PHILADELPHIA, PA — This June, as we observe Post-Traumatic Stress Disorder (PTSD) Awareness Month, a convergence of anniversaries provides a solemn opportunity for reflection. In 2025, we will commemorate the 250th anniversaries of the U.S. Army, Navy, and Marine Corps. For two and a half centuries, these institutions have remained pillars of our national defense, their histories told through the courage and sacrifice of the men and women who have worn their uniforms. Yet, as we pay tribute to this legacy of service, we must also face a silent epidemic that looms over the valor: the profound and often devastating link between post-traumatic stress disorder and the opioid crisis ravaging our veteran community.
The nature of warfare has consistently impacted the human psyche. What was once dismissed as “shell shock” or “combat fatigue” is now recognized as Post-Traumatic Stress Disorder, a debilitating mental health condition. The U.S. Department of Veterans Affairs has reported that the prevalence of PTSD among veterans varies by service era, with some studies indicating that as many as 20 percent of those who served in recent conflicts like Iraq and Afghanistan experience its symptoms. These are not just statistics. They represent lives transformed by the invisible wounds of war—hypervigilance, intrusive memories, and emotional numbness that can make the transition to civilian life a challenging and isolating experience. Chronic pain, albeit physical and emotional, evolves, thrusting the PTSD experience into a futile cycle seeking relief from omnipresent suffering.
Pain is defined by the International Association for the Study of Pain (IASP) as both a sensation and an emotion. It can be triggered by both physical and emotional threats, or even by the mere resemblance of such threats. Opioid medications work by activating the brain and nervous system’s inherent receptor systems, which are designed to suppress and inhibit both physical and emotional pain for the survival of the individual facing these threats, whether real or perceived. This is the critical interface that has perpetuated the illicit use of opioids and other substances that distract from or dissociate from pain and suffering. Individuals who are especially vulnerable to abuse include those exposed, such as our veterans and others, seeking to obliterate the stark realities of life.
It is within this crucible of psychological pain that the seeds of another crisis are often sown. For many veterans grappling with the daily torment of PTSD, the search for relief can be desperate. This desperation has too often led them down the path of opioid use. According to the U.S. Department of Veterans Affairs, more than two in ten veterans with PTSD also have a substance use disorder. The link is tragically logical. The emotional numbing sought by those with PTSD can be temporarily achieved through opioids, which are powerful pain relievers.
The journey from a legitimate prescription for a combat-related injury to a dependency on opioids is a slippery and insidious slope. A veteran returning with both physical and psychological trauma may be prescribed opioids for pain management. For someone also battling the demons of PTSD, these medications can offer a fleeting respite from not just physical agony, as well as the persistent anxiety and intrusive thoughts that are characteristic of the disorder. This dual-action relief makes opioids particularly seductive and creates a high risk for misuse and addiction.
The consequences of this intersection are stark. The Department of Veterans Affairs has been grappling with the opioid crisis within its ranks for years, implementing significant changes to its pain management and opioid prescription guidelines. Recognizing the heightened risk, the VA’s Opioid Safety Initiative aims to reduce the reliance on these drugs by promoting alternative and holistic approaches to pain. These include physical therapy, cognitive-behavioral therapy, and other non-pharmacological interventions that address the root causes of pain without the addictive potential of opioids.
Yet, the challenge remains immense. The stigma surrounding mental health, while diminishing, still prevents many from seeking the help they need for PTSD. This, in turn, can lead to self-medication and a descent into addiction. Breaking this cycle requires a multi-faceted approach. It demands that we, as a nation, foster a culture of understanding and acceptance around mental health, particularly within the military and veteran communities. It requires robust funding and accessibility for evidence-based PTSD treatments and a continued commitment to safer pain management protocols.
As we raise our flags and commemorate the storied histories of our armed forces, let us also commit to a more profound and meaningful form of patriotism. Let us honor the service of our veterans not just with parades and platitudes, but with a steadfast resolve to heal the unseen wounds they carry. The connection between PTSD and opioid addiction is not a sign of weakness. It is a testament to the profound and enduring costs of war. This PTSD Awareness Month, as we look back on 250 years of sacrifice, let us also look forward with a renewed promise to provide our warriors with the comprehensive care and compassionate support they have so bravely earned.
**Dr. Leonard Kamen is a member of the Opioid Task Force at Albert Einstein Medical Center, a Board Member at the Rothman Institute Foundation for Opioid Research and Education in Philadelphia, and President of the Pennsylvania Pain Society.
About the Rothman Institute Foundation for Opioid Research and Education.
The Rothman Opioid Foundation, for short, is a non-profit 501c3 organization dedicated to raising awareness of the ongoing opioid crisis, educating physicians and patients on safe opioid prescribing and use, respectively, and advising policymakers on sound opioid and pain management policy. Most importantly, the Rothman Opioid Foundation performs and supports the highest quality research on opioids and alternative pain modalities to yield findings that can better inform patients, physicians, and the greater healthcare community in the most evidence-based pain management strategies while working to mitigate opioid abuse and addiction. https://www.rothmanopioid.org/
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