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Pentagon Launches Prescription Monitoring Program to Curb Substance Abuse

Patricia Kime | Military.com

Military hospitals, clinics and pharmacies will soon share information on prescriptions written for controlled substances with civilian doctors in nine states, part of a growing effort to stem addiction and illegal transfer of medications such as opioids within the military population.

Defense Health Agency (DHA) officials said Tuesday that the information, which will include the number of prescriptions as well as the quantity and strength of dosages, will be shared to ensure that patients aren't receiving overlapping or additional prescriptions outside the military health system.

The goal is to sign agreements with all 49 states and several territories enrolled in the National Association of Boards of Pharmacy's Prescription Monitoring Program Interconnect System, which monitors prescriptions for restricted drugs nationwide, according to DHA.

Navy Vice Adm. Raquel Bono, director of the DHA, said the launch of the Military Health System Prescription Drug Monitoring Program, or MHSPDMP, gives military and civilian treatment facilities "a powerful tool for opioid safety."

"The [program] will allow civilian and military providers to review patient opioid prescription histories to ensure there are no overlapping opioid prescriptions that can worsen an opioid use disorder or cause an overdose," Bono said in a release.

Each state's monitoring programs differ in the types of medications they track. The DHA did not list the specific medications that would be shared through MHSPDMP, only that it will track "controlled substances."

This could include up to 150 types of medications -- narcotics; opiates; opioids; stimulants, including some medications for attention-deficit hyperactivity disorder; depressants; barbiturates; and benzodiazepines like Xanax and Valium, among others.

As the nation struggles to address opioid dependence in the general population -- in 2017, 47,600 Americans died of opioid overdoses -- drug-related addiction disorders in the military remain relatively rare.

Of the more than nine million beneficiaries in the military health system, which includes 1.3 million active-duty service members, roughly 600 active-duty troops were diagnosed with an opioid use disorder, or OUD, in 2016, down from nearly 2,000 in 2011.

That same year, about 500 military retirees and roughly 600 dependents of active-duty personnel were diagnosed as abusing opioids, and another 1,400 beneficiaries -- dependents of retired personnel, dependents of deceased retired personnel and other people seen in the military health system -- received the same diagnosis, according to a presentation given by Zachary Peters, a researcher with the DHA Psychological Health Center of Excellence, at the annual meeting of AMSUS, the Society of Federal Health Professionals, in December.

By contrast, nearly one in five active-duty members had a prescription for an opioid, while one in four retirees had one in 2016, according to Peters.

From 2006 to 2014, a total 117,118 Tricare beneficiaries, including active-duty service members, retirees and dependents, were considered to be dependent on opioids (excluding patients with a diagnosis of cancer, for whom opioids are used to treat pain).

The research, published in 2017 in JAMA Surgery, noted that just 458 of those patients received a prescription following an inpatient procedure. More than 30 percent were prescribed them for ill-defined conditions such as general pain.

The states now participating in the military's drug monitoring program include several with large military populations, including Virginia, North Carolina, Texas and parts of Colorado. The others are Idaho, Mississippi, North Dakota, Oklahoma and South Carolina. Puerto Rico also has signed on.

Eight of the nine states, plus Puerto Rico, track prescriptions for Schedule II through V drugs -- classifications that include medications with high risk for dependency as well as those with a low risk but potential side effects that require tighter controls.

South Carolina tracks only Schedule II through IV drugs, declining to monitor medications such as cough syrup with low doses of codeine or anti-diarrheal medications, which contain small amounts of opiates. Virginia tracks gabapentin and naloxone prescriptions, while North Dakota tracks gabapentin.

All nine states and Puerto Rico also share their databases with law enforcement.

In addition to DHA sharing its prescription data, the agreements with states are reciprocal, meaning that DHA providers will have access to prescription information written by civilian doctors for their military patients.

Patients who get their prescriptions for these medications through civilian doctors and the Tricare pharmacy network or mail-order system already have been participating in state PDMPs.

DHA officials said they intend to sign agreements with the remaining 40 states that participate, the District of Columbia and Guam "in the near future." Missouri is the only locale that doesn't have a statewide registry. St. Louis County, Missouri, participates in a PDMP.

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