U.S. Military veterans and the opioid overdose crisis: a review of risk factors and prevention efforts

Abstract

U.S. military veterans have been heavily impacted by the opioid overdose crisis, with drug overdose mortality rates increasing by 53% from 2010–2019. Risk for overdose among veterans is complex and influenced by ongoing interaction among physiological/biological, psychological, and socio-structural factors. A thorough understanding of opioid-related overdose among veterans, one that goes beyond simple pharmacological determinism, must examine the interplay of pain, pain treatment, and stress, as well as psychological and social experiences—before, during, and after military service. Comprehensive efforts to tackle the overdose crisis among veterans require interventions that address each of these dimensions. Promising interventions include widespread naloxone distribution and increased provision of low-threshold wrap-around services, including medications for opioid use disorder (MOUD) and holistic/complementary approaches. Interventions that are delivered by peers – individuals who share key experiential or sociodemographic characteristics with the population being served – may be ideally suited to address many of the barriers to opioid-related risk mitigation common among veterans. Community care models could be beneficial for the large proportion of veterans who are not connected to the Veterans Health Administration and for veterans who, for various reasons including mental health problems and the avoidance of stigma, are socially isolated or reluctant to use traditional substance use services. Interventions need to be tailored in such a way that they reach those more socially isolated veterans who may not have access to naloxone or the social support to help them in overdose situations. It is important to incorporate the perspectives and voices of veterans with lived experience of substance use into the design and implementation of new overdose prevention resources and strategies to meet the needs of this population. Key messages U.S. military veterans have been heavily impacted by the opioid overdose crisis, with drug overdose mortality rates increasing by 53% from 2010–2019. The risks for overdose that veterans face need to be understood as resulting from an ongoing interaction among biological/physiological, psychological, and social/structural factors. Addressing drug overdose in the veteran population requires accessible and non-judgemental, low threshold, wraparound, and holistic solutions that recognise the complex aetiology of overdose risk for veterans.

Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors

“…Members of the US military are at particularly high risk of OUD or use of other sedatives [72][73][74]. A 53% increase in drug overdose mortality from 2010 to 2019 has been reported [72].…”

“…Members of the US military are at particularly high risk of OUD or use of other sedatives [72][73][74]. A 53% increase in drug overdose mortality from 2010 to 2019 has been reported [72]. In the US military, 98% of patients treated for combat-related injuries received at least one prescription for opioids, and 83% of patients received an outpatient opioid prescription [75••].…”

“…Another risk factor identified in the development of long-term opioid dependence among members of the US military included the prescription of long-acting opioids during the first 30 days of an acute pain or physical trauma, rather than using immediate-release opioids [77]. Finally, veterans may benefit from peer support to help them reduce their substance use and improve their quality of life and mental health [72]. The "buddy system" used during military service can be applied to drug use in veteran circles, where the "buddy" is trained to administer naloxone or render first aid in case of opioid-related breathing problems [72].…”

Using formative evaluation of a community-based opioid overdose prevention program to inform strategic communication for adoption, implementation, and sustainability

“…Certain communities are affected more than others [ 4 ], necessitating multi-sector, community-based approaches [ 5 – 7 ] to ensure positive outcomes [ 8 ]. Communities disproportionately impacted by opioid addiction and overdose include veterans [ 9 ], specific racial/ethnic groups [ 10 ], incarcerated individuals [ 11 ], urban-located [ 12 ], and those experiencing homelessness or who are vulnerably housed [ 13 ]. The combined efforts of public health agencies, public safety agencies, law enforcement, mental health services, and various recovery resources are integral for successful adoption and implementation of comprehensive, multi-sector, community-based opioid overdose interventions [ 1 , 6 , 7 , 14 – 16 ] to ensure positive outcomes through increased collaboration, awareness, and resource allocation.…”

Barriers and facilitators to implementing medications for opioid use disorder and naloxone distribution in Veterans Affairs emergency departments

“…Compared to non-Veterans, Veterans are at an increased risk for opioid-related adverse drug events such as accidental opioid overdose. 10 As such, strategies for harm reduction, like naloxone distribution and M-OUD, have been key priorities for the Veterans Health Administration since 2013. 11 In the VA, there are more than 2.5 million Veteran visits to ~140 urgent care centers (UCC) and EDs annually.…”