Following a 2010 report on health promotion, risk reduction and suicide prevention in the Army that cites prescription drug abuse as a growing issue, the Army is making changes to reduce the misuse of prescription pain medications.

Prescription drug abuse in the military mirrors a growing trend in the country as a whole, but soldiers may have specific job-related reasons to start using prescription painkillers, which can lead to abuse, says Col. Paul Bliese, Ph.D., Director of the Center for Military Psychiatry and Neuroscience at the Walter Reed Army Institute of Research.

While young adults in the general population who abuse prescription drugs often do so to get high, soldiers tend to misuse prescription painkillers to treat pain, not for recreational use, Col. Bliese says.

“The military has seen an increase in the rate of prescription drug abuse, and that’s to be expected since we draw from the civilian population, which is also seeing a rise,” Col. Bliese said. “But we also tend to create chronic pain as an occupational hazard. Soldiers are wearing body armor, carrying heavy backpacks, wearing helmets and getting banged around in vehicles in addition to getting physically injured in combat.”

The report by the Army’s Suicide Prevention Task Force, entitled Health Promotion, Risk Reduction, Suicide Prevention, notes that while pharmaceutical drugs account for only 18 percent of illicit drug use cases in the Army, they were involved in almost one-third of the active duty suicides the previous year.  The report also states that of the 188 accidental or undetermined deaths caused by drugs or alcohol from 2006-2009, 139 (72 percent) were caused by prescription drugs. Recently reported data indicates that 73% of the accidental or undetermined deaths in 2010 were related to prescription medications.

Oxycodone and hydrocodone have become the second and third most frequently used pain management medications in the U.S. military, the report notes.

The report contains more than 250 recommendations to identify and mitigate problems in the Army related to suicide and high-risk soldier behavior, including several recommendations aimed at curbing prescription drug abuse.

Limiting Duration of Prescriptions

One recommendation that the Army has implemented is limiting the duration of a prescription so that it is not considered valid after six months without a doctor’s reevaluation and renewal, says Bruce Shahbaz of the Army’s Health Promotion and Risk Reduction Task Force. Previously, the amount of time a soldier could use a prescription was open-ended. “If a person tested positive for a prescription pain medication, they could say, ‘I hurt my knee last weekend and I’m just using up an old prescription,’ but we’ve eliminated that excuse,” he says.

The maximum amount of time a person is authorized to use an oxycodone prescription, for example, is now six months from the time the prescription is written. “If they test positive for the drug more than six months after the prescription is written, an investigation is conducted by the commanding officer to determine why,” Col. Bliese says. “Our goal is to find out whether a person is taking the medication for a bona fide medical issue, or whether they may have a substance abuse problem or are using the drugs recreationally. If the person says they got hurt again, then they have to go back to the doctor for a new prescription.”

Shahbaz says that sometimes soldiers share prescription drugs as a favor to a fellow soldier in pain. “Someone who is being treated for pain may run out of pills and borrows more from a buddy, or a soldier’s knee hurts and someone gives him a pill and says, ‘Try this, it helped me,’” he says.

When a drug screen turns up prescription pain medication, a medical review officer checks to ensure that the soldier has a prescription for that particular drug, Col. Bliese says. He notes that the Army conducts random drug testing even in Iraq and Afghanistan, although it is more difficult to do in a war zone.

More Closely Managing Medications

Another recent change that results from the report is the Surgeon General’s directive to health care providers about treating acute and chronic pain. For acute pain, a doctor cannot prescribe more than 30 days of pain medication. For a person suffering from chronic pain, medical exams are required twice a year. “We saw we needed to more closely manage these medications and have a closer relationship between the doctor and patient,” Shahbaz says.

There is also a new policy that requires any solider who has multiple prescriptions for both behavioral and pain medications to have someone coordinating their care so that they do not have any adverse reactions between medications.”If someone is being treated for PTSD (post-traumatic stress syndrome) and physical injuries, we want to make sure there are no bad interactions between the medications prescribed by different specialists,” Shahbaz says. In these cases, a pharmacist is responsible for performing a review of medications to look for potential drug interactions, and hands the case off to a primary care physician or a nurse case manager if any are spotted.