The military's policy for supplying combat troops with psychotropic drugs is damaging the force, critics say.
After surviving two tours in Iraq, 21-year-old Marine Cpl. Chad Oligschlaeger, early in 2008 sought help from his command for post-traumatic stress disorder, only to die alone in his barracks room five months later after overdosing on prescription drugs.
According to his father, Eric Oligschlaeger, who lives in Austin, Texas, Chad had participated in some of the worst fighting in Iraq during his first tour in the city of Ramadi, some 70 miles north of Baghdad. He says his son also grieved over the loss of his platoon leader and mentor, 2nd Lt. Almar "Fitz" Fitzgerald in the Ramadi battle. Many doctors today view exposure therapy-in which veterans relive the horrors of combat in face-to-face sessions with a trained therapist-as the best way to treat PTSD. But Oligschlaeger says the Navy clinicians at the Marine base in Twentynine Palms, Calif., treated Chad with a combination of powerful psychotropic drugs, including Seroquel, developed to treat schizophrenia, bi-polar disorders, mania and depression.
"They just piled on the meds," Eric Oligschlaeger says. He knew the drugs were not working because Chad told him about conversations he would have with an imaginary Fitz seated at the foot of his bed after waking up from a drugged sleep. According to Oligschlaeger, Seroquel made Chad dizzy and so forgetful he could not even remember whether he had taken his pills.
In April 2008, the Marines sent Chad to the Navy's first residential PTSD treatment program at Naval Base Point Loma in California, providing him some hope that he at least could talk about the combat experiences that had bedeviled him, his father says. But when Chad tried to relate his experiences at a group therapy session, the counselor cut Chad off, saying, "We only do that on Wednesdays. You will have to wait," according to his mother, Julie, who lives in Houston.
Chad's mother says at that point he gave up on the program and returned to Twentynine Palms in early May. He was last seen alive on Saturday, May 17. After a worried call from a friend, the Marines conducted a "welfare check" and found Chad dead in his barracks room on May 20, Julie says. An autopsy showed the young corporal died of multiple drug toxicity, viewed by both his parents as a direct result of the wrong approach to treating PTSD. His mother says reports she has received from the Naval Criminal Investigative Service show the prescription drugs recovered from Chad's room included three bottles of Seroquel in doses of 25 and 50 milligrams and a bottle of 1-milligram tablets of Clonazepam, a powerful benzodiazepine antidepressant and anti-anxiety drug. Julie says Chad also had been prescribed 50-milligram doses of Zoloft, another antidepressant; Lorazepam, an anti-anxiety medication, in a 1-milligram dose; 40-milligram doses of Inderal, a high blood pressure drug; and two prescriptions for Chantix, a smoking cessation drug, in doses of 1 and 5 milligrams.
Eric Oligschlaeger says he views this list of prescriptions as tantamount to drug abuse in the military, pointing out that abuse is a risk regardless of whether the narcotics are dispensed by people in white coats, or bought on the street. Zeroing in on Seroquel, he says there is no protocol for using the drug to treat PTSD.
Stan White, a retired high school teacher who lives in the small town of Cross Lanes, W.Va., blamed high doses of Seroquel for the death of his son, Andrew, also a Marine, who died in his sleep on Feb. 12, 2008. When Andrew returned from a tour in Iraq with the Marine Reserve 4th Combat Engineer Battalion in 2007, he was diagnosed with PTSD. He was prescribed three psychotropic drugs, including Seroquel, by the Huntington Veterans Affairs Medical Center, White says.
VA doctors started Andrew on 25 milligrams of Seroquel a day and upped the dose to 1,600 milligrams a day to help him sleep, White says. He says Andrew was so befuddled by his drug cocktail-which included Klonopin, a benzodiazepine, and hydrocodone, an opiate-that his wife, Shirley, had to dole them out to her son. White says Seroquel did not diminish Andrew's nightmares even at such a high dosage. In April 2010, about three weeks before Chad Oligschlaeger's death after a prescription drug overdose, AstraZeneca, the manufacturer of Seroquel, reached a $520 million settlement with the Justice Department for selling Seroquel to treat "off label" conditions such as PTSD and sleep problems.
Despite this action and the experience of the Oligschlaeger and White families, U.S. Central Command continues to prescribe Seroquel as a sleep aid through a policy that allows troops a 90- or 180-day supply of 126 psychotropic drugs before they deploy to combat.
The CENTCOM central nervous system drug formulary includes highly addictive medications like Valium and Xanax, used to treat anxiety and depression, as well as Seroquel.
Although CENTCOM policy does not permit the use of Seroquel to treat deploying troops with the conditions for which it was originally developed, it does allow its use as a sleep aid. And it allows deployed troops to be provided with a 180-day supply, even though the drug has been implicated in the deaths of Oligschlaeger and White.
The Army endorsed Seroquel as a sleep aid in the May 2010 report of its Pain Management Task Force, which, among other things, called for a reduction in the number of prescription drugs given to troops. An appendix to that report recommended Seroquel dosages of 25 or 50 milligrams for sleep disorders.
A June 2010 internal report from the Defense Department's Pharmacoeconomic Center at Fort Sam Houston in San Antonio showed that 213,972, or 20 percent of the 1.1 million active-duty troops surveyed, were taking some form of psychotropic drug: antidepressants, antipsychotics, sedative hypnotics or other controlled substances.
Dr. Grace Jackson, a former Navy psychiatrist, says she resigned her commission in 2002 "out of conscience, because I did not want to be a pill pusher."
Jackson believes psychotropic drugs have so many inherent dangers that "the CENTCOM CNS formulary is destroying the force," she says.
Dr. Gregory Smith, who runs the Los Angeles-based Comprehensive Pain Relief Group, which treats chronic pain and prescription drug abuse through an integrative medical approach called the Nutrition, Emotional/Psychological, Social/Financial and Physical program, says he is shocked by CENTCOM's drug policy for deployed troops. "If I was a commander I'd worry about what these troops would do," as a result of their medications, he says.
Dr. Peter Breggin, an Ithaca, N.Y., psychiatrist who testified before a House Veterans Affairs Committee in September 2010 on the relationship between medication and veterans' suicides, said flatly, "You should not send troops into combat on psychotropic drugs." Medications on the CENTCOM CNS formulary can cause loss of judgment and self-control and could result in increased violence and suicidal impulses, Breggin said.
The Army implicated prescription drugs as contributing to suicides in a July 2010 report, which said one-third of all active-duty military suicides involved prescription drugs. When the suicide report was released, Gen. Peter Chiarelli, the Army's vice chief of staff, said the service needed to develop better controls for prescription drugs. "Let's make sure when we prescribe that we put an end date on that prescription, so it doesn't remain an open-ended opportunity for somebody to be abusing drugs," he said.
But when it comes to the CENTCOM CNS formulary-which for some drugs allows a 180-day supply when troops deploy, followed by a 180-day refill in theater, according to an October 2010 update to the psychotropic drug policy-neither the Army nor CENTCOM sees a need for change.
In an e-mailed statement to Government Executive, Col. John Stasinos, chief of addiction medicine for the Army surgeon general, and Col. Carol Labadie, pharmacy program manager in the Directorate of Health Policy and Services for the surgeon general, said soldiers are supplied with these amounts of medications because they "serve in remote areas without easy access to pharmacies. It is important that soldiers on chronic medications do not run out of them during combat operations, because not taking the medications can be as dangerous as taking too much medication."
Abuse of prescription drugs, Stasinos and Labadie noted, can be prevented by improving communication among health care providers, soldiers and commanders.
Comprehensive reviews of soldiers' medication profiles by pharmacists are another way to ward off abuse, they said.
The statement from Stasinos and Labadie added that it is possible that troops could receive a 180-day supply of more than one psychotropic medication. Navy Lt. Cmdr. William Speaks, a CENTCOM spokesman, echoes comments from the Army. He says the drug-supply policy for deployed troops was "established to ensure personnel who required these medications had an adequate supply before deployment to last through pre-deployment activities and training, as well as travel to theater and initial deployment phase."
He adds, "Some of these medications can cause duty-limiting side effects if they are withdrawn abruptly [i.e. if the individual runs out]. This policy prevents that from occurring."
Suicide and Drug Abuse
The Army's suicide report drew a link between a significant increase in prescription drug use among troops and the service's rising suicide rate. It also raised concerns about troops trafficking in prescription drugs.
Jackson, the former Navy psychiatrist, now has a civilian practice in Greensboro, N.C. She says at least one drug on the CENTCOM formulary-Depakote, an anticonvulsant that military doctors prescribe for mood control-carries serious physical risks for troops. Depakote is toxic to certain cells, including hair cells in the ears, and can lead to hearing loss. Troops in a howitzer battery who already run the risk of hearing loss should not take Depakote, she says.
The medication also can cause what she calls "cognitive toxicity," also known as Depakote dementia, impairing a person's ability to think and make decisions. Jackson says while Depakote has been investigated as an adjunct therapy for cancer, its use has been limited due to the drug's effects on cognition.
The antidepressant Wellbutrin, also on the CENTCOM formulary, likely poses a long-term risk of Parkinson's disease, especially for older troops, says Jackson, who also is author of Drug-Induced Dementia: A Perfect Crime (AuthorHouse, 2009).
Jackson and Breggin both express deep concerns about Xanax, perhaps the most addictive of all benzodiaze-pines, on the CENTCOM formulary. Benzodiazepines are class of depressant medications used to treat anxiety.
Breggin, author of Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime (St. Martin's Griffin, 2009), calls Xanax "solid alcohol" and says all the benzodia-zepines on the CENTCOM formulary "amount to a prescription for abuse." He also says there is no rationale for prescribing multiple psychotropic drugs to troops.
Smith of the L.A. pain relief center says he is "flabbergasted" that military doctors prescribe Seroquel as a sleep aid, noting the Food and Drug Administration has not approved it for such a use and other drugs are more effective. Jackson notes Seroquel has the addictive potential of opioids such as heroin.
CENTCOM's allowance of Seroquel as a sleep aid also seems to fly in the face of a high-level Defense policy set in November 2006. In a memo titled "Policy Guidance for Deployment Limiting Psychiatric Conditions and Medications," William Winkenwerder Jr., then assistant secretary of Defense for health affairs, said psychotropic medications that would prohibit troops from deployment included those used to treat chronic insomnia.
Asked if prescribing Seroquel to aid sleep violated this policy, Stasinos and Labadie said in an e-mail, "Seroquel is not prescribed for chronic insomnia. Lower doses have been used to aid soldiers with troubled sleep for anxiety-related nightmares." They added while other sleep medications are on the CENTCOM formulary, none appears to relieve nightmares as effectively as Seroquel.
Laura Woodin, a spokeswoman for the U.S. division of London-based AstraZeneca, which makes Seroquel, says the drug is not approved by FDA as a sleep aid or to treat post-traumatic stress disorder. But, she adds, mental health professionals often prescribe it to treat conditions not approved by FDA. "Like patients, we trust doctors to use their medical judgment to determine when it is appropriate to prescribe medications," Woodin says.
Julie Oligschlaeger says troops suffering from PTSD need "talking therapy" sessions, ideally conducted with troops who share similar experiences, and has started a foundation in Houston in memory of her son, Chad, to support peer-to-peer counseling.
Stan White says his mission in life now is to expose the dangers of Seroquel. The drug, he notes, "turns people unto zombies. I cannot imagine going into battle on Seroquel." CENTCOM, White said, needs to reassess its policy on prescribing Seroquel based on his experience with Andrew: "Why would you send someone into combat armed with an automatic weapon who is on Seroquel?"