Executive Summary: There is quite a significant body of research on the subject of homelessness as experienced by veterans of the UK Armed Forces. This provides for a good understanding of both the size of the problem and the experiences of those involved. The proportion of veterans among London’s single homeless population is estimated to have fallen from above 20% in the mid to late 1990s, down to 6% in 2008. In terms of the number of veterans, this is a reduction from an estimate of between 3,000 and 4,000 down to approximately 1,100. This has been attributed to a combination of reduced output from the Armed Forces, improved Ministry of Defence (MoD) resettlement provision and better intervention from ex-Service charities. The characteristics, profile and experiences of homeless veterans are largely the same as those of the wider homelessness population, although there are some notable differences. Homeless veterans have been found on average to be older, have slept rough for longer, be less likely to use drugs and more likely to have alcohol-related problems. Post Traumatic Stress Disorder (PTSD) has been found among a small number of homeless veterans although other non-military related mental health problems were more common.There is little evidence to support the notion that military life, or institutionalisation, is a cause of veterans’ homelessness. There is some evidence that, for a minority, military life, through factors such as trauma of combat, mobility of the job or the drinking culture, had reduced their ability to cope post-Service. In some cases, military life had suspended the impact of pre-existing vulnerabilities and these had resurfaced post-discharge. However, in the main, homelessness had occurred some time after Service. In common with the wider homeless population, a variety of factors and events had influenced and preceded homelessness.
Abstract: Context: In response to the opioid crisis, federal guidelines were implemented, including the Veterans Health Administration's (VA) Opioid Safety Initiative in 2013. The impact of policies on patients near the end of life is unknown. Objective: Examine temporal trends in opioid prescribing, pain, and opioid overdoses among Veterans near the end of life. Methods: Retrospective, time series analysis of VA decedents between October 2009 and September 2018 whose next-of-kin participated in VA's Bereaved Family Survey (BFS). Using multivariate regression to adjust for sociodemographic and clinical covariates, we examined temporal trends in outpatient opioid prescribing, uncontrolled pain based on BFS report, and opioid overdose-related hospitalizations, in the last month of life, overall and by clinical diagnosis (cancer versus non-cancer). Results: Among 79,409 decedents, mean daily outpatient opioid dose in morphine milligram equivalents in the last month of life decreased from 4.6 mg in 2010 to 2.1 mg in 2018 (adjusted change -0.20 mg/year; P