By Marija Kelber, Ph.D.
July 9, 2024

U.S. Navy photo by Mass Communication Specialist 2nd Class Jeffrey F. Yale.

The use of opioids for the treatment of pain became increasingly common towards the end of the 20th century and has led to a decades-long opioid epidemic. In the United States, the total number of opioid prescriptions increased by 104% from the year 2000 to 2010.¹ In 2010, close to 12% of adult Americans used prescription opioids.¹ Opioids can be highly addictive and dangerous if used inappropriately. One pathway to opioid addiction involves being prescribed opioid medication for pain that then escalates to prescription opioid misuse, and even use of illicit drugs such as heroin. High opioid doses or use with other drugs, such as benzodiazepines, can also lead to overdoses and other injuries. Service members experience occupational hazards that may necessitate opioid use to manage pain. In 2010, approximately a quarter of active duty service members received an opioid prescription.²

In recent years, the Department of Defense has devoted a lot of attention to educating providers about how to prescribe opioids responsibly. However, opioid use among service members is not always avoidable and it may negatively affect personnel readiness. Recently, our team at the Psychological Health Center of Excellence conducted a research study to better understand consequences of opioid use in service members.³ Specifically, we sought to examine the association between opioids and subsequent injuries in active duty service members.

The study sample consisted of service members who entered the military between 2005 and 2010. This timeframe was selected because opioid use was particularly high due to lack of awareness of potential risks associated with opioids and a large number of service members who needed opioids to treat wounds they may have incurred during the wars in Afghanistan and Iraq. We examined medical records of 104,261 injured service members and matched them to a control group of uninjured participants. We categorized injuries as self-inflicted injuries, non-self-directed violence, vehicle accidents, accidental falls, alcohol- and drug-related injuries, accidents due to natural and environmental factors, and other accidents. Opioid and benzodiazepine prescriptions in the 30 days prior to injury were examined for both injured participants and controls.

We found that 17% of individuals with an injury and only 4% of the controls had an opioid prescription in the 30 days prior to injury. Benzodiazepines and even low opioid doses (e.g., less than 20 morphine milligram equivalents) were associated with greater odds of injuries. Though the association between opioid dose and injury was similar across injury categories, opioid use increased the likelihood of vehicle accidents, accidental falls, other accidents, non-self-directed violence, and alcohol- and drug-related injuries compared to natural/environmental accidents and self-inflicted injury. Because service members may be less likely to receive high dose prescriptions currently, more research is needed to examine the association between opioids and injuries using more recent data. 

Much attention has been devoted to the increased risk of overdose following opioid use. Our study’s results also highlight the association between opioid/benzodiazepine use and other types of harm. Findings are consistent with the Department of Veterans Affairs/Department of Defense and Centers for Disease Control and Prevention guidelines that recommend avoiding opioids whenever possible, as well as using opioids and benzodiazepines concurrently.^4,5 Opioid use may be unavoidable among service members who become injured in the line of duty and/or are managing chronic pain.  Better understanding of risks associated with opioid use can inform prevention efforts and improve readiness.

References

1. Sites, B. D., Beach, M. L., & Davis, M. (2014). Increases in the use of prescription opioid analgesics and the lack of improvement in disability metrics among users. Regional Anesthesia & Pain Medicine, 39, 6-12.
2. Jeffery, D. D., May, L., Luckey, B., Balison, B. M., & Klette, K. L. (2014). Use and abuse of prescribed opioids, central nervous system depressants, and stimulants among U.S. active duty military personnel in FY 2010. Military Medicine, 179, 1141-1148.
3. Kelber, M. S., Smolenski, D. J., Belsher, B. E., O’Gallagher, K., Issa, F., Stewart, L. T., Evatt, D. P. (2024). The associations of opioid and benzodiazepine prescriptions with injuries among US military service members. Pain.
4. Department of Veterans Affairs, Department of Defense. (2022). VA/DoD Clinical Practice Guideline for the Use of Opioids in the Management of Chronic Pain.
5. Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., Chou R. (2022). CDC clinical practice guideline for prescribing opioids for pain—United States, 2022. Morbidity and Mortality Weekly Report, 71, 1-95.

Marija Kelber, Ph.D. is a research psychologist and a team lead for Evidence Synthesis and Dissemination at the Psychological Health Center of Excellence.