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More Information Is Needed to Make the Best Decisions Moving Forward

• Few available evidence-based solutions focus specifically on the prevention or treatment of prescription drug misuse (PDM) in the military or civilian practice. Those guidelines that do exist largely focus on assessing risk, but generally within context of broader substance use.
• Many health providers lack general knowledge or training on how to deal with complex patient cases suffering from acute or chronic pain and PDM.
• U.S. Department of Defense (DoD) regulations are complex, emphasizing a general zero tolerance approach to drugs with little mention of addressing prescription drug use and misuse.
• Providers reported greater collaboration between providers since the institution of patient-centered medical homes (PCMHs) through the use of embedded case managers and behavioral health therapists to facilitate chart reviews and communication about and management of active-duty service members (ADSMs) with PDM and at risk for PDM.
• Pain management and patient-centered, complementary services are not readily available or accessible to those suffering from chronic pain, which leads many to rely on prescription pain medications. Few within the Military Health System (MHS) provide these services; where they are available, waiting lists can be long.
• There is a need for more consistent guidelines for PDM patients and adherence to those guidelines in both the military and civilian practice.

Prescription drug misuse (PDM) is of critical concern for the military because of its potential impact on military readiness, the health and well-being of military personnel, and associated health care costs. The purpose of this report is to summarize insights gleaned from a series of activities that the RAND Corporation undertook for the Deputy Assistant Secretary of Defense for Readiness to address this important health and military readiness issue. The authors completed a review of U.S. Department of Defense policies and a comprehensive literature review of clinical guidelines and the empirical literature on the prevention and treatment of PDM and conducted individual face-to-face interviews with 66 health and behavioral health care providers at nine medical treatment facilities across three regions within the contiguous United States to identify best practices in the prevention, identification, and treatment of PDM and the extent to which those practices are known and followed. The report also presents the framework of an analytic tool that, once informed by data available to the military but not available to the authors, can assist the military in predicting future trends in PDM based on current demographics of active-duty service members and rates of injury and prescribing of prescription drugs. The findings from this work led the authors to formulate a set of key insights that they believe might improve the rapid identification and treatment of service members dealing with PDM, thereby improving future force readiness.

• Chapter One

  Introduction

• Chapter Two

  Literature Review of Military and Civilian Practices and Guidelines for Prescription Drug Misuse

• Chapter Three

  Designing a Tool to Assist in Identifying Prescription Drug Misuse Among Current and Future Active-Duty Service Members

• Chapter Four

  Our Qualitative Assessment of Military Health Providers' Views on Prescription Drug Misuse

• Chapter Five

  Recommendations and Conclusions

• Appendix A

  Key-Word Literature Searches

• Appendix B

  Analytic Tool for Understanding Flow of Prescription Drug Misuse

• Appendix C

  Tools Used in the Qualitative Interview