Vice Admiral Raquel Bono, MD, Director, Defense Health Agency https://www.health.mil/dha and Captain Mike Colston MD, Director for Mental Health Programs, within the Office of the Assistant Secretary of Defense Health Affairs, appeared before the House Armed Services Committee’s Subcommittee on Military Personnel on June 20, 2018 to discuss the Defense Department’s current state and future aims in curbing opioid use and abuse.
Research efforts, diagnostic testing, evaluation, and treatments were discussed. Although the Defense Department (DOD) https://www.defense.gov finds it difficult to quantify chronic pain in any population, it is safe to say, chronic pain rates are especially high in active duty and veteran populations.
Dr Bono MD and Dr. Colston MD told the Subcommittee, “The Military Health Service (MHS) https://www.health.mil has introduced a number of initiatives to lower the risk of adverse outcomes from the use of opioids”. For example, DOD has partnered with Express Scripts Inc. https://www.express-scripts.com, DOD’s pharmacy benefits manager, to develop and use the TRICARE Prescription Monitoring Program (PMP).
DOD has also rolled out the MHS Opioid Registry which identifies patients receiving care in Military Treatment Facilities (MTF) who are taking opioids. The data in the registry includes the number of opioid prescriptions filled, the cumulative dosage of opioids, supplemental medical information to enable providers in the MTFs to understand a specific patient’s risk for addiction, death from overdose, or if there are opioid-related complications.
DOD uses a database that examines provider prescribing practices, identifies providers with the highest volume of opioids prescribed by total dosage, and the number of prescriptions issued over a period of time.
DOD is working on adopting and implementing the MHS “Stepped Care Model”, a comprehensive model used for pain management. The “Stepped Care Model” is a help to patients with evidence-based pain management by promoting non-pharmacologic treatments to use to prevent acute pain from becoming chronic and to minimize the use of opioids by appropriately prescribing opioids only when indicated.
In addition, DOD has established the drug “Take Back” program” to help beneficiaries with a way to properly and safely dispose of unused or expired controlled medications. By December 2017, 100 percent of DOD’s MTF’s have established a local “Take Back” program which has collected over 166,000 pounds of drugs.
The Prescription Drug Monitoring Program (PDMP) is an important tool to use for opioid safety. DOD currently shares controlled substance prescription data with state PDMPs for prescriptions issued through DOD mail order or through retail pharmacy networks.
DOD has partnered with NIH and its National Center for Complementary and Integrative Health (NCCIH) https://nccih.nih.gov on developing chronic pain and non-pharmacologic treatment approaches to control pain. This project to be jointly supported by NIH, DOD, and VA, will work on twelve research projects for $81 million over six years.
The research projects will focus on developing, implementing, and testing cost-effective large scale real world research on non-pharmacologic approaches for pain management in both military and veteran healthcare organizations.
Lastly, DOD collaborates with state governments and academic institutions. The Defense and Veterans Center for Integrative Pain Management https://www.dvcipm.org, has established a cooperative research and development agreement with West Virginia University to share pain management education, tools, and expertise.