The US Army Special Forces, known as the Green Berets, as well as the Army’s two most important infantry divisions, the 101st Airborne Division and the 82nd Airborne Division, all have a significant problem with substance abuse and fatal drug overdoses, according to data, the Pentagon released this week to five US senators.

Massachusetts Sen. Edward Markey, Massachusetts Sen. Elizabeth Warren, and others raised concerns about the increasing use of drugs in the military. 

This came after reports stated in September that at least 14 and as many as 30 US soldiers had died in 2020 and 2021 of overdoses at Fort Bragg, North Carolina, which is the headquarters of the Special Forces and the top-secret Joint Special Operations Command.

In a letter to Secretary of Defense Lloyd Austin in late September, the senators asked for detailed statistics, going back five years, on accidental overdoses in the ranks.

“We share your concern that drug overdose is a serious problem,” the Pentagon’s undersecretary for personnel and readiness wrote in response this week. “We must work to do better.”

Among 15,293 US soldiers, sailors, airmen, and Marines who overdosed on illicit drugs from 2017 to 2022, according to data enclosed with the letter, 332 were fatal.

Following these reports, new data revealed a rising long-term trend, followed by a sharp spike in OD deaths in 2020 and 2021 among active-duty military men. It was also revealed that Fentanyl was responsible for more than half of the casualties.

“The number of OD deaths involving fentanyl has more than doubled over the past five years,” the Pentagon disclosed.

The demographics of those hardest hit paralleled the opioid crisis in the civilian population, where people without college degrees have suffered the most from the scourge of opioid addiction.

Analysis of the data available showed that the overdose rate at the Department of Defense is significantly higher than the civilian baseline. Army infantrymen, Green Berets, and other elite soldiers, together with the smaller Naval Special Warfare Command, have borne nearly all of the burden of the war in Afghanistan and a half-dozen other countries.

Veterans suffer "moral injury,” a term used to refer to symptoms resulting from a damaged conscience, involving profound feelings of guilt, shame, and anger. Military personnel who take part in combat are most at risk of suffering this form of trauma.

Read: Mental health issues among top concerns in US adults

The Pentagon data makes clear that Fort Bragg is far and away the site of the most drug overdoses, both in absolute terms and per capita, with 31 confirmed OD’s since 2017, a rate of 36.0 per 100,000 soldiers.

Besides North Carolina, Washington state, home of Joint Base Lewis-McChord, also has a major problem where service members died of overdoses at a significantly higher rate than civilians. Since 2017, 11 soldiers have fatally overdosed at JBLM, a number that is much fewer than at Fort Bragg but still comes out to an annual rate of 29.5 per 100,000.

Looking at the military in Kentucky, data showed that the overdose rate was very high. From 2017 to 2022, the annual rate was 50.4 per 100,000, more than double the national rate.

The Fort Campbell military base in Kentucky is home of the 101st Airborne Division, the 5th Special Forces Group, and the covert, night-flying 160th Special Operations Aviation Regiment, which has all been embroiled in continuous low-level wars fought in near-total secrecy over the last decade, in countries like Yemen, Syria, Mali, Niger, and Somalia.

“We like to characterize SOF-ambitious soldiers as lacking in empathy,” says Dr. Jaime Earnest, an epidemiologist and expert on behavioral health and substance abuse who has worked on staff at the Pentagon, referring to soldiers who aspire to join the Special Operations Forces.

“But they’re not, they’re human,” she adds, giving the example of a Special Forces soldier who started using cocaine “because it makes you feel braver. And like a big man, you can handle the pressure of your job, when you actually feel kind of scared inside, or deeply morally injured because you’re not a robot automaton, and you’re having nightmares about the people you shot.”

The government trains these men to kill and sends them into war zones to do that.

“We expect moral injuries to be a consequence of combat,” Earnest says, adding, “Particularly when there’s been a traumatic event. And we cannot abdicate our ethical responsibility as an organization, as the U.S. federal government, when we put people in occupational situations that we know cause collateral psychological damage,” to properly care for their mental health in the aftermath.

The Pentagon’s letter to Markey and his colleagues makes reference to a significant number of programs used in the military to address substance abuse.

“The Army loves its policies and programs,” Earnest says. “The massive size and organizational structure of the DOD and the military health system is mind-boggling. There are a million links you can click, text alerts, phones you can jingle, hotlines with three numbers, chat apps.”

However, she notes, “our duty of care to these soldiers is not being fulfilled,” because so many of these programs are not designed to actually heal an individual, but to coldly evaluate whether or not he or she is “operationally deployable.”

Earnest also points out the lack of highly qualified psychologists dealing with reducing drug addiction, overdoses, and suicide in the Special Forces.

In addition, “the Army’s commitment to optics management is in direct conflict with its ethical duty of care to its soldiers. You cannot pretend that everything is OK and make managing optics your priority. You cannot put people and optics first. It has to be people first. And that actually has to mean something.”

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