Prescription Medication Misuse Among Service Members
Epidemiology
Slide 3
PMM Lecture Goals Define prescription medication misuse (PMM)
Describe the incidence of PMM between military and civilian
matching population subgroups and patterns within subgroups of
Service Members Identify the sources for obtaining misused
medications
Slide 4
Prescription Medication Misuse Definition Taking medications
for non-intended uses, differently than prescribed, without a
prescription or with interacting substances.
Medications Misused 2008 DoD Health Related Behaviors Survey of
Active Duty Service Members, RTI 2008 National Survey on Drug Use
and Health, SAMHSA
Slide 7
Epidemiology of PMM Patterns in Service Members compared to the
US population Age matched Employment matched Gender matching Limits
to comparisons Rates for different groups of Service Members Age
specific rate among Service Members Rates for different ranks of
Service Members Other demographic groupings of Service Members
Increase in incidence over time among Service Members Sources of
misused medications Proportions of medications misused in both
populations
Slide 8
Limitations to Service Member to Civilian Comparison Comparison
of two DIFFERENT studies! Differently worded questions Trends still
revealing Direct comparisons to rate of marijuana use very telling
of scope of problem Limited conclusions but still the best evidence
available
Slide 9
Civilian vs. SM PMM Perspective Potentially higher incidence of
PMM in SMs Service Member vs. civilian rate 11% vs 2.5% 30 day
incidence rate More common than Marijuana use among SMs 3% 30 day
incidence rate (2008 DoD Health Related Behaviors Survey) More
common among Service Members than Marijuana use among civilians
5.8% 30 day incidence rate (National Survey on Drug Use and Health,
2008) Even the limitations of comparing two studies can not explain
this contrast away.
Slide 10
Civilian vs. Military Incidence of PMM Age Matched Comparison
Civilian Incidence 2.5% PMM in past 30 days, 4.4% among members of
general population age matched with Service Members Substance Abuse
and Mental Health Services Administration. Results from the 2009
National Survey on Drug Use and Health: National Findings.
Rockville: Office of Applied Studies 2009. 2008 Department of
Defense survey of health related behaviors among military
personnel, Research Triangle Institute, Research Triangle Park NC
2009 Incidence in Service Members 11.1% 30 days incidence of PMM
18.4% in the past 12 months (23.1% in Army) 2008 Department of
Defense survey of health related behaviors among military
personnel, Research Triangle Institute, Research Triangle Park NC
2009
Slide 11
Rates Matched for Employment Status (PMM or ISA) Higher rate of
all substance misuse or abuse in Service Members when compared to
fully employed civilians Substance Abuse and Mental Health Services
Administration. Results from the 2008 National Survey on Drug Use
and Health: National Findings (Office of Applied Studies, NSDUH
Series H-36, HHS Publication No. SMA 09-4434). Rockville, MD. 2009.
2008 Department of Defense Survey of Health Related Behaviors among
Active Duty Military Personnel. Research Triangle Institute,
Research Triangle Park NC. 2009.
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Service Member vs. Civilian Contrast By age grouping Incidence
significantly decreases with increasing age in general population,
not in Service Members Oldest Service Members show the greatest
deviation from age matched civilian cohort
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PMM by Age Group Service Members Vs. Civilian
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PMM Incidence Gender Comparison Service Members Vs. US
Population US population males have higher incidence Males 4.6% 30
day incidence Females 3.2% 30 day incidence Service Members females
have higher incidence Males 11.4% 30 day incidence Females 13.2% 30
day incidence
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Choice of Medications Misused Roughly equal ratios of %
misusers by medication category/ % of total misusers per population
between the two groups Analgesics chosen by most misusers
Slide 16
Medications Misused Data from 2008 DoD Health Related Behaviors
Survey and 2008 National Survey on Drug Use and Health
Slide 17
Misusers by Medication Category/ Total Misusers in Each
Group
Slide 18
Sources of Misused Medications
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22% obtained through prescription Friends or relatives were the
most common sources 47% obtained them from a friend or relative for
free 13% purchased 2/3 purchased from a friend or relative.
Partnership for a Drug-Free America, Partnership Attitude Tracking
Study Schepis T and Krishnan-Sarin S. Sources of Prescriptions for
Misuse by Adolescents: Differences in Sex, Ethnicity, and Severity
of Misuse in a Population-Based Study. J Am Acad Child Adolesc
Psychiatry. 2009; 48: 828-36. Corroborated by data from National
Survey on Drug Use and Health (NSDUH) performed for Substance Abuse
and Mental Health Administration (SAMHSA) 18% of medications
misused obtained with a prescription Majority from friend or
relative No Service Member specific data 14% of Army received a
prescription for an opioid US Army Suicide Report Media reports
have documented sharing Personal reports of card games with
oxycontin
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Patterns of PMM Among Service Members Varied by rank Varied by
service Varied by deployment history
Slide 21
PMM by Military Rank Rates vary more by military rank (enlisted
vs. officer) than by age
Slide 22
PMM Differences by Rank Difference based on educational level
seen in the general population of the US may partially contribute
to the officer enlisted differences PMM among civilian high school
grads 8.6% PMM among civilian college graduates 5.7% 2008 National
Survey on Drug Use and Health, SAMHSA Junior enlisted typically
have a high school diploma while most officers have a college
degree Doesnt explain the entire difference, particularly among
senior enlisted who routinely have college degrees or higher
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PMM by Service Highest rates in the Army and Marine Corps
Differences achieved statistical significance
Slide 24
PMM by Service Different rates between services not explained
by average age, % enlisted, % officers, % with high school
education only, % with college degree or higher or
combinations
Slide 25
PMM Impact of Deployment 19.1 % of OIF/OEF deployed endorsed in
previous 12 months 17.0 % for never deployed Mild increased
incidence in every service 2008 DoD Survey of Health Related
Behaviors
Slide 26
PMM Overall Trends Common place, recent surveys suggest it is
more common among Service Members Occurring without a prescription
in most cases More common in enlisted Service Members Female
Service Members have higher incidence Increased incidence among
previously deployed Service Members Soldiers and Marines have the
highest incidence, but all services are affected Cause of
increasing health care costs and lost productivity
Slide 27
Patient Scenario Anthony Salazar - Complaint A 21 year old male
who suffers from pain after an upper extremity injury is in a
primary care clinic for the chief complain: I need more pills He
appears agitated as he reports constant pain He would like the
following refills: Oxycodone, Gabapentin, Lorazepam, Quetiapine and
Fluoxetine He would also like a prescription for methadone. A
fellow WTU member shared this drug with him. Methadone has helped
with the pain and sleep
Slide 28
Anthony Salazar - History An IED encounter in Iraq resulted in
the loss of his right arm/forearm and a partial bowel resection He
has had an explorative laparotomy, frequent wound washouts (both
abdomen and upper extremity) and skin grafting to his arm. His most
recent hospitalization was for a medication overdose The patient
finds it difficult to be awake, sleep and interact with anyone He
drinks large quantities of alcohol and smokes 1-2 packs of
cigarettes a day
Slide 29
Anthony Salazar - Questions How common is medication misuse
among US Service Members? How likely is he to seek misused
medications if you refuse to prescribe them? What percentage of
misuse occurs in the absence of a prescription? What about his drug
overdose history? Do you think this patient is suicidal? What
treatment plan would you consider? Medications, therapy?
Detoxification? Complementary medicine?
Slide 30
Military Resources Military Homefront Support 800-342-9647
www.militaryonesource.com Branch Specific Support is also
available: Army Substance Abuse Program (ASAP) Navy Alcohol and
Drub Abuse Prevention (NADAP) Marine Substance Abuse Combat Center
(SACC) Air Force Alcohol and Drub Abuse Prevention and Treatment
(ADAPT)
Slide 31
Non-Military Resources Substance Abuse and Mental Health
Services Administration (SAMHSA)
www.findtreatment.samhsa.govwww.findtreatment.samhsa.gov
1-800-662-HELP National Suicide Prevention Lifeline 800-273-TALK
National Alliance on Mental Illness www.nami.orgwww.nami.org Mental
Health America
www.mentalhealthamerica.netwww.mentalhealthamerica.net American
Academy of Addiction Psychiatry www.aaap.orgwww.aaap.org American
Academy of Child and Adolescent Psychiatry www.aacap.org
www.aacap.org National Drug Abuse Clinical Trials
www.drugabuse.gov/CTN/ or
www.clinicaltrials.govwww.drugabuse.gov/CTN/ www.clinicaltrials.gov
Narcotics Anonymous www.na.org/www.na.org/ Alcoholics Anonymous
www.aa.orgwww.aa.org
