By Capt. Christina Lyon, Courtesy of 19th Medical Group
/ Published January 24, 2019
According to the Centers for Disease Control and Prevention, on average 130 Americans die every day from opioid overdose. Over the past 10 years, there has been growing concern regarding misuse and overdose with prescription opioids and benzodiazepines. Active-duty and veteran service members are at an increased risk when compared to the civilian population due to the higher level of chronic pain and mental health disorders.
Opioid Crisis by the numbers (NIH):
Roughly 21-29 percent of patients prescribed opioids for chronic pain misuse them.
8-12 percent of patients develop an opioid use disorder/addiction.
4-6 percent of patients who misuse prescription opioids transition to heroin for pain management.
Opioids are pain medications that are commonly prescribed to treat acute pain following an injury or surgery. While opioids have been shown to be effective in treating moderate to severe acute pain, their use for long-term chronic pain is less effective and carries increased risk for adverse effects. Prolonged use of opioids can lead to dependence, and when misused, can lead to addiction, accidental overdose and death. The most common opioids prescribed include: hydrocodone (Norco/Vicodin) and oxycodone (Oxycontin/Percocet).
A 2014 study evaluating post-deployment soldiers revealed 44 percent suffered from chronic pain (pain greater than 3 months) and 15 percent reported using prescription opioids to manage this pain. In 2016 the CDC released “Guidelines for prescribing Opioids in Chronic Pain Management”, which has prompted a paradigm shift encouraging providers to utilize non-opioid and non-pharmacologic ways to manage chronic pain.
In conjunction with the opioid crisis, there has been growing concern regarding the use of benzodiazepines among service members. Benzodiazepines are a prescription sedative that can be prescribed to treat anxiety, insomnia, and post-traumatic stress disorder. Common benzodiazepines include: diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin). Like opioids, benzodiazepines have a high risk of dependence, addiction, and fatal overdose. These medications are particularly dangerous when combined with opioids or alcohol, due to their ability suppress breathing and cognitive function. Per the NIH in 2015, 23 percent of people who died from opioid overdose also tested positive for benzodiazepines. The CDC’s recent guidelines discourage providers from prescribing opioids and benzodiazepines concurrently. Additionally a Food and Drug Administration “black box” warning has been added to these medications to expose the dangers of using them together.
In 2012, the DOD expanded the urine drug test panel to include opioids and benzodiazepines. Expansion of the panel has unveiled the misuse of prescription medications among service members. These medications are commonly misused when they are taken more frequently, taken in a larger quantity, or taken for a different indication (for example, using opioids prescribed for dental surgery to treat chronic back pain or to attain a “high”). Per the CDC, more than 11.5 million Americans, reported misusing prescription opioids in 2016. Not only is misuse of prescription opioids dangerous from a health perspective, it is subject to legal ramifications. Inappropriate use of prescription drugs is a military readiness issue due to the risk for addiction and mind altering properties that interfere with the service member’s ability to complete the mission.
At Little Rock AFB, we are joining the national efforts to combat this public health crisis. The 19th Medical Group providers adhere to the CDC’s guidelines for prescribing opioids. The 19th MDG pharmacy has a site for safe disposal of unused prescriptions, further preventing the opportunity for misuse. Additionally, the 19th MDG offers the Alcohol and Drug Abuse Prevention and Treatment program to promote readiness and health through the prevention and comprehensive treatment of substance abuse problems.