor. The VA hospital in Muskogee is an hour's drive from the region's main population center in Tulsa. And the VA's single-story clinic in Tulsa has no emergency room or urgent care ward and rarely makes same-day appointments.
Veterans who need treatment for the root causes of pain often wait months, said Craig Prosser, who coordinates the court's mentor program.
"If I have to wait 30 days, 45, all the way up to 90 days to be able to get seen by my doctor, I'm probably going to go out and try to find something to deal with the pain prior to," Prosser said.
The region's opiate prescription rate has dropped slightly in the past year, and Prosser credits a new director of the Muskogee VA for expanding services. The VA would not allow the hospital director, James R. Floyd, to be interviewed.
A Day in Treatment Court
It's 100 degrees and humid outside as dozens of veterans file into the first-floor courtroom of Judge Rebecca Nightingale, who presides over Tulsa's Veterans Treatment Court. Prosser greets each of them individually and goes over their treatment, slapping them on the back and occasionally giving one a hug.
"They don't know who they are anymore; they lost their self-identity," said Prosser, who served two tours in Iraq with the Army's 101st Airborne Division. "What I want to do is help them find that, help to find their … true north, as we say in the infantry."
On this August afternoon, they range from elderly Vietnam veterans who've pleaded guilty to possession of methamphetamines to an Iraq War veteran who beat his girlfriend so brutally that her eyes swelled shut.
John Cloud, a Vietnam veteran who is the American Legion's liaison to the court, describes a troubling pattern among Iraq and Afghanistan veterans arrested in Tulsa. It starts in the military, after injuries from an explosion or enemy fire leads to a prescription for Vicodin or oxycodone, he said, and then continues at the VA.
Eventually, Cloud said, the veteran builds up a tolerance. The VA's prescriptions are not enough, so "they'll go to the streets and buy the drugs, turn to alcohol" and cheat and steal to get money to feed their habit.
A bearded man in a denim jacket drags his right leg as he approaches the judge. Chance Oswalt has been struggling with painkiller addiction since 2007, when the Army prescribed Percocet after he was wounded in Baghdad.
Last Christmas Eve, police found Oswalt passed out in Room 906 at the Marriott Tulsa Hotel Southern Hills, surrounded by syringes, spoons and other drug paraphernalia, with a black rock of heroin on the nightstand.
Since the arrest, Oswalt hasn't tested positive for heroin while participating in the VA's court-mandated pain management program. But he has continued to doctor-shop, driving 100 miles to a private physician near the Arkansas border for oxycodone.
During the hearing, the judge remains relentlessly upbeat, telling veterans they have the power to stay clean. Nightingale reassures them that they are not to blame for their addictions. She tells Oswalt: "You wouldn't have chosen to take all those medications," and he agrees.
"It was just a last resort," he said. Now, "I'm trying to make the program work for me and see if I can get better."
Officials in Tulsa take pride in their program – more than 90 percent of veterans who enter the treatment court graduate. Very few have re-offended.
But Nightingale knows the stark facts: For every veteran who graduates, another enters the criminal justice system.
The most difficult thing about breaking the cycle of veterans' painkiller addiction, she said, is that most are hooked on a legal drug. Even when they supplement their prescriptions with pills or other drugs bought on the street, psychologically, they find it "easy to fall back on, ‘Oh, my doctor said it's OK.' "