policy to set limits on the length of prescriptions and the quantity dispensed for controlled substances (U.S. Army Surgeon General, 2011) has the potential to decrease ready access to some of the most commonly abused medications. Monitoring of the implementation of this policy change, coupled with an enhanced prescription drug monitoring system, could identify risky use, abuse, and questionable prescribing practices.
Additionally, DoD should conduct research on the current utilization of Pharmacoeconomic Center (PEC) programs intended to support the clinicians who care for service members receiving prescriptions for long-term (i.e., more than 180 days) use of controlled substances (at a minimum, opioids and benzodiazepines) that may impair their health and combat readiness. This research should identify the extent to which clinicians make use of the Controlled Drug Management Analysis and Reporting Tool (CD-MART) and Deployment MART to identify and monitor the use of controlled substances among all individuals with long-term use, as well as the clinical response among medical personnel preparing service members for deployment. DoD should investigate how it can enhance the clinical utilization of these PEC reporting tools by disseminating additional clinical guidelines on the prescribing of controlled substances and instructions on the use of the tools for providers, or by promulgating mandates, regulations, and policy changes requiring the use of these tools in caring for service members. DoD should also investigate the extent to which individuals with high-risk alcohol use behavior or aberrant drug use behavior are receiving long-term supplies of controlled substances for use during deployment. This research should focus on determining whether additional guidance or policy changes are needed to ensure that controlled medications are given only when not clinically contraindicated for individuals at risk of developing an alcohol or other drug use disorder. While it is necessary for Army medics and Navy corpsmen to be able to dispense medications in the field that have the potential for abuse, such as opioids and benzodiazepines, enhanced training is needed on dose limitations and signs of aberrant behavior or abuse. Health care professionals at all levels (e.g., general medical officers, flight surgeons, medics) should be trained in recognizing patterns of substance abuse and misuse and provided clear guidelines for referral to specialty providers, including pain management specialists and mental health providers. Training and ongoing education should also be provided to all clinicians on effective pain management, with attention to the risks associated with prescribing pain medications, particularly shortacting opioids, which have a high potential for abuse and have not been found to be effective for treating chronic pain conditions (Martell et al., 2007).
Beyond general training and education of providers, a system is needed to monitor the implementation of the VA/DoD Clinical Practice Guideline