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Research Questions

  1. How do prescription drug use and misuse among service members affect the military?
  2. Is it possible to build a predictive model to help the military understand future trends in prescription drug misuse?
  3. What promising practices can be applied to the military context to prevent and manage (i.e., treat) prescription drug misuse among military personnel?

Prescription drug misuse (PDM) is of critical concern for the military because of its potential impact on military readiness, the health and well-being of military personnel, and associated health care costs. The purpose of this report is to summarize insights gleaned from a series of activities that the RAND Corporation undertook for the Deputy Assistant Secretary of Defense for Readiness to address this important health and military readiness issue. The authors completed a review of U.S. Department of Defense policies and a comprehensive literature review of clinical guidelines and the empirical literature on the prevention and treatment of PDM and conducted individual face-to-face interviews with 66 health and behavioral health care providers at nine medical treatment facilities across three regions within the contiguous United States to identify best practices in the prevention, identification, and treatment of PDM and the extent to which those practices are known and followed. The report also presents the framework of an analytic tool that, once informed by data available to the military but not available to the authors, can assist the military in predicting future trends in PDM based on current demographics of active-duty service members and rates of injury and prescribing of prescription drugs. The findings from this work led the authors to formulate a set of key insights that they believe might improve the rapid identification and treatment of service members dealing with PDM, thereby improving future force readiness.

Key Findings

More Information Is Needed to Make the Best Decisions Moving Forward

  • Few available evidence-based solutions focus specifically on the prevention or treatment of prescription drug misuse (PDM) in the military or civilian practice. Those guidelines that do exist largely focus on assessing risk, but generally within context of broader substance use.
  • Many health providers lack general knowledge or training on how to deal with complex patient cases suffering from acute or chronic pain and PDM.
  • U.S. Department of Defense (DoD) regulations are complex, emphasizing a general zero tolerance approach to drugs with little mention of addressing prescription drug use and misuse.
  • Providers reported greater collaboration between providers since the institution of patient-centered medical homes (PCMHs) through the use of embedded case managers and behavioral health therapists to facilitate chart reviews and communication about and management of active-duty service members (ADSMs) with PDM and at risk for PDM.
  • Pain management and patient-centered, complementary services are not readily available or accessible to those suffering from chronic pain, which leads many to rely on prescription pain medications. Few within the Military Health System (MHS) provide these services; where they are available, waiting lists can be long.
  • There is a need for more consistent guidelines for PDM patients and adherence to those guidelines in both the military and civilian practice.

Recommendations

  • Implement and parameterize the compartmental model developed in this report to enable a clear assessment of the extent to which the current prescription drug misuse (PDM) problem within the military stems from abuse following legitimate medical need or simple inappropriate use.
  • Dedicate resources to providing remedial training and support to all military health care providers in the identification and treatment of PDM in patients.
  • Facilitate interdisciplinary provider coordination in approaches to identifying and treating PDM, as well as the transition to integrated care.
  • For those suffering with chronic pain, expand the availability of and access to pain management and patient-centered practices within the military health system.
  • Encourage military provider access to and participation in state-run prescription drug monitoring programs, which are designed to help prevent over-prescribing of opioids to patients in civilian practice.
  • Determine whether military substance abuse programs should provide unique, PDM-focused treatment for service members who develop dependence on prescription medications.
  • Consider adoption, implementation, and improved dissemination of a U.S. Department of Defense–wide limited-use policy.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Literature Review of Military and Civilian Practices and Guidelines for Prescription Drug Misuse

  • Chapter Three

    Designing a Tool to Assist in Identifying Prescription Drug Misuse Among Current and Future Active-Duty Service Members

  • Chapter Four

    Our Qualitative Assessment of Military Health Providers' Views on Prescription Drug Misuse

  • Chapter Five

    Recommendations and Conclusions

  • Appendix A

    Key-Word Literature Searches

  • Appendix B

    Analytic Tool for Understanding Flow of Prescription Drug Misuse

  • Appendix C

    Tools Used in the Qualitative Interview

This research was sponsored by the Deputy Assistant Secretary of Defense for Readiness and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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