Nearly 1 in 4 active-duty service members had at least one prescription for an opioid at some point in 2017, according to Defense Department research.
There’s not a lot of variation between the services in terms of the percent of active-duty members who are receiving opioid prescriptions, although the Marine Corps numbers are slightly lower, said Zachary J. Peters, a researcher with the Defense Health Agency’s Psychological Health Center of Excellence, in a presentation at the annual meeting of AMSUS, The Society of Federal Health Professionals. “Overall there’s overwhelming consistency between services,” he said.
About 1 in 4 retirees also had at least one opioid prescription.
That doesn’t necessarily equate to opioid addiction. Opioids are prescribed for moderate-to-severe pain after surgery, injury, or for pain from conditions such as cancer. Especially with long-term use, there are risks of addiction, overdose and death.
“Among the beneficiaries of the Military Health System, we actually see that there are very few people who are receiving care for opioid use disorder,” Peters said. In any given year, across the Military Health System — including those who get treatment in military clinics and hospitals, as well as those who get treatment by civilian providers who accept Tricare — there are fewer than 4,000 beneficiaries who are receiving care for opioid use disorders, Peters said. That equates to less than one-tenth of 1 percent (0.001 percent) of beneficiaries with a diagnosed opioid disorder.
Among active-duty troops, the prevalence of those diagnosed with opioid use disorder has decreased — from nearly 2,000 in 2011 to fewer than 700 in 2016 — about 0.04 percent of the active-duty population.
About 500 retirees in the Military Health System were identified as having opioid use disorder in 2016, about 0.02 percent of the retiree beneficiary population.
Fewer than 600 active-duty family members, or about 0.03 percent had the diagnosis in 2016.
“We know that diagnoses aren’t necessarily the entire picture,” Peters said, so researchers also looked at prescribing patterns, including the number of prescriptions, the prevalence of high-dose prescriptions, and the chronic use.
According to the Centers for Disease Control, the dangers of prescription misuse, opioid use disorder and overdose have been a growing problem throughout the U.S.
The amount of opioids prescribed has been increasing since the 1990s, and the number of overdoses and deaths from prescription opioids has also increased, according to CDC.
There has been increased attention across the country to the prescribing of opioids, and the Defense Health Agency and military services have also been taking steps to address the issue. That includes a DoD instruction establishing a comprehensive, standardized pain management model for the system to provide consistent, quality and safe care for patients with pain.
Some takeaways from Peters' presentation:
- Active-duty troops with opioid prescriptions have an average of less than two opioid prescriptions per beneficiary.
- Retirees with opioid prescriptions have an average of about three per beneficiary.
- Dependents of active duty have an average of about two per beneficiary.
- Dependent survivors have an average of more than four prescriptions per beneficiary — the highest average number of prescriptions.
- Overall, from 2010 to 2011, the number and percentage of high-dose opioid prescriptions to military community beneficiaries decreased. But there has been a plateau since then, Peters noted.
- Overall, the percentage of chronic-use opioid prescriptions (90 days or more of medication) declined as a percentage of all opioid prescriptions in the military community decreased between 2010 and 2017. The biggest drop was between 2012 and 2013.
Researchers have also been mapping the geographic opioid prescription patterns in counties with military treatment facilities and separately, in counties where civilian providers accept Tricare.
“Overall these maps really show us that opioid prescription rates have decreased in our system over time on the whole, which is an exciting finding,” Peters said, adding that matches changes in the civilian sector. There were large reductions in the western and southeastern U.S., he said.
But the findings were mixed in terms of the dosage per patient and the percent of providers prescribing opioids.
“In some counties these metrics were increasing, where in others they were decreasing. There was no real pattern,” Peters said.
He said it could be helpful to look further at why certain counties are increasing in the dosage and the prescriptions, while others are decreasing.
“The context of certain localities might be useful in understanding how to identify potentially problematic prescribing and misuse,” he said.
They also mapped the locations of substance-abuse specific treatment facilities, and found very few of those facilities for individuals in the Military Health System.
“Again, we have really low rates of opioid use disorders among our beneficiaries, so that could be driving some of the low utilization of those treatment facilities for that purpose,” Peters said.