In the months before Joseph Petit, a trained Army airborne ranger, died in a bathroom at the Atlanta Veterans Affairs Medical Center, his sister Brandie watched her brother age far beyond his 42 years.
"He would twitch and run his fingers through his hair in the manner of an old person when their motor skills are slowing. It took him physically longer to think. Because of the medication, he wasn't there," she says.
The medical examiner's report on Petit's death, which was obtained by U.S. News, ruled the death a suicide, by plastic bag asphyxiation. But the report also listed six anti-psychotic, antidepressant and anti-anxiety drugs in Petit's system, including the drug duloxetine, which has failed at least one use-approval in the U.S. because of incidents of suicide among its users. Petit suffered from knee pain as a result of an injury during parachute training, as well as mental health issues, according to his sister.
Dr. Franklin Schneier, a professor of psychiatry at the Columbia University Medical Center, says it would be "hard to have a rationale" for the combination of anti-psychotics Petit was on, but that it was "not necessarily poor medicine."
Brandie Petit feels otherwise. "Do I think they overmedicated him?" she asks. "There is not a doubt in my mind."
For years, veterans groups and advocates have warned that the U.S. Department of Veterans Affairs was dangerously medicating returning soldiers, while the VA has said it wasn't. (However, the Department of Defense took Seroquel -- a controversial anti-psychotic the VA widely prescribed off-label to veterans for years -- off its list of approved drugs in June 2012.)
And since September, data have come out that for the first time quantified the levels of medication the VA has given out. A CBS records request of VA data in mid-September revealed that while the number of patients at the VA had risen by just 29 percent in the last 11 years, narcotics prescriptions written by VA doctors and nurse practitioners have risen 259 percent.
Days later, the Center for Investigative Reporting found that the number of VA prescriptions for four major opiates – hydrocodone, oxycodone, morphine and methadone – had spiked by 270 percent in the past 12 years.
On Thursday, the House Committee on Veterans Affairs sought to move on the new data, hosting a combative hearing to investigate the VA's "skyrocketing prescription painkiller rate."
"It's nothing less than skyrocketing," Committee Chairman Jeff Miller, R-Fla., told U.S. News. "Because unfortunately the status quo has been to medicate veterans and not to help veterans manage their pain."
Two spouses of deceased veterans testified Thursday that their husbands died because of the interaction of multiple drugs prescribed to them by the VA. Pamela Gray, a physician who formerly worked at a VA medical center in Hampton, Va., said she was coerced multiple times to prescribe large amounts of Schedule II narcotics that "I knew in my medical judgment were wrong," and that she was later dismissed by the agency for speaking out. Schedule II drugs are drugs deemed by the U.S. Controlled Substances Act as having a high possibility for abuse or for serious physical or psychological dependence.
In his testimony, Veterans Health Administration health secretary Robert Jesse apologized to the spouses who had spoken, but said veterans receive more medication in part because they are more affected by pain than the general population. Fifty percent of veterans treated by the VHA suffer from chronic pain, he said.
The VA, which declined to provide a spokesperson for an interview for this story, said in a statement provided to U.S. News that it was working hard to provide "safe and effective" drug therapy for veterans with acute pain, cancer pain and chronic pain, and that VA clinicians are careful to discuss the drugs and side effects with their patients.
But Petit says doctors didn't properly weigh the side effects for her brother. "He begged them to get him on something that didn't give him suicidal thoughts," she says.
If doctors aren't weighing the side effects, it may be due in part to the VA's severe lack of resources. VA Healthcare has remained fully operational during the government shutdown this month, but reserves are slim under normal circumstances. According to a VA report on pain management in 2012, which was obtained by U.S. News, only two VA physicians who provide pain clinic services are available to every 100,000 patients.
The consequences of constrained resources became painfully clear for a VA hospital in Jackson, Miss., where a recent internal investigation found that the lack of doctors in its primary care unit led nurse practitioners to see too many patients and to write narcotics prescriptions without the needed federal certification. It also led the hospital to ask doctors to write prescriptions for patients they had not met.
"In the VA system you'll find that nurse practitioners can write prescriptions at a level that is not done anywhere in the civilian practice," says W. Robb Graham, a Philadelphia-based attorney who represents veterans with malpractice cases against the VA.
"I've had clients that have just gotten tremendous amount of medications. Part of it is also the VA's mail order pharmacy system that just sends this stuff out in droves. Part of it is that a variety of [VA] providers ... will just prescribe and prescribe and prescribe."
In its statement, the VA said it had uniform guidelines and procedures for prescribing medication, and that those guidelines were in accordance with "generally accepted pain management standards of care."
Veterans groups say another factor is that the VA is still coming to terms with how to treat soldiers who go to war today. A new age of chemical warfare, coupled with new kinds of injuries, such as post traumatic stress disorder and traumatic brain injury, have presented new problems for VA doctors., these groups say. Better medicine and better armor have also kept more soldiers from dying, but they are coming to the VA with more damage doctors can't see.
"You've got a lot of people with multiple, complicated wounds that we've never seen before in combat," says Tom Tarantino, chief policy officer at the Iraq and Afghanistan Veterans of America. "And so in an honest desire to alleviate pain, you have an overmedication of soldiers."
The breadth of these mental wounds is, as is now quite well-known, astounding. Some 30 percent of vets treated by the VA have been diagnosed with PTSD, according to the agency. More than 280,000 veterans have been diagnosed with traumatic brain injury since the year 2000, the Department of Defense reports.
Medication may simply be the VA's first impulse to get these suffering veterans back on track, according to Tarantino. "On the battlefield you hand out medication like crazy, just trying to get someone stable and back out in the fight. That ethos has translated back home."
Handing out "medication like crazy" is what so many find problematic.
In testimony Thursday, military spouse Heather McDonald described how her husband would come home from every VA appointment with new and different medications -- until the day he did not wake up. Scott McDonald, who was discharged in 2011 after 15 years in the Army, was initially given basic drugs, like ibuprofen, and then put on a seizure drug, gabapentin. He was later prescribed anti-depression and anxiety medications, including zoloft and valium, and finally a powerful narcotic, percocet, according to his widow.
On Sept. 17, a VA Office of the Inspector General report detailed a lethal cocktail given to a veteran who died unexpectedly in a mental health rehab program at the VA campus in Lyons, N.J. He died, the report found, of "acute intoxication due to the combined effects of cyclobenzaprine, tramadol, gabapentin, sertraline, hydroxyzine, and amlodipine."
And despite the coroner's report that ruled her brother's death a suicide, Brandie Petit insists it was the medication that killed him. At a special field hearing of the House Committee on Veterans Affairs in Pittsburgh on Sept. 9, Petit testified that "he did not commit suicide because he felt sorry for himself; he committed suicide to protect others from the voices in his head and hallucinations."
"I'm angry they treated him basically like a guinea pig," she says. "And I want the people who were giving it to him, I want them to [expletive] take all the pills that he took and see how they do."