The Opioid Epidemic: Challenge to Military Medicine and National Security

Abstract

Introduction We examine the current status of the military relevance of opioids, their use and misuse in military and veteran populations, the national security consequences of opioid use in our military age population, public health implications, and military, veteran, and government solutions for opioid addiction. Materials and Methods A literature search of recent published research, federal government, and related open source materials was conducted using PubMed, Google, and Google Scholar, and all materials retrieved were manually identified, screened, and evaluated for inclusion. A modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach was used for the selection of relevant articles. Heath policy literature and relevant demographic information published within the last 5 years was also included to provide current information and search for solutions to address the escalating national opioid crisis. Results Synthetic opioids are used for pain and trauma management, not readily substituted, and have exceptionally high addiction potential. Combat wounded veterans have greater potential for opioid misuse than civilian populations. Assessment, management, and treatment of opioid use in this population are essential. Veterans receiving synthetic opioids have been noted to have multiple overdose risk factors. Opioids are readily available nationally as “street drugs” and also in the form of fentanyl-contaminated heroin. The opioid crisis affects the military age population and the top states for military enlistments. Younger age males with lower education and income are at significant risk for opioid use disorder. Recently increased drug overdose deaths contribute to an increased U.S. mortality rate with a commensurate decline in life expectancy at birth. Opioid abuse contributes to increased incidence of infectious disease. Behavioral health programs directed at military and veterans to identify risk factors for opioid misuse have been introduced. Prescription drug monitoring initiatives continue for these populations with increased information exchanged between military and civilian healthcare. Lifesaving interventions for opioid addiction include methadone maintenance and fentanyl test strip accessibility. Newly implemented federal funding healthcare initiatives to the states are now directed at opioid use prevention and enhanced surveillance. Conclusions Given increasing rates of opioid addiction and death, viable solutions are universally needed. Successful intervention measures should be widely shared between military, veteran, and civilian healthcare and public health communities. Increased collaboration between these groups could inculcate successful programs to prevent and decrease opioid use. Results received from recent military and veterans’ programs for prescription and electronic medical record (EMR) monitoring and data sharing may also prove useful for civilian healthcare providers and hospital systems. Future evaluations from ongoing federally funded programs to the states for addiction surveillance and intervention may help create measures to address the proliferation of opioid addiction with increased death rates. Anticipated results from these federal efforts should help inform opioid programs in military and veterans’ health systems.

Novel Vaccine That Blunts Fentanyl Effects and Sequesters Ultrapotent Fentanyl Analogues

“…8 − 10 The more potent fentanyl analogues, for example, carfentanil, could pose a risk to national security because of its potential use as a chemical weapon. 11 , 12 The abuse of fentanyl and other opioids has also been shown to be one of the causes of the spread of human immunodeficiency virus (HIV), 13 hepatitis C virus (HCV), and other infectious diseases. 14 , 15 Among the 1.8 million HIV cases reported in 2018 in the United States, 125,000 were attributed to injection drug use.…”

Extension for Community Healthcare Outcomes (ECHO) Telementoring in the Military: Where We Are Now, Opportunities and Challenges

“…Each program has done a comprehensive job of making its content available across services, of collaborating in design and delivery of needed content, and of engaging a broad variety of clinical learners in acquiring new knowledge and skills. Military ECHO programs are integral parts of reducing the burdens of opioid overdose, 16 diabetes, sexual assault, and amputation care among active and retired personnel and their dependents. These programs ensure that small and large MTFs can deliver a uniform standard of care while expanding the capacity of military primary and specialty clinicians to make effective use of limited resources.…”

How sleep can help maximize human potential: The role of leaders

“…44 To further complicate the issue, opioids have become common for the management of chronic pain, with opioid misuse rates higher in the military, and especially those post combat-deployment, compared to civilian populations. 45 However, opioids are also associated with disordered sleep 46 ; as little as one dose can adversely affect sleep architecture. 47 Mental health disorders, especially depression and post-traumatic stress disorder are highly prevalent in service members and often co-present with chronic pain disorders.…”