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DoD's lack of Rx management policy is risk to ill troops, report says

Feb. 21, 2014 - 03:21PM   |  
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Injured and ill service members are at risk of accidental drug overdoses because the Defense Department lacks overarching policies on medication management, a Pentagon investigation has found.

In a report released Friday, the Defense Department Inspector General said the absence of a single policy across the services to track and reconcile medications, as well as the lack of reliable drug take-back programs put personnel at risk.

“Wounded warriors may be at risk for overdose or misuse of unneeded medications that could result in unnecessary hospitalization and death,” the report stated.

According to the Armed Forces Health Surveillance Center, the military saw nearly 13,000 drug-related hospitalizations for overdoses or poisonings from 2001 to 2010. During the same time, another 2,500 active-duty troops were hospitalized for alcohol or illegal drug misuse.

Although the Pentagon does not have a singular policy on prescription management, it does have safeguards designed to track medication management. The Warrior Transition Unit Prescription Medication Analysis and Reporting Tool, or P-Mart, allows doctors and nurses to monitor high-risk medications and identify patients those who need to be watched. The DoD Pharmacy Data Transaction Service also has a medication restriction program that puts limits on who can prescribe medication for at-risk personnel, what the physicians can prescribe and which pharmacies the at-risk troops can use.

The inspector general called these programs “noteworthy practices.”

But even with these safeguards in place, troops are vulnerable, said Kenneth Moorefield, deputy inspector general for special plans and operations.

“An overarching DoD policy ... will enable the services to develop clear and consistent policies for medication management and decrease the risk of adverse drug events and poor patient outcomes,” Moorefield wrote.

While the Pentagon lacks a singular policy, the military services have varying policies and tools for medication management. The Army surgeon general has issued a policy on multiple prescriptions of anti-depressants and psychotropic medications as well as programs for at-risk individuals.

The Air Force and Navy leave the responsibility to individual commands.

“Some of the [service] policies were not sufficiently specific to ensure the safety and well-being of the wounded warrior population,” the IG wrote. “This variance in service policies was caused by the lack of overarching DoD guidance to establish minimum requirements to properly reconcile and manage ... use of multiple medications.”

In the DoD response to the report, Assistant Secretary for Health Affairs Dr. Jonathan Woodson concurred with the findings and recommendations, including the need for a policy and better education for patients.

Woodson highlighted the recommendation for the department to establish its own drug take-back program, with the authority of the Drug Enforcement Agency.

“The DoD supports enhanced ability to implement return/take-back and disposal programs to aid in the removal of unwanted, unused and expired controlled substances,” Woodson wrote.

The Army surgeon general’s office also concurred with the report and said its military treatment facilities have received a designation from the DEA that will allow them to collect medications. A review of that authorization is underway, according to the Army.

In its response, the Navy Bureau of Medicine said it has left the decision on medication management and reconciliation to commands, given the “differences that exist at the local level, including unique patient populations, differences in facility capabilities and staffing.”

The report did not include an Air Force response.

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