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U.S. Troops: More Deaths Related to Prescription Drugs

October 2010

Sidney M. Wolfe, M.D.

Last month in Health Letter we wrote about a military study finding that in U.S. troops, the increased use of suicide-linked antidepressants, antipsychotics and anti-seizure drugs exactly parallels the increase in troop suicides since 2005. Commenting on 32 deaths on prescription drugs in military Warrior Transition Units since 2007, an internal review found “the biggest risk factor may be putting a soldier on numerous drugs simultaneously, a practice known as polypharmacy.”

In August, Matt Perrone of The Associated Press published an article based on his investigation into another military drug prescribing problem that may also have resulted in deaths of soldiers. These deaths were not from suicides but were associated with life-threatening interactions between the antipsychotic drug Seroquel and other drugs.

Perrone wrote that “thousands of soldiers suffering from post-traumatic stress disorder (PTSD) have received the same medication [Seroquel] over the last nine years, helping to make Seroquel one of the Veteran Affairs Department’s top drug expenditures and the No. 5 best-selling drug in the nation.”

The article examined the case of a young Marine, Andrew White, who returned from a nine-month tour in Iraq with several PTSD-related problems including insomnia, nightmares and constant restlessness. Doctors tried to treat his symptoms using three psychiatric drugs, including Seroquel, a tranquilizer and a pain medication.

Because the nightmares persisted, according to Perrone’s investigation, “doctors recommended progressively larger doses of Seroquel. At one point, the 23-year-old corporal was prescribed more than 1,600 milligrams per day — more than double the maximum dose recommended for schizophrenia patients. A short time later, White died in his sleep.”

A Veterans Affairs investigation concluded that White died from a rare drug interaction involving Seroquel and other drugs he was taking, but that he had received the “standard of care” for his condition.

The article stated that “it is unclear how many soldiers have died while taking Seroquel, or if the drug definitely contributed to the deaths. White’s father has confirmed at least half-dozen deaths among soldiers on Seroquel, and he believes there may be many others.”

The drug-related military suicides previously discussed and this case are similar in that polypharmacy — the use of multiple drugs with greatly increased chances of drug interactions — may well be the culprit. As should be the case for all physicians, doctors in the military need to pay more attention to their prescribing practices. Maybe the standard of care is not high enough.

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