Addressing Opioid Use After Service-Related Injuries

Key Takeaways

• Service-related injuries, including PTSD and musculoskeletal injuries, significantly contribute to opioid use among veterans.
• Physical injuries from service duties, such as TBIs and musculoskeletal injuries, often lead to chronic pain and opioid use for pain management.
• Psychological injuries like PTSD can lead to self-medication behaviors and an increased risk of opioid use disorder (OUD).
• The opioid crisis has notably affected service members, with mental health issues and lack of healthcare access exacerbating the risk of OUD.
• Opioid prescription rates in the Military Health System have declined, but opioid-related overdose deaths continue to rise in the broader population.
• Opioid misuse has extensive consequences, including health risks, economic costs, and social challenges for service members.
• Comprehensive treatment approaches for OUD in service members include medication-assisted treatment (MAT) and behavioral therapies.
• Prevention strategies focus on enhancing pain management alternatives, education, and access to mental health services.
• Policy recommendations emphasize expanding treatment access, improving prevention programs, and addressing systemic issues.

Common Service-Related Injuries Leading to Opioid Use

Service-related injuries among military veterans are a significant concern, often leading to long-term health complications and the potential for opioid use. These injuries can be both physical and psychological in nature, with some of the most common being post-traumatic stress disorder (PTSD), traumatic brain injuries (TBI), musculoskeletal injuries, and conditions related to toxic exposure. Musculoskeletal injuries, such as strains, sprains, and stress fractures, are prevalent and typically affect the lower extremities, back, and shoulders. These injuries are often the result of overuse and the physical demands of service, including lifting and carrying heavy equipment.

Psychological injuries like PTSD can have profound effects on veterans, necessitating proper medical documentation and treatment. The Pew Research Center notes that veterans with major service-related injuries report more difficulties readjusting to civilian life compared to their uninjured counterparts. Additionally, exposure to harmful substances during service, such as asbestos or oil-well fires, can lead to chronic health issues like mesothelioma or Gulf War Syndrome, characterized by unexplained illnesses including severe fatigue and gastrointestinal disorders.

The prevalence of these service-related injuries contributes to the increased risk of opioid use as veterans seek pain management solutions. With the opioid crisis affecting many Americans, including veterans, understanding these injuries is crucial for providing appropriate care and developing preventive strategies against opioid dependency.

Common Physical Injuries in Service Members Leading to Opioid Use

Service members are at a heightened risk for various physical injuries due to the demanding nature of military duties. Musculoskeletal injuries (MSKIs) are particularly prevalent, often leading to significant healthcare utilization, limited duty, and disability. The spine, especially the lower back, is a common site of injury, with pain in this region reported frequently among the U.S. Armed Forces, both deployed and at home station. These injuries can result in over 40% of outpatient visits being related to overuse injuries in the lower back and knee/lower leg areas.

Another notable injury type is traumatic brain injuries (TBIs), which have seen a substantial increase among active-duty military personnel. Symptoms of TBIs, such as headaches, sleep disorders, and dizziness, can severely impact service members' quality of life and duty performance. Additionally, severe injuries like torn ACLs can increase the risk of osteoarthritis (OA), with smaller injuries or excessive joint loading over time also contributing to OA risk. These conditions are not uncommon in the military due to the physical demands placed on service members.

These physical injuries, particularly when chronic or leading to disability, can contribute to opioid use as service members seek pain management solutions. The financial impact of MSKIs is profound, with billions spent on direct and indirect costs, highlighting the need for effective pain management strategies that mitigate the risk of opioid dependency.

Understanding the Link Between Psychological Injuries and Opioid Use in Service Members

Service members are often exposed to traumatic events that can result in psychological injuries such as Post-Traumatic Stress Disorder (PTSD), which has been identified as a significant factor leading to opioid use and misuse. The interplay between PTSD and opioid use disorder (OUD) is complex, with PTSD symptoms such as agitation and hypervigilance potentially driving self-medication behaviors.

Studies indicate that the presence of PTSD can have a more substantial impact on the quality of life and neurobehavioral outcomes than the severity of traumatic brain injury (TBI) itself. This suggests that psychological injuries can be as debilitating as physical ones, if not more so. Service members with PTSD are at an increased risk for a range of health concerns, including chronic pain, sleep disturbances, and consequently, heightened opioid usage. The prevalence of military sexual trauma is also high among veterans, with those having experienced such trauma showing a 50% higher likelihood of an OUD diagnosis.

Addressing psychological injuries in service members is crucial not only for improving individual health outcomes but also for mitigating the risk of opioid misuse and addiction. This underscores the need for comprehensive care that addresses both the psychological and physical aspects of service-related injuries.

Analyzing the Opioid Crisis Impact on Service Members

The opioid crisis continues to be a significant public health challenge in the United States, with service members being notably affected. The prevalence of opioid use disorders (OUD) among service members is a pressing concern, as evidenced by recent research which indicates a complex interplay of factors contributing to the crisis. The National Institutes of Health highlights the multifaceted nature of opioid misuse within this population, including the influence of mental health issues such as PTSD, depression, and the experience of military sexual trauma. These factors often lead to self-medication with opioids, exacerbating the risk of developing OUD.

Access to healthcare services, particularly through the Veterans Affairs (VA), is a critical barrier for many veterans, with a lack of access or low rates of utilization posing significant risks. However, those who do utilize the VA often have complex medical needs, potentially skewing overdose mortality rates higher due to this concentration of high-risk individuals. The American Psychological Association discusses federal initiatives that aim to address this crisis, including the expansion of evidence-based practices like medication for opioid use disorder and education on safer prescribing.

Efforts to combat the opioid crisis must consider the unique circumstances of service members, including the need for integrated care to address comorbid conditions and the importance of coordinated aftercare following inpatient treatment. The current situation calls for a robust, multi-pronged approach that incorporates evidence-based treatment, prevention strategies, and policies that are responsive to the evolving nature of the opioid crisis.

Opioid Use Prevalence Among Service Members

Recent studies and reports have shed light on the prevalence of opioid use among service members, revealing a nuanced picture of the issue. According to a study published in Regional Anesthesia & Pain Medicine, the proportion of military members who received a prescription opioid through the Military Health System declined from 2.7% in 2017 to 1.3% in 2020, indicating a significant reduction in opioid prescriptions among this population ( source ).

Furthermore, the Centers for Disease Control and Prevention (CDC) provides broader context for opioid-related overdose deaths, highlighting that opioids were involved in over 80,000 overdose deaths in 2021, a dramatic increase from 1999 ( source ). While this data is not exclusive to service members, it reflects the broader opioid crisis that also affects this community.

It is also important to note that opioid misuse and the subsequent crisis were recognized as a public health emergency by the Department of Health and Human Services in 2017, underscoring the gravity of the situation ( source ). The decline in prescription rates within the military may be a response to the increased awareness and efforts to combat the crisis.

Consequences of Opioid Use in Service Members

The opioid crisis has had a profound impact on service members, with ramifications that extend beyond individual health to affect families and communities. Opioid misuse often begins with the treatment of service-related injuries and can lead to opioid use disorder (OUD), a condition characterized by harmful behaviors such as increased opioid consumption and neglect of responsibilities. Research indicates that OUD can severely limit an individual's participation in the workforce and social interactions.

Physically, opioids can cause respiratory depression, increased risk of infectious diseases, and overdose, which may result in death. The presence of synthetic opioids like fentanyl in the drug supply has exacerbated the risk of overdose. Mental health consequences include the development or exacerbation of conditions like depression and anxiety. Socially, opioid misuse can lead to strained relationships, loss of employment, and financial instability. The barrier of prior authorization for treatment, as reported, can delay access to life-saving medications, increasing the risk of these adverse outcomes.

Moreover, the opioid crisis has significant economic implications, with the Department of Veterans Affairs spending over $1 billion annually on healthcare costs related to opioid addiction. The crisis's far-reaching effects necessitate comprehensive interventions, including timely treatment, prevention strategies, and policy changes to mitigate the consequences for service members.

Comprehensive Treatment Approaches for Opioid Use in Service Members

Addressing opioid use disorder (OUD) in service members requires a multifaceted treatment approach, integrating medication-assisted treatment (MAT), behavioral therapies, and supportive services. MAT options include the use of medications like buprenorphine, methadone, and extended-release naltrexone, each with unique mechanisms and administration protocols. For instance, extended-release naltrexone involves intragluteal injections of 380 mg every 28 days, following a washout period from last opioid use confirmed by a naloxone challenge test. Guidelines suggest these treatments be tailored to individual needs and circumstances.

Recent policy changes have expanded access to these treatments. For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) has made permanent regulatory flexibilities for methadone take-home doses and the use of telemedicine for MAT, allowing service members greater convenience and access to care. SAMHSA's updates represent a significant leap forward in OUD treatment accessibility.

Therapeutic approaches, such as cognitive-behavioral therapy and motivational interviewing, are essential complements to MAT, addressing the psychological aspects of OUD. The NIH HEAL Initiative is also exploring novel non-opioid treatments and interventions to manage pain and prevent opioid misuse among service members. These efforts are part of a broader push to integrate care and support recovery through evidence-based practices and innovative research.

Understanding Medication-Assisted Treatment for Opioid Use Disorder

Medication-Assisted Treatment (MAT) is a critical component in the treatment of opioid use disorder (OUD), combining FDA-approved medications with counseling and behavioral therapies. Among the medications used in MAT are methadone, buprenorphine, and naltrexone, each playing a distinctive role in managing addiction and aiding recovery. Methadone and buprenorphine reduce withdrawal symptoms and cravings, while naltrexone blocks the effects of opioids.

Recent policy updates by the Substance Abuse and Mental Health Services Administration (SAMHSA) have made significant strides in improving access to these treatments. The regulatory changes include making permanent the COVID-era flexibilities for take-home doses of methadone and allowing for the prescription of medication via telehealth without an initial in-person evaluation. These updates are aimed at closing the gap in care, as previously, fewer than 1 out of 10 Americans could access treatment for substance use disorder.

Despite these advancements, challenges remain, such as insurance-related barriers like 'prior authorization' which can delay the start of treatment. Efforts to reduce these barriers are ongoing, with the recognition that timely access to MAT can be lifesaving, especially amidst the nation's overdose epidemic. The cost-effectiveness of MAT, along with its positive impact on recovery and reduction in illicit opioid use, underscores the importance of broadening access to these treatments for individuals with OUD.

Integrating Therapeutic Approaches for Opioid Use Treatment

Therapeutic approaches for treating opioid use disorders are diverse, with Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI) being two of the most effective methods. CBT is a structured, goal-oriented therapy that addresses maladaptive thinking patterns, helping individuals to develop coping strategies for dealing with cravings and avoiding high-risk situations. It is particularly effective for treating anxiety disorders which often co-occur with substance use disorders.

MI, on the other hand, is a client-centered counseling style that enhances motivation to change by helping clients explore and resolve ambivalence. It is especially useful when clients are hesitant about engaging in treatment or making behavioral changes. MI can be effectively combined with other therapeutic interventions, such as CBT, to address substance use disorders. Studies have shown that integrating MI with CBT can lead to better treatment engagement, reduced substance use, and improved coping skills.

Research indicates that the combination of MI and CBT, known as MICBT, can lead to improved outcomes compared to traditional treatment methods, such as the twelve-step facilitation therapy. MICBT has been shown to increase retention in treatment programs, reduce the number of relapses, extend periods of abstinence post-discharge, and help in coping with cravings and modifying problematic behaviors ( source ).

Understanding that addiction is a chronic disorder of the brain influenced by social factors, therapeutic approaches are continually being personalized to target specific neurobiological processes and symptoms relevant to addiction and relapse risk. This personalization includes considering factors such as genetics and age, which can affect an individual's response to addictive drugs and their treatment ( source ).

Strategies to Prevent Opioid Use in Service Members

Preventing opioid use among service members requires a multi-faceted approach that addresses both the unique challenges faced by this population and the broader opioid crisis. The recent regulatory changes by the Substance Abuse and Mental Health Services Administration (SAMHSA) highlight the importance of increasing access to medication-assisted treatment (MAT) and leveraging telemedicine to reach more patients, especially in the context of service-related injuries SAMHSA's regulatory changes.

Key strategies include:

• Enhancing pain management alternatives to opioids, such as physical therapy, acupuncture, and non-opioid medications, to reduce the risk of opioid dependence after injuries.
• Implementing education and awareness programs that inform service members about the risks of opioid use and the availability of non-opioid pain management options.
• Improving access to and the quality of mental health services to address psychological injuries that may lead to self-medication with opioids.
• Adopting evidence-based practices for overdose prevention, including the distribution of naloxone and the establishment of peer support services.
• Investing in research to build an evidence base for interventions targeting social determinants of health that can influence opioid misuse.

The Department of Defense acknowledges the gravity of drug overdoses among service members and is committed to bolstering prevention efforts. By integrating these strategies into a comprehensive prevention system, the impact of service-related injuries can be mitigated, reducing the potential for opioid misuse and improving the overall health and readiness of service members.

Non-Opioid Pain Management Strategies for Service Members

Managing pain in service members without relying on opioids is a critical aspect of healthcare, particularly given the risks of addiction and dependence associated with opioid medications. Recent advancements and research have highlighted several non-opioid alternatives that show promise in effectively managing pain. These include:

• Transcutaneous Electrical Nerve Stimulation (TENS): A method that uses electrical currents to stimulate nerves for pain relief and is considered for various types of pain including neuropathic pain.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Acetaminophen: Over-the-counter options that can reduce inflammation and alleviate pain.
• Antidepressants: Certain classes like SNRIs and TCAs are used to manage chronic neuropathic pain.
• Radiofrequency Ablations: A procedure to reduce pain by disrupting nerve conduction.
• Sympathetic Nerve Blocks: Injections that can manage pain by interrupting sympathetic nerve activity.
• Spinal Cord Stimulation (SCS): An implanted device that sends electrical pulses to the spinal cord to relieve pain.
• Experimental Drugs: New pharmaceuticals, such as VX-548, are being developed to block pain signals before they reach the brain.

These alternatives are being researched and developed to provide service members with effective pain management options that carry fewer risks than opioids. It is important to note that while these treatments may offer relief, they should be considered within the context of a comprehensive pain management plan tailored to the individual's specific needs and medical history. The National Center for Biotechnology Information provides further insights into the efficacy of these treatments.

Enhancing Education and Awareness to Prevent Opioid Misuse Among Service Members

The critical role of education and awareness in preventing opioid misuse among service members is multifaceted, encompassing initiatives that target students, families, and educators. The U.S. Department of Education adopts a two-pronged approach, focusing on prevention through education about the dangers of opioid misuse and on supporting local efforts to mitigate abuse [U.S. Department of Education, 2018]. State-wide education programs also play a significant role in enhancing community knowledge and preparedness to address opioid use disorder (OUD) and overdose mitigation, as evidenced by the impact of the Opioid Training Institute (OTI) on influential community members [BMC Public Health, 2022].

Furthermore, school-based opioid prevention strategies are being employed, focusing on awareness, education, and collaboration as promising approaches to combat the rising rates of addiction and opioid-related deaths [SAMHSA, 2018]. Mass media campaigns, like 'The Truth About Opioids,' are designed to shift opioid-related knowledge, attitudes, and beliefs among young adults, showing some effectiveness in targeted areas [NIH, 2022]. Additionally, medical education is evolving to better equip healthcare providers with the knowledge to prevent an excess of prescription opioids from circulating in the community [NIH, 2022].

Education initiatives are crucial in equipping service members with the knowledge to make informed decisions about opioid use and in fostering environments that support healthy lifestyle choices. These programs, coupled with coordinated actions and advocacy, can form a comprehensive strategy to prevent opioid misuse and promote recovery among those affected.

Policy Recommendations to Address Opioid Use Among Service Members

Addressing opioid use among service members requires strategic policy interventions that focus on prevention, treatment, and education. Based on a synthesis of recent research and federal initiatives, several key recommendations emerge:

• Expand Overdose Education and Naloxone Distribution (OEND) programs to include service members and their networks, ensuring ready access to life-saving interventions in high-risk settings.
• Enhance Medication-Assisted Treatment (MAT) availability within military healthcare systems and criminal legal settings, utilizing medications like methadone and buprenorphine to support recovery.
• Implement comprehensive pain management programs that provide non-opioid alternatives and multimodal approaches to pain, reducing the reliance on opioids for service-related injuries.
• Invest in targeted education campaigns to raise awareness among service members about the risks of opioid use and the availability of treatment options.
• Improve access to mental health services, including cognitive-behavioral therapy and motivational interviewing, to address co-occurring psychological injuries that may contribute to opioid misuse.
• Support policies that facilitate continuity of care, such as allowing initiation of buprenorphine treatment via telehealth and providing transitional services for incarcerated individuals prior to release.
• Address systemic issues by ensuring equitable access to treatment and prevention resources, particularly for marginalized and minoritized communities within the service member population.

These initiatives should be underpinned by a robust evidence base and aim to address the complex nature of the opioid crisis among service members, taking into account both individual and systemic factors.

Policy Recommendations to Enhance Treatment Access for Opioid Use in Service Members

Access to treatment for opioid use disorder (OUD) among service members is crucial for recovery and reintegration. According to a policy brief from the Leonard Davis Institute of Health Economics, expanding access to medications for OUD, such as methadone and buprenorphine, is essential and can reduce overdose risk while promoting higher recovery rates compared to abstinence-based treatments. Research indicates that policy changes during the COVID-19 pandemic, which increased access to these medications, had a positive impact on recovery outcomes.

State policy reforms can further facilitate access by mandating reimbursement for OUD treatment services delivered via telehealth, as highlighted by The Pew Trusts. Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) has proposed updates to federal rules to make permanent the medication flexibilities introduced during the pandemic and to modernize definitions and standards for Opioid Treatment Programs (OTPs).

Addressing racial inequities in care and ensuring culturally and linguistically appropriate services are also vital, as per the American Medical Association's national policy roadmap. Furthermore, the Pew Trusts suggest that improving the quality and reach of OTPs, which are the only facilities where all forms of MOUD can be offered, is a critical step in expanding access to effective OUD treatment. These recommendations collectively aim to create a more equitable, accessible, and effective treatment landscape for service members struggling with opioid use.

Policy Recommendations for Enhancing Opioid Prevention in Service Members

Preventing opioid misuse among service members requires a multifaceted approach that addresses the unique challenges faced by this population. Based on recent federal initiatives and research, the following policy recommendations are proposed to strengthen prevention efforts:

• Expand access to prevention, treatment, and recovery services, emphasizing the availability of medications for opioid use disorder (MOUD) which have shown to reduce overdose risk and promote recovery [source].
• Implement evidence-based prevention programs at the community level, tailored to the specific needs of service members, including training for healthcare practitioners on best practices for opioid prescribing and pain management [source].
• Improve data collection and reporting to guide resource allocation and policy development, ensuring that prevention strategies are informed by accurate, up-to-date information [source].
• Address racial inequities in care, ensuring that prevention and treatment services are accessible to all service members, including historically marginalized and minoritized communities [source].
• Support universal access to naloxone and training in its use to reduce overdose deaths, with a focus on expanding access in primary care, rural areas, and correctional settings [source].
• Develop and support a prevention workforce by identifying and reviewing existing training programs and providing federal funding for states to incentivize ongoing training [source].

These recommendations aim to create a robust prevention framework that mitigates the impact of opioid misuse and fosters a healthier, more resilient service member community.

There are quite a few different options for people who are seeking treatment for drug & alcohol addiction. Your individualized treatment plan at The Recovery Village Palmer Lake may include:

• Medical detox : Patients detox from substances in a clinical environment where doctors monitor health and provide medications to ease withdrawal symptoms.
• Inpatient treatment : Patients in inpatient treatment live at our facility and attend a full schedule of individual and group therapy, counseling and peer support sessions.
• Partial hospitalization program (PHP) : PHPs provide patients with additional flexibility and independence than inpatient programs.
• Intensive outpatient program (IOP): IOPs help patients transition to life outside of rehab, with fewer hours of care and more time building skills and habits for recovery.
• Outpatient treatment : Outpatient care provides ongoing treatment after an inpatient stay and supports clients as they transition back into their daily lives.
• Aftercare : Aftercare programs help support long-term recovery through clinical and medical recommendations for follow-up care, relapse prevention plans and more.

If you or someone you love is struggling with drug or alcohol addiction, help is available. The Recovery Village Palmer Lake is here to support you throughout the entire recovery process. It's time to get your life back. Call our Recovery Advocates today.