Is Overprescription Fueling Veteran Suicides? | Derek Blumke

Veterans are not being told the risks of their medications, and the reason I believe that they're most commonly not being told is because the doctors themselves are not aware of the risks of those medications. Derek Blumke served 12 years in the U.S. Air Force and Michigan Air National Guard and is a long-time advocate for veterans. A bad experience with psychiatric drugs changed his life trajectory. The more people you put into this machine under our current prescribing and care paradigm, the more cold bodies are going to be coming out of the back end. He's been sounding the alarm about suicide and the over-prescription of psychiatric drugs among veterans. I think where we're at today is that there is a huge point of hope because we have leaders in government that care about this problem. This is American Thought Leaders, and I'm Jan Jekielek. Derek Blumke, such a pleasure to have you on American Thought Leaders. Great to be with you, Jan. Thank you so much for the invitation. Until last year, the U.S. Department of Veterans Affairs, colloquially known as the VA, had never mentioned psychiatric drugs in their annual suicide report, which is something that's mandated in an important report that comes out every year. You highlighted this to me as an incredibly important point. Why is this so unusual? This is unusual because approximately 70% of all veterans under VA care are prescribed a psychiatric drug. Almost 30% are on antidepressants. Almost all of these drugs have box warnings, a warning of suicidal thoughts and behaviors. When you have a treatment modality being used for 70% of your population, and you're not even mentioning these medications that your primary modality of treatment, almost all of which have risk profiles of suicidal thoughts and behaviors, this is alarming. In this last report, the first ever mention of any psychiatric medication whatsoever was where they referenced sedative use disorder, which is primarily connected to those have been prescribed benzodiazepines, and the VA for the past 10 to 15 years has been actively deprescribing veterans from benzodiazepines because they know they're contraindicated for veterans diagnosed with post-traumatic stress disorder. In 2012, approximately 30% of all veterans under the VA care who had been diagnosed with post-traumatic stress had been prescribed benzodiazepines, Xanax, Valium, drugs of these types, and they learned that these drugs were causing harm. During this entire period, they've been deprescribing veterans from these medications now to a prescription rate for vets with PTSD under, I believe, 8%. As you're deprescribing veterans from these medications, you're at increased suicide risk because these drugs, when you're coming off of them, can be very dangerous, benzodiazepines, antidepressants, and other drugs. Let me jump in here, a whole bunch of things. So I'm hearing that the VA is responsive when it sees problems, that that happens. That's great to hear. But wait a sec, 70% of veterans being treated by the VA are on antidepressants. Sorry, not antidepressants, but some sort of psychiatric medication. Correct. That seems to me to be a very significant statistic. These prescription rates are about four times that of the civilian population. And so when you have suicide rates that high of what we're seeing with veterans, suicide rates almost two and a half times or more that of the civilian population. You've got prescription rates four times that of the civilian population. You have medications that we've got multiple studies showing that suicide risk goes up by three and a half times, three times, two and a half times of suicide compared to placebo. Suicide attempt rates going up two and a half, three and a half times while on these medications compared to placebo or non-treatment. This is a math problem that we're looking at. And this is pretty much the only way you can really look at this problem at this point. A math problem. Explain that to me because it feels to me like something much bigger than a math problem. It's a math problem in that the problem is that we're not doing enough outreach. We spent $16, $17 billion in VA mental health in the past six years alone, I believe. And so we're putting piles of money towards this problem. And the primary effort has been trying to get veterans into care. The problem lies when you start having your sole treatment modality of medication. So I worked at the VA. I built a national mental health program for the VA in 2011 to 12, 13. And I learned the way we do mental health, which is you do outreach, you screen the veteran. If they have some type of mental health issue, whether it's depression or anxiety or post-traumatic stress, first diagnose. Then prescribe a medication to get the acute crisis under control so that way the patient can accept therapy or the treatment. And it's at that point where we're putting this risk profile. This is where we're causing problems. There's a research out of Austria that shows there's about a .08% suicide risk during antidepressant starts. So like the first six weeks you're on an antidepressant. And this is not just for veterans, this is for everyone. And so if you've got a .08 suicide risk during that first six weeks and then you look at the number of veterans in the VA prescribed antidepressants. So 1.75 million or so annually are prescribed antidepressants. Not all of those are started on that medication in that year. But say 150,000 it might be. You just multiply that out by that .08% suicide rate and you have about 120 dead veterans of the VA's 22, 2300, 2400 or so annual suicides that happen while the veterans are under VA care of the 6,000 and change that occur annually. I guess what you're saying is you would hope there would be more care taken in those decisions to prescribe or not prescribe or offer some other kind of therapy given that the cost is at least by your calculations 120 people of the current policies. And that's just antidepressant starts. That's not the tapering, withdrawal, getting somebody off a medication that may have been on it for a year or years. My experience I've been prescribed Zoloft after being given a six drug cocktail for a period of time and I was trapped on Zoloft for a year. I mean I've had a number of people on this show now who explain that there's just generally an over prescription problem when it comes to psychiatric medications in many countries and including the U.S. But you're saying that the VA, it's actually four times greater than the existing what people would call over prescription reality. So in 2019 I published a report with Robert Whitaker, author of Anatomy of an Epidemic, and we looked at the VA and suicides and medications. Screening plus drug treatment equals increase in veteran suicides was the title of this report. And as you start looking at the prescription rates, you start looking at how these medications interact and then you also start looking at the failure to provide informed consent, which is the biggest issue here, which is veterans are not being told the risks of their medications. And the reason I believe that they're most commonly not being told is because the doctors themselves are not aware of the risks of those medications. And so when you start looking at the larger picture of seven in 10 veterans under VA care prescribing these medications, you start realizing, you just start multiplying out suicide risk of these treatments. And that's not even including polypharma, three, four, five, six. My friend Angela Peacock was prescribed 18 different drugs at the same time. There's no one that hears these things that can say that is okay. Well, and of course that these just aren't studied. These various mixes of drugs just aren't, in some cases, not studied at all what the impact might be. There's no studies showing a six drug, seven drug, eight drug cocktail is safe. You will not find a single one. What you will find though, and leadership at the VA Office of Mental Health will tell you that anything more than three medications, psychiatric or CNS or central nervous system drugs at the same time, you'll start seeing diminishing outcomes. And so I'm not sure the confusion, why we're also wondering why these suicide rates continue to increase when you just look at the prescription rates. And if the prescriptions and these medications were working and a treatment modality used for seven and 10 veterans under VA care, you would think you'd actually see diminishing suicide rates. And we're seeing the inverse. Right. Well, listen, at this point, you have an absolutely fascinating story on how you kind of got into becoming kind of a leading advocate around this issue of global prescription, but why don't you tell me that? So I'm an Air Force vet. I did six years in active duty, six years in the International Guard. I did three deployments, my first being right after 9-11. I was deployed to an airbase in southern Uzbekistan called Karshi Khanabad Air Base, or K2. It was an old Russian base. And only in 2019 would we learn that the tactical nuclear weapon had been detonated there. And it was a chemical weapons depot for the Russians as they're using their fighter bombers going into Afghanistan in the 70s and 80s. And so myself and about 15,000 other troops we'd later learn were exposed to all these horrific toxins. Fast forward to 2007, wound up transferring to the University of Michigan. I started a student veterans group on campus because I was looking to connect other veterans in my transition. And this turned out to be a wildly popular idea. And we ended up starting an organization called Student Veterans of America. And I helped to lead efforts in our advocacy to help pass the post 9-11 GI Bill in 2008. During that time, we had a suicide of a student veteran at UC Berkeley. And I felt like a commander that did not have the tools to address this crisis or to help other vets on campuses with this issue. That one death really drove me to start building towards mental health programming. My degree was already in psychology. I'd already had a passion and wanted to work with troops with PTSD. And that was kind of the path that really set me down this road. And so during that time, I got introduced to the head of VA Mental Health, was recruited to build and run a national mental health program for the VA. Around that time, I was also invited to be a founding committee member of the National Action Alliance on Suicide Prevention, which is the group that really wrote the National Strategy for Suicide Prevention in 2012, and then most recently last year. And so I ran that program for about a year and a half, two years. And then moved to New York City, got into technology startups, and then got put on a drug cocktail. I started with Adderall. Well, right. So you're working to help people in this, and then you kind of experience the other side of it, I guess, right? It's been unfortunate and painful for me, as an example. Hunter Whitley is a 23-year-old former Marine. He was at Abbey Gate in Afghanistan during the withdrawal. He'd suffered a minor TBI during the bombing there. Wound up at the University of Alabama. Was a student veteran going to school full-time there, and then was also volunteering at the mental health clinic on campus, a VA mental health clinic on campus. The program that I built was focused on helping veterans on college campuses access VA mental health care. And so Hunter took his own life about two and a half years ago. And the program that I built is basically what became that clinic, which was to help get vets into care. And Hunter was prescribed an antidepressant, mirtazapine, along with hydroxyzine. And a month and a half later, he was dead. And the VA did an investigation into his death and found that they failed to provide informed consent, failed to provide safe medication management. My friend Brian and Kim Brumfield we were with last night, along with Shannon, they lost their son Connor, 22 years old. Both of these young men had fit cleanly within the box warning by the FDA, but in both cases it seems neither had been provided informed consent. Their families had been unaware that they were on a medication that could increase their suicide risk, and both were gone far too young. Thank you for tuning in to American Thought Leaders. In a world where spin and agendas dominate the headlines, I'm proud to bring you unfiltered insights from the brightest minds in America, from a relative outsider Canadian perspective. To keep this possible and to access even more exclusive content, in-depth documentaries, in our daily digital newspaper, consider subscribing to The Epoch Times today. It's your way to support independent journalism. Just hit the link in the description below to subscribe and unlock the full American Thought Leaders experience and so much more. You can try it today for just $1 a week. So just hit the link in the description below. And now back to the interview. And we're back with Derek Blumke, Veteran Impact Fellow of the Grunstein Foundation. You have countered so many of these horrible stories, but you also avoided becoming one yourself. Tell me what happened from the beginning. Yes, I was in New York City. I got behind in some of my class. I was trying to pad my resume to go to Harvard Business School because I believe at that time that if I didn't go to Harvard, my life would be a career, my career would be a failure. I think that's really funny today, especially funny today. And I was starting a technology company at the same time. And so I went to a psychiatrist realizing that, hey, maybe I do have a problem. Maybe this ADHD diagnosis I had as a kid is real. And I went and got prescribed Adderall and not long after prescribed Ambien because I couldn't sleep because of stimulant. Gabapentin for anxiety, two or three other medications. Life is falling apart. Career is falling apart. Company's on fire. A friend packs me up and hauls me back to Michigan and U-Haul. And I spent the next year and a half kind of bouncing around from Airbnb to not so great Airbnbs, hotels, sleeping on friends' couches and floors. That's the story of many vets who struggle or have gone down that path. And so it was during that time I met a friend and they shared that they were going to get their antidepressant increased. And I asked how their counseling was going, which is a common question you'd ask working in mental health. And she shared that she wasn't getting counseling because her insurance didn't cover that. And that was the moment I started realizing, wait a minute, when's the last time I saw a counselor? I started looking back through my time at the VA of almost three years of care at that point. Never once had I had a single counseling session. My care had primarily been just psychiatric drugs. And then I started realizing, wait a minute, how many medications am I on? And then I hit my second hand and I realized, what the hell is going on? And that was the moment that I realized that what we're doing is not working. What I was doing was killing me. What we did with some of these medications, getting them through the market and the over prescribing these drugs nationwide and frankly, across the Western hemisphere is driving what we're seeing today. And it's resulting in tragedies every day. You mentioned something called a black box warning. I think there might be a number of viewers who don't even know what a black box warning is. It's a relatively new concept for me, frankly. Black box warnings are associated with medications that have increased risk of harm. And antidepressants, benzodiazepines and other classes of psychiatric drugs come with this warning that there can be an increased risk of suicidal thoughts and behaviors. They don't call it suicide because the researchers like to split these terms between suicides, suicide attempts, thoughts and behaviors. I frankly think it's just because it sounds better than saying what it really is, which is causing suicides. And so you have these box warnings that are supposed to be there to warn patients that there is an increased risk of possible harm. But it's also something like, if I may, right? Not every drug gets a black box warning. Correct. It's something that's saying there's a significant risk that definitely anyone that's prescribing it should be talking about, I think. In order to get any of these warnings on these medications by the FDA, they had to show causation. And the studies that they had showed there was causation in the thoughts and behaviors of suicide. And so that's what resulted in these box warnings. Kim Witzak, she helped to get these warnings on these drugs in 2004 and then 2006 after her husband killed himself after a five-week sample of Zoloft. And these warnings are serious. Unfortunately, the mental health industry as a whole has not treated them with that same respect. If we're going to treat a firearm with the respect that we should and we do, which is making sure there's a safety, making sure the weapon's not always loaded, don't point at people, this is a similar thing. If one of these medications can cause you to harm yourself or others, you should be told of that. And right now, we're not. But how is it possible that a medical practitioner or a doctor that's prescribing this, you alluded to this earlier in our conversation, how would it be possible that they might not actually even know that black box warning is on there? Because that's kind of the purpose of it in the first place, isn't it? They know the warning, but in their medical training, and I'm meeting doctors fresh out of medical school today, that they're not even learning anything at all about antidepressant withdrawal. I was in a VA clinic just two weeks ago, and a doctor wanted to prescribe me an antidepressant. And I shared my experience of being trapped on an antidepressant for a year. And she seemed as though it was the first time she'd ever heard of antidepressant withdrawal. So if you're not being trained on these things in medical school, you don't know. And so you come to believe that the patients that are coming in and out of your doors, when you start seeing mania or psychosis after you've been treating them for a little while, with the medication, for example, they see increased diagnoses. They see bipolar disorder. They see schizophrenia. They see other psychotic disorders. And so instead of identifying the side effects, mania and psychosis being among them for antidepressants, as an example, and SSRIs, they're seeing these other disorders, and you wind up going from one antidepressant to an iron antipsychotic, an additional antidepressant, another mood stabilizer, benzodiazepine, and all of a sudden you're on five, six, or more drugs. And so it's this evolution that we keep on creating these cascading effects of these medications. Intent is good. But unfortunately, the way we do care, we're causing more harm than we are good at this point. There's a whole new Maha approach at HHS. How is that manifesting in your work in this roundtable you recently hosted with an HHS official? The convening that we held the past couple of days, the roundtable, the Veteran Harm Reduction Roundtable, exploring the relationship between medications and veteran suicides, was basically a follow-up from the 2010 House Veterans Affairs Committee hearings, where they discussed this issue. They focused on this issue. But unfortunately, the APAs, the Psychiatric and Psychological Associations, came forward and testified and said, everything's fine. Nothing to see here. Don't take any hasty action legislatively that might stop the prescribing these medications that are lifesaving, was the argument. And so I think where we're at today is that there is a huge point of hope because we have leaders in government that care about this problem. Secretary Kennedy has public statements on this issue. The Maha executive order calling for investigations into the threat of selective serotonin reuptake inhibitors, antipsychotics, stimulants, and weight loss drugs. We're at a point in time in history that I never thought I'd see. I thought that I'd wind up becoming a martyr over this issue. And I never believed that we'd have leaders come into government with President Trump and with RFK Jr. going in there and saying, we have a problem and we're going to talk about it. And we're going to do something about it. And so having met Dr. Herodopoulos, acting chief of staff and senior advisor at the Surgeon General's office, she came and spoke at our roundtable yesterday, committing that this is a priority of this administration. Meeting the former acting head of the FDA in tears as we're talking about this crisis and the loss of these families. And her doubling down and saying, this is a priority of this administration. This is a priority of the U.S. Department of Health and Human Services. And finding myself high-fiving a senior FDA official was the moment in history that I never thought I'd ever see come or could have even dreamed of. And so I believe we're in a place where we are going to see action in, I believe, the near future. I believe that these changes can occur through a very, very robust and detailed partnership between HHS and VA, where we look to provide more information for patients and more information for doctors. And so we can make prescribing safer and smarter. And I believe we're at a point in time where we're going to see that in the very near future. And I do believe Secretary Collins is one of those leaders that can act on this and wants to work with Secretary Kennedy on these types of problems. Regardless of what your political affiliation is, Democrat, Republican, Independent, or whatever else it may be, we can do mental health better, not just for veterans, but for all Americans. And I believe that that's the path that we're on. Well, Derek Bumke, it's such a pleasure to have had you on. It's been an honor. Thank you very much, Jan, for having me. Thank you all for joining Derek Bumke and me on this episode of American Thought Leaders. I'm your host, Jan Jekielek.