A Systematic Review of the Prevention and Treatment of Prescription Drug Misuse

Published in: Military Medicine, v. 181, no. 5, May 2016, p. 410-423

Posted on RAND.org on May 09, 2016

by Janice C. Blanchard, Sarah B. Hunter, Karen Chan Osilla, Warren Stewart, Jennifer Walters, Rosalie Liccardo Pacula

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Research Questions

  1. Are there effective approaches to prevent, identify, and treat the misuse of prescription drugs that the U.S. Department of Defense (DoD) can adopt?
  2. What guidelines does DoD have in place, and how do they compare with non-military guidelines?

OBJECTIVES: This is a review and evaluation of the current clinical guidelines and empirical literature in relation to the Department of Defense (DoD) policies and directives regarding prescription drug misuse (PDM). METHODS: Sources were 11 clinical guidelines and consensus statements, 20 DoD Directives and the published literature from 2000 to 2012. Articles were included if they specifically focused on the prevention or treatment of PDM. RESULTS: DoD directives were evaluated in relation to the clinical guidelines and the relevant research literature. Empirical evidence supporting the directives was limited. CONCLUSIONS: There is little empirical evidence for the prevention and treatment of PDM and the majority of published guidelines and studies focus on prescription opioids. Important limitations include the lack of information about appropriately identifying and managing persons at risk for PDM. More research is needed to identify and recommend effective mechanisms for the prevention and treatment of PDM.

Key Findings

  • Of 20 directives authored by DoD and other military entities, none focused on treatment options for prescription drug misuse.
  • Guidelines and consensus statements within and outside the military mainly focused on misuse of prescription opioids; clinical recommendations appear to be similar.
  • The evidence base for current approaches to predicting misuse is not strong.
  • Treatment approaches need to be based on individual needs.


Policymakers and researchers should seek more data on prevention and treatment approaches to build a stronger evidence base.

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