Medications in the Military

While I was at the ASAM meeting in Atlanta last month, I heard an interesting presentation by Diana Jeffery, PhD, from the Department of Defense. She described the results of an assessment of controlled substance medications prescribed to U.S. military personnel on active duty in 2010.

To put her information into context, the military’s Health Related Behavior Survey, done every three to five years, showed a near-tripling of self-reported prescription medication misuse, going from 4% in 2004 to 11% in 2011. This health survey asks anonymous questions of randomly selected military personnel, regarding drug and alcohol use, as well as questions about tobacco use and some gender-specific topics.

In the newer 2010 survey, information was gathered on schedule II, III, and IV controlled substances prescribed to about 1.4 million U.S. active duty military personnel during 2010. The study’s interesting results show that during 2010, approximately 26.4% of these military personnel were prescribed an opioid, which compares to 11% of the civilian population. Central nervous system depressants were prescribed to 11% of military personnel, while only 3.4% of civilians were prescribed these sedatives. And for stimulant medications, only 1.1 % of military were prescribed these, while 1.7% of civilians were prescribed stimulants.

When further examining the information about prescribed opioids, 90% of the military personnel received between 1 to 5 prescriptions for opioids during 2010, and 6% of personnel has from 6 to 10 prescriptions, and 2% received more than 15 prescriptions during 2010.

In further analysis of opioid prescriptions, personnel over age 45 were more likely to be prescribed opioids, and those in the Army and Air Force were twice as likely to be prescribed opioids as personnel in the Navy, marines and Coast Guard. (The latter arms of service tend to have younger personnel than the Army and Air Force.)

Around 32% of active military personnel had a prescription for any controlled substance during 2010, which compares to around 14% for the U.S. civilian population.

Around 8% of military personnel were prescribed controlled substances for more than 90 days, and those with prescriptions were more likely to have been injured, have mental illness, substance abuse or dependence, be male, and be married.

For me, this information raises more questions than it answers. Are military personnel overmedicated? After all, they should be much healthier than civilians, since many illnesses exclude people from military service. But on the other hand, this survey was done on people actively serving in the armed forces. Many of the personnel receiving opioids were wounded in battle, whether in 2010 or earlier. With more advanced treatments available in this war compared to those twenty years ago, soldiers with more severe injuries are able to survive their injuries, and need treatment for the pain of those injuries. For many injuries, that pain doesn’t go away after a few weeks.

And what about the central nervous system sedatives? Are soldiers in active combat impaired by these medications? From this data we can’t tell if military personnel are taking sedatives once every couple of weeks to help them sleep, or if are they taking three doses every day while in active service. That would make a huge difference, because one pattern of use wouldn’t cause impairment, while multiple daily dosing can impair.

The Army branch of the military has already initiated measures to help reduce the risk of addiction. For example, known risk factors for the development of addiction are noted by Army physicians: past treatment for anxiety or depression, past personal history of drug or alcohol abuse or addiction, increased stress, or family history of addiction. Then the patient can be given more information about his or her personal level of risk when prescribed potentially addictive medications. The Army has also been more closely monitoring the use of scheduled prescription medication, to identify a problem with medication misuse early.

As in civilian life, the risks and benefits of potentially addicting medications have to be carefully considered to avoid over or under reaction to the information gleaned from the military’s studies. Many more studies are on the way to further illuminate the incidence and risks of addiction in military personnel.

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3 responses to this post.

  1. Posted by Heather on May 5, 2012 at 8:41 pm

    I served in the Navy (2001-2004) and joined to changed my life. But, what I learned was that drugs were used all the time (illegal and prescription) and of course alcohol.
    The funny thing was that so many people joined for the same reasons I did. I swore I wasn’t going to use anymore, but during my 5th week at Basic Training I had all 4 wisdom teeth pulled and a script for 8 hydrocodone(what a tease), which turned the switch back on. I was able to hustle pills from other shipmates that got sick from taking opiates. After that pills were around, especially oxycodone when I got to my duty station in Washington State. If you’re an addict thinking about joining the military I would l think twice, unless you’re in recovery or really ready to change. Great experience, but would’ve been better if I wasn’t high and drunk all the time.

    Reply

  2. Posted by Elizabeth Godwin on May 6, 2012 at 11:26 am

    I was intrigued by the numbers in your blog in which a 2010 Army study compared prescription drug use of Schedules II,III, & IV controlled substances by the Army but wonder why the group was compared to a civilian group. As of 4 May 2012, during a time of war–which includes Operations Iraqi Freedom, Enduring Freedom and New Dawn, we have had 6,437 military troops killed along with 464,011 wounded. I did not research whether we had more fatal and/or wounded casualties during 2010 to compare if that particular year was any more stressful than any other years of the war. To be quite honest, I was disappointed that a DOD researcher performed this study without taking into consideration the enormous difference in control groups. One being an active duty military organization during a period of war and the second being a civilian group who may not have seen any war action at all. Numbers can be extremely impressive if not put in their proper perspective and I wounder how the numbers would look if the military group had been compared to another military unit or even possibly one of its own. We can easily take a knee-jerk reaction and quickly say that the Army overprescribes its Schedules II,III& IV controlled substances and should stop presbribing them altogether; thereby,denying much needed medications to a group that potentially needs them. Perhaps we really need to take another look at this research or (what I think would be the most efficient use of Army time at this moment) and evaluate whether a soldier needs the medication on a case-by-case basis. As far a the CNS drugs are concerned, I think the number of casualties, types of casualties & the number of troops struggling with Post-Traumatic Stress Disorder is a good indicator as to the type of war they are fighting–many are serving their 3rd & 4th tour overseas & the stressors of serving in Iraq has been much different than for those who have had to serve in Afghanistan where the enemy is literally in your back door. I do not condone unnecessarily prescribing potentially addictive drugs to our troops because when they come home, they’re much more likely to become addictive to something else but our troops need to learn coping skills in addition to whatever medical treatments they are being given so that they don’t have to be totally dependent on these drugs. However, as in the civilian world–which they are nowhere near –medical professionals and those in charge of those decisions need to make the determination on an individual basis what is best for that troop & his squad in order for them to complete their mission and make it back at the end of the night– whenever that is.

    Reply

    • Actually, this study was done on all branches of the armed service, including Army, Navy, Marines, Air force, and Coast Guard. I’m not sure about Reserves but if they were actively serving I think they were counted too.
      Yes, as I said twoard the end of the the blog, the numbers raise more questions than they answer. Given the tremendous number of war-time injuries, perhaps more survivable than in past wars, it’s possible opioids are being appropriately prescribed or even underprescribed. The numbers alone are interesting but just a starting point for more investigation.

      Reply

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