Christina R. Dean, PhD
March 11, 2022

Prescription medication misuse amongst the general population continues to be a significant concern in the Unites States, as overdose deaths involving prescription opioids increased from 14,139 deaths in 2019 to 16,416 deaths in 2020.¹ Despite increased military prevention and treatment efforts for substance misuse, prescription medication misuse is also a concern amongst veteran and military populations who are at a greater risk for developing physical or mental health conditions compared to the general public. Military service members commonly experience increased and ongoing stress or pain levels specifically related to their unique military experiences (e.g. deployment, combat exposure, physical injuries, and post-deployment civilian/reintegration challenges) – all of which increases their risk of developing mental health concerns and a substance use problem.² Below are some recent military-related facts related to substance use problems:

• Research shows that mental health concerns (e.g., PTSD, depression and anxiety)2 are strongly associated with substance use problems
• Nearly 11 percent seeking first-time care within the VHA system, meet criteria for a substance use diagnosis
• Since 2003 nearly 30 percent of Army suicides and over 45 percent of suicide attempts involved substance misuse²

When used as recommended, prescription medications can be very effective in treating the symptoms of pain, anxiety or depression. However, long-term use or misuse can result in dangerous side effects that must also be considered. Prescription medication misuse is defined as taking an approved, medication in a way that differs from how your doctor prescribed it:³

• Taking prescription medication for a concern or a complaint that it was not prescribed for
• Using more than the prescribed dose or against your doctor's advice
• Using another person's prescribed medications
• Using prescription medication to get high or for stress relief

Common warning signs of prescription medication misuse include:

• "Losing" your prescriptions repeatedly or requesting refills too soon
• "Shopping" for a doctor to get a new prescription
• Using medications prescribed to someone else
• Using illicit medications as a replacement

We live in a world where taking a pill may often seem like a quick solution to many of life's problems. For example, while prescription opioids have proven to be very effective in relieving chronic pain when used as prescribed, the misuse of opioid prescriptions has become a significant concern. Unfortunately, many individuals continue taking too much medication, or use it after their prescription has expired, and may develop an addiction over time. Some television and radio advertisements promote the use of prescription medications for health concerns, while promising to make us feel better quickly - only to briefly note potentially harmful side effects. The potentially harmful side effects of taking prescription medications can be easily overlooked, confusing, or even ignored altogether.

In 2020, individuals age 12 or older (including military personnel) reported prescription medication misuse rates⁴ as follows:

• Psychotherapeutic medications: 5.8% (16.1 million people)
• Pain relievers: 3.3% (or 9.3 million people)
• Tranquilizers or sedatives: 2.2% (6.2 million people)
• Stimulants: 1.8% (5.1 million people)
• Benzodiazepines: 1.7% (4.8 million people)

Prevention is key

Before taking any prescribed medication discuss your concerns, use of alcohol, over-the-counter medications or supplements with your doctor due to potentially harmful side effects. Attempt to educate yourself about the pros and cons of taking each prescription, set realistic expectations, and be aware of your common "go to" stress response to develop healthier ways to deal with stress (e.g., resilience training, meditation, counseling, etc.). Prescribed medications should only be taken based on your doctor's recommendations.

To help prevent misuse of your prescription medications, here are some important steps⁵ to keep in mind:

• Follow the prescribed instructions as provided on the medication label, by your pharmacist and your doctor
• Identify possible concerns early; be aware of and always ask your doctor or pharmacist about possible interactions with other medications, drugs, or alcohol
• Only take medicine prescribed to you and keep your prescription medication to yourself
• Store and discard all prescriptions as recommended and in a safe manner (e.g., store away from children or pets, properly throw away unused or expired medication at approved facilities or containers, etc.)

Who can help?

If you are misusing your prescription medication(s), consider seeking professional help. You can reach for help through your chain-of-command (e.g., commander, first line leader, or peers), seek care directly with a behavioral health or substance misuse/abuse treatment specialist at your military treatment facility, or obtain a referral to specialized treatment from your healthcare provider. Commanders and medical providers are required to refer service members with a suspected medication use problem for further assessment. Free treatment is available to all service members for substance misuse and abuse.

Service members can request assessment at a military treatment facility, without having to notify their commander, if prescription medication use becomes a problem; service members must notify command when enrolling in specialized treatment programs.

Confidentiality is limited: your commander can check treatment progress for substance misuse/abuse and may ask for information to assist in your progress or for determining your fitness for duty; their involvement can support your treatment success and your efforts to rebuild close relationships.

If you are misusing your prescription medications or are having suicidal thoughts, the following resources may provide the help you need. Most importantly, while it may be difficult to admit that you have developed a problem, reaching out for help is a sign of strength. Talk to your command, therapist, chaplain, or healthcare provider about your concerns now for a brighter tomorrow.

Additional Resources

• Military Crisis Line
• Substance Abuse and Mental Health Services Administration (SAMHSA)
• Department of Veterans Affairs & Department of Defense. (2021). VA/DOD Clinical Practice Guideline for the Management of Substance Use Disorders. Version 4.0.

References

1. Centers for Disease Control and Prevention, National Center on Health Statistics. (2021, December). Multiple Cause of Death 1999-2020. (CDC WONDER). https://wonder.cdc.gov/wonder/help/mcd.html
2. Teeters, J. B., Lancaster, C. L., Brown, D. G., & Back, S. E. (2017). Substance use disorders in military veterans: prevalence and treatment challenges. Substance abuse and rehabilitation, 8, 69–77. https://doi.org/10.2147/SAR.S116720
3. Inoue, C., Shawler, E., Jordan, C. H., & Jackson, C. A. (2021). Veteran and Military Mental Health Issues. StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK572092/
4. Center for Behavioral Health Statistics and Quality. (2021). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (Publication Number PEP21-07-01-003). U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration. https://www.samhsa.gov/data/sites/default/files/reports/rpt35325/NSDUHFFRPDFWHTMLFiles2020/2020NSDUHFFR1PDFW102121.pdf
5. National Institute on Drug Abuse. (2020, June). Misuse of prescription drugs research report. U.S. Department of Health and Human Services, National Institutes of Health. https://nida.nih.gov/publications/research-reports/misuse-prescription-drugs/overview

Dr. Dean is a contracted psychologist subject matter expert for clinical care at the Psychological Health Center of Excellence. She has a doctorate in clinical psychology and has both civilian and military experience in administrative, research, training and practice experience working with service members and veterans. She also currently serves as the Indiana Deputy State Surgeon with the Indiana Army National Guard.