Addressing Opioid Use After Service-Related Injuries

Key Takeaways

• Service-related injuries can lead to long-term health consequences for veterans, including chronic pain and PTSD.
• Opioid use among service members is a significant concern, with a high prevalence of opioid use disorders in the general population.
• Factors contributing to opioid use among injured service members include pain management challenges, mental health issues, and access to healthcare services.
• Opioid use has substantial physical, psychological, and social effects on service members, necessitating comprehensive strategies for management and recovery.
• The Military Health System has seen a decline in opioid prescriptions, reflecting a shift towards safer pain management practices.
• Prescription practices play a crucial role in opioid dependency, with efforts to curb overprescription and improve monitoring.
• Alternative pain management therapies are emerging as promising options to reduce opioid dependency among service members.
• Comprehensive strategies to combat opioid use among service members include prevention, treatment, and policy reforms.
• Effective prevention strategies for opioid use involve education, early intervention, and evidence-based practices.
• Comprehensive treatment approaches for Opioid Use Disorder combine medication-assisted treatment with behavioral therapies.
• Policy initiatives are being implemented to improve treatment access and modify prescription practices for service members.

Overview of Service-Related Injuries and Their Impact on Veterans

Service-related injuries encompass a wide range of health issues that veterans may experience as a result of their military service. These injuries can occur during combat or as a result of the physical demands placed on service members. Common injuries include hearing damage, traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and exposure to harmful substances such as asbestos and burn pit emissions. Research shows that military service members often enter service healthier than their civilian counterparts but face unique risks that can lead to long-term health consequences.

Some veterans carry the burden of their injuries for a lifetime, with the largest share of wounded warriors having served during the Vietnam War era. Injuries can be both physical and psychological, with conditions like chronic pain and PTSD being prevalent among veterans. These conditions not only affect the quality of life but also contribute to disability and the need for medical care, as indicated by RAND Corporation's findings that pain and injuries are leading causes of hospitalizations and disability payments within the Department of Defense.

Moreover, service-related injuries can have cascading effects, leading to secondary conditions such as depression and anxiety, which arise from the challenges of living with chronic pain and the diminished quality of life. The healthcare needs of veterans with service-related injuries are complex and multifaceted, requiring a holistic approach to address the physical and mental health challenges they face post-service.

Understanding Opioid Use Prevalence Among Injured Service Members

The prevalence of opioid use among service members, particularly those with service-related injuries, is a pressing concern. Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that in 2022, approximately 6.1 million Americans aged 12 and older had an opioid use disorder. While specific data on service members is not provided, the high-stress environment and the nature of service-related injuries suggest that opioid use may be a significant issue within this population. SAMHSA's annual survey provides insight into the broader trends of substance use and mental health, which can impact service members both during and after their service.

A study published in Regional Anesthesia & Pain Medicine highlights that the proportion of military members receiving prescription opioids through the Military Health System (MHS) decreased from 2.7% in 2017 to 1.3% in 2020. This decline suggests a shift in prescription practices within military healthcare, potentially reflecting a growing awareness of the risks associated with opioid use. However, the prevalence of opioid use disorders remains a concern, with the general population showing an 11.9% prevalence, and even higher rates among those with chronic pain (CP) and high-impact chronic pain (HICP).

Moreover, the Centers for Disease Control and Prevention (CDC) reports that opioid overdose deaths have increased tenfold since 1999, with over 80,000 fatalities in 2021 alone, a significant portion of which involved synthetic opioids like fentanyl. These statistics underscore the gravity of the opioid crisis and its potential impact on service members who may turn to opioids as a means of coping with pain and trauma associated with their service.

Understanding the Contributing Factors to Opioid Use Among Injured Service Members

The opioid crisis continues to affect millions, with a notable impact on service members who have sustained injuries. A variety of factors contribute to the high rates of opioid use among this group, including pain management challenges and mental health issues. The Substance Abuse and Mental Health Services Administration reported that millions have an opioid use disorder, highlighting the scale of the issue. Research indicates that the biology of injury and neurological dysfunction in chronic pain are significant contributors to opioid use. Furthermore, mental health concerns such as depression, PTSD, and military sexual trauma can lead to self-medication with opioids, exacerbating the risk of opioid use disorder (OUD).

Access to healthcare services, particularly through the Veterans Affairs (VA), plays a crucial role in managing opioid use. A lack of access to healthcare and low rates of VA utilization are potential risk factors for overdose among veterans. Conversely, those with complex clinical conditions and higher medical needs are more likely to utilize the VA, potentially increasing the overdose mortality rate in this high-risk population. The Journal of the American Medical Association has linked higher initial doses of opioids post-injury to long-term opioid use, emphasizing the importance of prescription practices in the development of OUD.

Addressing these factors requires a multifaceted approach, including careful prescription practices, increased access to alternative pain management treatments, and mental health support tailored to the unique experiences of service members. By understanding the complex interplay of these factors, we can better support injured service members in their recovery and reduce the risk of opioid dependency.

Physical, Psychological, and Social Effects of Opioid Use on Service Members

The opioid crisis has deeply affected service members, leading to significant physical, psychological, and social consequences. Physically, opioid use can lead to dependence and increased tolerance, necessitating higher doses for pain relief and potentially resulting in overdose. The prevalence of non-medical use of prescription opioids has more than doubled, and the severity of nonmedical use has also increased among service members.

Psychologically, opioids can serve as a refuge from trauma and stress, but they also impair executive functions critical for decision-making and self-regulation. This impairment is associated with deficits in the prefrontal cortex, which can affect emotional regulation and lead to further substance use disorders. The stigma surrounding opioid use further undermines care and can prevent service members from seeking help, as highlighted by the American Psychological Association.

Socially, opioid use can lead to isolation and a breakdown of community and family relationships. The crisis is not only a health issue but also a social one, where factors like employment, housing, and education play a role in substance use disorders. Service members may face challenges in reintegration into civilian life, further exacerbating the issue. The Brandeis Opioid Resource Connector discusses how addressing social determinants of health could improve outcomes for those affected by opioid use disorder (OUD).

Overall, the impact of opioid use on service members is multifaceted, requiring comprehensive strategies that address the biological, psychological, and social aspects of addiction.

Healthcare System Influence on Opioid Use Among Service Members

The healthcare system plays a significant role in managing opioid use among service members, both in terms of prescribing practices and offering alternative treatments. A notable trend within the Military Health System (MHS) is the decline in opioid prescriptions, with a 69% reduction in prescriptions for active-duty service members from April 2017 to July 2021. This decline reflects efforts to mitigate the risk of opioid misuse and dependency.

Despite the reduction in prescriptions, the risk of opioid use disorder (OUD) and overdose remains a concern, particularly given the presence of fentanyl in illicit drugs. The Department of Defense has begun to track drug overdoses more closely and provide overdose antidotes like naloxone, indicating a proactive approach to the opioid crisis within military ranks.

Alternative pain management strategies are crucial in reducing reliance on opioids. The healthcare system's role includes not only the safe prescribing of opioids but also the integration of interdisciplinary approaches to pain management. Studies suggest that such strategies can improve rehabilitation outcomes and reduce long-term opioid therapy needs. The biopsychosocial framework is one example, addressing the physiological, psychological, and sociological aspects of pain and recovery.

Overall, the MHS is adapting its approach to opioid use, balancing the need for effective pain management with the risks of addiction and overdose. The shift towards data-driven practices and the provision of alternative treatments is a positive step towards safeguarding service members' health and readiness.

Understanding Prescription Practices and Their Role in Opioid Dependency

Prescription practices within the healthcare system play a critical role in the management of pain but also bear a significant responsibility in the development of opioid use and dependency. The emergence of the opioid epidemic has been partly attributed to the overprescription of opioids for pain management, leading to increased rates of misuse and addiction. Efforts to address this issue have included the implementation of prescription drug monitoring programs and legislative measures aimed at curbing excessive opioid prescriptions. Studies indicate that these interventions have contributed to reductions in sustained opioid use.

However, the culture of drug distribution and prescriber behavior remains complex, with factors such as community models of drug distribution, peer intervention models, and the influence of social networks playing a role in opioid use trends. The need for an integrated public health approach is underscored by the recognition that individual-focused treatment strategies may not be sufficient to address the diverse and evolving nature of the opioid crisis. These strategies must consider social determinants, the availability of services, and the design of interventions to fit into existing clinical practices.

Insurance barriers such as 'prior authorization' have also been identified as impediments to timely access to treatment for opioid use disorder (OUD), according to reports from The Guardian. This bureaucratic process can delay the prescribing of critical medications, potentially costing lives in the midst of the opioid epidemic. The healthcare system's role in mitigating opioid use extends beyond prescription practices to include the implementation of evidence-based treatments and ensuring coordinated care post-inpatient treatment to reduce the risk of mortality.

Exploring Alternative Pain Management Therapies for Service Members

Service members dealing with pain from service-related injuries often face the challenge of managing their condition without becoming reliant on opioids. Recent advances in alternative pain management therapies present promising options that may reduce dependency on opioids. A notable development is VX-548, an experimental drug that targets pain in the peripheral nervous system, offering a different mechanism of action compared to opioids and potentially avoiding associated safety risks.

Furthermore, the integration of technology in pain management, such as virtual reality and non-invasive brain stimulation, provides innovative approaches to pain relief. Holistic and alternative therapies, including yoga, meditation, and acupuncture, are gaining traction and are supported by clinical trials indicating their effectiveness in pain management. The comprehensive pain recovery programs combine multiple approaches, including physical therapy and cognitive behavioral therapy, to address pain on an individual level.

Accessibility to these treatments is crucial for service members, as it can significantly influence opioid use. The rise in alternative therapy utilization, as reported by the Pain News Network, may correlate with a national increase in pain prevalence and a concerted effort to mitigate opioid use. The American Medical Association advocates for patient access to non-opioid alternatives, emphasizing individualized care decisions for pain management. As the healthcare system continues to evolve, the availability of these alternative treatments could play a pivotal role in managing service-related injuries while curbing opioid dependency.

Comprehensive Strategies to Combat Opioid Use Among Service Members

Addressing opioid use among service members necessitates a multifaceted approach that includes prevention, treatment, and policy reforms. Prevention strategies involve educating service members on the risks of opioid use, implementing early intervention programs, and ensuring access to non-opioid pain management options. Treatment for opioid use disorder (OUD) should be comprehensive, incorporating medication-assisted treatment (MAT) alongside counseling and behavioral therapies. The recent update of Opioid Treatment Program regulations by HHS is a significant advancement in this area.

Policy changes are also critical in addressing opioid use. This includes improving prescription practices to prevent dependency and ensuring that service members have access to effective treatment during and after their service. The allocation of opioid settlement funds towards opioid remediation efforts is a key example of policy action. Furthermore, expanding access to harm reduction resources such as naloxone can save lives by reversing overdoses.

It is also essential to support service members' reentry into civilian life by providing adequate substance use treatment in reentry programs, as indicated by the Federal Bureau of Prisons' findings on reduced recidivism. Ensuring continuity of care through initiatives like California's Section 1115 reentry services can help prevent relapses and overdoses. A coordinated effort across government and society is necessary to effectively combat the opioid crisis among service members.

Effective Prevention Strategies for Opioid Use

Preventing opioid use, particularly among service members, requires a multifaceted approach that includes education, early intervention, and the implementation of evidence-based practices. The Centers for Disease Control and Prevention (CDC) outlines strategies to assist various stakeholders in preventing opioid overdose within communities. These strategies emphasize the importance of understanding and navigating prevention methods effectively. CDC's evidence-based strategies provide a critical framework for this effort.

Early intervention strategies are crucial, especially in addressing the opioid epidemic among at-risk populations, including service members. Healthcare providers are encouraged to ensure equitable access to evidence-based treatment and resources. Addressing factors such as traumatic events, mental health conditions, and personal or family history of substance use can significantly contribute to prevention efforts. National strategies also call for the development of a skilled prevention workforce, the enhancement of national preventive intervention registries, and the professionalization of the field through training and advocacy.

The U.S. Department of Health and Human Services has taken bold actions as part of its Overdose Prevention Strategy, which aligns with President Biden's initiatives. These include expanding access to life-saving medications for opioid use disorder and supporting the use of grant funds for related programs. HHS' strategy is a testament to the ongoing efforts to combat opioid misuse.

Furthermore, the NIH HEAL Initiative underscores the need for prevention interventions that can be delivered in systems and settings reaching those most affected by the opioid crisis. This includes a focus on social determinants of health and the development of scalable prevention services. NIH's prevention interventions are vital to these comprehensive prevention efforts.

Comprehensive Treatment Approaches for Opioid Use Disorder

Opioid Use Disorder (OUD) is a complex condition that requires a multifaceted approach to treatment, combining medication-assisted treatment (MAT) with behavioral therapies. The U.S. Food and Drug Administration (FDA) has approved several medications for the treatment of OUD, including buprenorphine, methadone, and naltrexone, which are used in conjunction with counseling and psychosocial support. Studies have shown that MAT can improve patient adherence to treatment and reduce illicit opioid use compared to non-pharmacological approaches alone.

Behavioral therapies, such as Cognitive Behavioral Therapy (CBT), are crucial in addressing the psychological aspects of addiction. These therapies help patients modify their thinking and behavior related to drug use, and develop coping strategies to manage stress and triggers for relapse. Integrating behavioral therapies with MAT is considered the most effective intervention for treating OUD, as it addresses both the biological and psychological facets of the disorder.

Access to MAT is essential for effective treatment, yet many individuals face barriers such as inadequate funding for programs and a shortage of qualified providers. The FDA emphasizes the importance of making all approved MAT options available to provide tailored treatments that meet individual needs. Furthermore, the adoption of telehealth services has expanded the reach of MAT, allowing for remote management of OUD, which can be critical for service members who may be geographically isolated or have mobility challenges post-injury.

Policy Initiatives to Curb Opioid Use Among Service Members

Recent policy changes aim to mitigate opioid use among service members by improving treatment access and modifying prescription practices. The Opioid-Overdose Reduction Continuum of Care Approach emphasizes the importance of Overdose Education and Naloxone Distribution (OEND) programs and expanding Medications for Opioid Use Disorder (MOUD) in healthcare and legal systems. These initiatives are crucial for venues where overdoses are more likely to occur and among first responders.

The Biden-Harris Administration has made permanent COVID-19 era flexibilities that allow take-home doses of methadone, reducing the need for frequent clinic visits and easing the treatment process for service members. The Substance Abuse and Mental Health Services Administration (SAMHSA) has proposed updates to federal rules to expand access to OUD treatment, marking the first substantial change to Opioid Treatment Program (OTP) standards in over two decades.

Moreover, the introduction of telehealth services for OUD treatment and the flexibility to prescribe medication without an initial in-person evaluation have been game-changers in increasing treatment accessibility. These policy shifts are expected to help service members receive the necessary care without the barriers of traditional healthcare settings, ultimately aiming to reduce reliance on opioids and enhance recovery outcomes.

If you’re a military veteran seeking addiction treatment, The Recovery Village Cherry Hill at Cooper is here to help. We are a part of the VA Community Care Network, and we offer a trauma-informed program designed for veterans and first responders. Contact a Veteran Advocate today to learn more or to get started with treatment.