This article, in a slightly edited form, first appeared on Pain News Network on May 25, 2019.

On Memorial Day, we honor those who lost their lives while serving in the United States military. It is a time when we should also acknowledge the sacrifices all veterans have made, and continue to make, for our country.

Physical and mental trauma are some of the most devastating consequences veterans suffer as a result of their sacrifices.

A 2014 JAMA paper reported that more than 44 percent of active-duty U.S. infantry soldiers in 2011 suffered from chronic pain. Other reports state that combat injuries cause most of the chronic pain.

That doesn’t surprise me. I’ve received many emails from veterans who describe their struggles to find treatments for the pain they acquired during their service. Here are three typical stories.

A Persian Gulf veteran, John, is being forced to slowly taper from a combination of opioids that he claims worked for him. His dose of medication is being tapered because his physician feels pressured to comply with recommendations of the CDC Opioid Prescribing Guideline.

John is afraid that the new limit will be inadequate to treat his pain. “I am VERY upset with my government, as their draconian ‘solutions’ to the perceived ‘drug problem’ will only exacerbate pain issues with legitimate chronic pain patients. I don’t think their efforts will have ANY effect on the illegal drug problems that plague the U.S.,” John tells me.

He may be more fortunate than others. At the time when John contacted me, he had a pain specialist who was still able and willing to support his need for treatment.

Others have not been as lucky. Mark is a 100% disabled veteran with PTSD, severe lower back pain, and severe knee problems. After surgery, he was only able to get a two week supply of pain medicine. For two and a half months, he suffered without any medication until he was able to go outside the VA system to obtain oxycodone.

Then there is Jason. He is a young American hero who used opioids to self-medicate his PTSD and chronic pain. His story may help people understand why there are approximately 20 suicides each day by America’s veterans.

Although firearms are a common method of suicide with veterans, the use of prescription medications has also been implicated. Having access to opioids gives veterans a less violent way to end their lives.

Unfortunately, the number of suicides may even be underreported. As many as 45 percent of drug overdoses — including those of military members — might be related to suicide, according to a former past president of the American Psychiatric Association.

Veterans’ suicides make up 18% of all suicides in the U.S. The suicide rate among members of the military is nearly 3 times that of civilians.

In 2012, the number of military suicides vastly exceeded the number of military personnel who were killed in battles.

Approximately 20% of recent war veterans suffer from PTSD in addition to chronic pain.

PTSD was the most common mental health condition for almost 1 million soldiers who served between 2001 and 2014. Nearly one in four of those who served during those years developed PTSD within one year of coming back home.

Yet much of the general public, and many mental health professionals, have doubted that PTSD was a true disorder until recently.

Even now, soldiers with symptoms of PTSD often face rejection by their military peers and are feared by society, in general, as potentially dangerous. Movies ranging from “American Sniper” to “Thank You for Your Service” frequently depict characters with PTSD as struggling to fit into society. In real life, those with PTSD symptoms are often labeled as “weak” and removed from combat zones, and sometimes they are involuntarily discharged from military service.

Opioid drug use in military populations is nearly triple that of civilian populations. Females are more than three times as likely as males to have concurrent PTSD symptoms and prescription opioid use problems.

Those statistics are difficult to read anytime, but they seem especially troubling as the United States commemorates Memorial Day. This is the time for us to acknowledge that those who have served our country deserve the best medical care available.

Retired Generals Wayne B. Jonas, M.D. and Eric B. Schoomaker, M.D. wrote a commentary in JAMA, Aug 2014 titled “Pain and Opioids in the Military: We Must Do Better.” Recognizing that veterans often misuse opioids to self-medicate mental health disorders, they proposed teaching members of the military a greater degree of self-management skills such as problem-solving and goal setting.

Of course, self-management would be preferable to using opioids if it were sufficient to afford veterans a quality of life they deserve. However, often, teaching self-management skills is an insufficient treatment. That is clear in the cases of John, Mark, and Jason.

On Memorial Day, I hope we can take a moment to think about the men and women who have fought — and, sometimes, died — for a country they believed in.

I also hope we honor the living by showing them that they deserve treatment for their chronic pain, PTSD, addiction, and any other health care issues they may have. We owe it to them.