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Are Prescription Drugs Behind Troop Suicides?

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Why are troops killing themselves?

The long awaited Army report, "Health Promotion, Risk Reduction, Suicide Prevention" considers the economy, the stress of nine years of war, family dislocations, repeated moves, repeated deployments, troops' risk-taking personalities, waived entrance standards and many aspects of Army culture.

What it barely considers are the suicide-inked antidepressants, antipsychotics and antiseizure drugs whose use exactly parallels the increase in US troop suicides since 2005.

antidepressants

In the report Chief of Staff General Peter W. Chiarelli acknowledges antidepressant risks, saying there's "fair quality evidence that second generation antidepressants (mostly SSRI) increase suicidal behavior in adults aged 18 to 29 years" while adding that "other research evidence shows the benefit of antidepressant use."

But nowhere does he acknowledge the suicide potential of antiseizure drugs so widely used for pain and as "mood stabilizers" by troops even though the FDA mandated suicide warnings on Lyrica, Topamaz, Depakote, Lamictal, Tegretol, Depakene, Klonopin and 16 others in 2008.

(Lamictal also has the distinction of wasting more taxpayer money than any other drug according to a July American Enterprise Institute report. Medicaid spent an unnecessary $51 million on Lamictal instead of buying a generic last year, thanks to GSK salesmen.)

When asked by NPR's Robert Siegel if the high number of medicated troops contributed to suicide, Gen. Chiarelli said, "The good thing about those numbers is...the prescriptions were all made by a doctor." Asked why troops who had not even deployed were among the suicides, Chiarelli said there were other stressors involved.

In June Marine Times reported 32 deaths on prescription drugs in Warrior Transition Units (WTUs) since 2007 and said an internal review "found the biggest risk factor may be putting a soldier on numerous drugs simultaneously, a practice known as polypharmacy."

But instead of citing dangerous drugs and drug cocktails for turning troops suicidal (and accident prone and at risk of death from unsafe combinations) the Army report cites troops' illicit use of them along with street drugs. (The word "illicit" appears 150 times in the Army report and "psychiatrist" appears twice.)

No, it's not the 8,000 urine samples in 2009 which showed prescription drug traces according to the Army report - it's the fact that 21 percent of the drugs were "illicit."

No wonder the revised suicide report form suggested by the Army report doesn't even have a box to enter "adverse reactions to drug or drug combinations." Instead, it has a box that asks how long before a suicide a patient was "compliant" with the prescription. Was the medication "taken as prescribed? Skipped?" Taken "In excess of prescription? In different manner (e.g., crushed instead of in capsule)?"

Nowhere is there the possibility that the medication was taken as prescribed and compliance not noncompliance was the problem.

On the same day the Army report was released, another suicide report which ignores the elephant in the room called Big Pharma was released.

In response to a request from the Illinois Department of Juvenile Justice for help after the recent suicides of two youths in two of its eight WTU-like facilities, the Illinois Models for Change initiative compiled a "Report on the Behavioral Health Program for Youth Committed to Illinois Department of Juvenile Justice."

Like the Army report, the Juvenile Justice report notes lack of staff training and resources, lack of assessment tools, lack of aftercare, family problems and repeated moves and dislocations to explain suicides without mentioning suicide-causing psychoactive drugs themselves.

The team of mental health and corrections professionals mentions youths who fail to "follow the medication orders" and revert to street drugs but nowhere in the 146-page report are the health and mental health effects of psychoactive drugs mentioned. Even though 98 percent of youth at one facility are on them, according to the report! Denial is not just the name of a river in Egypt.

Worse youth are screened for suicide when they enter facilities not after they're put on psychoactive drugs.

The report explores poor food and dorms with no electric sockets so youth "cannot have TVs in their rooms and only walkmans" and visitor policies, but doesn't pursue the one reference to psychoactive drugs: the youth who says he is pretty much "knocked out" on the antidepressant Trazadone they give him.

Like the Army report, the Juvenile Justice report ignores the pharmaceutical elephant in the room and the tax dollars and human costs of feeding it.

Martha Rosenberg is a columnist and cartoonist, who writes about public health.

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