For some troops, wide use of medications can be deadly

By some estimates, well over 300,000 troops have returned from Iraq or Afghanistan with post-traumatic stress disorder, depression, traumatic brain injury, or some combination of those. The Pentagon has looked to pharmacology to treat those complex problems, following the lead of civilian medicine. As a result, psychiatric drugs have been used more widely across the military than in any previous war.

But those medications, along with narcotic painkillers, are being increasingly linked to a rising tide of other problems, among them drug dependency, suicide, and fatal accidents — sometimes from the interaction of the drugs themselves. An Army report on suicide released last year documented the problem, saying one-third of the force was on at least one prescription medication.

“Prescription drug use is on the rise,’’ the report said, noting that medications were involved in one-third of the record 162 suicides by active-duty soldiers in 2009. An additional 101 soldiers died accidentally from the toxic mixing of prescription drugs from 2006 to 2009.

“I’m not a doctor, but there is something inside that tells me the fewer of these things we prescribe, the better off we’ll be,’’ General Peter W. Chiarelli, vice chief of staff of the Army, who has led efforts on suicide prevention, said in an interview.

The New York Times reviewed in detail the cases of service members who died from what coroners said were toxic interactions of prescription drugs. All were classified as accidents, not suicides.

Given the complexity of drug interactions, it is difficult to know precisely what killed the men, and the Pentagon declined to discuss their cases, citing confidentiality. But there were important similarities to their stories.

All the men had been deployed multiple times and eventually received diagnoses of post-traumatic stress disorder. All had five or more medications in their systems when they died, including opiate painkillers and mood-altering psychiatric drugs, but not alcohol. All had switched drugs repeatedly, hoping for better results that never arrived. All died in their sleep.

The military medical system has struggled to meet the demand caused by two wars, and to this day it still reports shortages of therapists, psychologists, and psychiatrists. But medications have always been readily available.

Across all branches, spending on psychiatric drugs has more than doubled since 2001, to $280 million in 2010, according to numbers obtained from the Defense Logistics Agency by a Cornell University psychiatrist, Richard A. Friedman.

Paradoxically, the military came under criticism a decade ago for not prescribing enough medications, particularly for pain. In its willingness to prescribe more readily, the Pentagon was trying to meet standards similar to civilian medicine, Chiarelli said.

Thousands of troops struggle with insomnia, anxiety, and chronic pain — a combination that is particularly treacherous to treat with medications. Pairing a pain medication like oxycodone, a narcotic, with an antianxiety drug like Xanax, a so-called benzodiazepine, amplifies the tranquilizing effects of both, doctors say.

Similarly, antidepressants like Prozac or Celexa block liver enzymes that help break down narcotics and anxiety drugs, extending their effects.

The widespread availability of prescription medications is increasingly being linked by military officials to growing substance abuse, particularly with opiates.

A Defense Department survey last year found that the illegal use of prescription drugs in the military had tripled from 2005 to 2008, with five times as many troops claiming to abuse prescription drugs than illegal ones like cocaine or marijuana.

The problem has become particularly acute in specialized units for wounded troops, in which commanders say the trading of prescription medications is rampant.