Many of the more than two million veterans who served in Iraq or Afghanistan suffer from both pain and post-traumatic stress disorder (PTSD). Often they are treated with opioid painkillers, which can be a dangerous mix with mental illness because of the risk of addiction, The Wall Street Journal reports.

Veterans with PTSD are nearly twice as likely to be prescribed opioids as those without mental health problems, according to a study by a Veterans Affairs researcher. They are more likely to get more than one opioid, and to receive the highest dose. The study found veterans with PTSD were more than twice as likely to suffer injuries, overdoses and other bad outcomes if they were given opioids.

According to VA records, about 30 percent of Iraq and Afghanistan veterans under VA care have PTSD. More than half of them suffer chronic pain.

More than 50,000 veterans were treated by the VA last year for serious problems associated with opioid use—almost double the number compared with 10 years earlier. During that time, the total number of VA patients grew 30 percent. The newspaper found the number of opioid prescriptions written by the VA increased by 287 percent between 1999 and 2012.

Another study led by a VA doctor found the rate of accidental drug overdoses among veterans receiving VA care is almost double that of the U.S. population as a whole.

Dr. Andrew Kowal, who helped develop clinical guidelines for pain management used by the VA, said the number of troops “retiring out of the Army on narcotics chronically is just absolutely unbelievable.”
In 2010, the VA revised opioid prescribing guidelines to emphasize the risks. The VA says it will make additional revisions.