for Management of Opioid Therapy for Chronic Pain (VA and DoD, 2010), with clear and measurable standards of practice and accountability of providers to deliver evidence-based care. DoD should move forward to implement the recommendations in the final report of the Army pain management task force, particularly those related to routinely assessing for drug abuse in patients on opioid therapy and implementing sole provider programs to prevent “doctor shopping” (U.S. Army, 2010). DoD currently does not share its pharmacy data with state-run prescription drug monitoring programs (PDMPs). Because many service members and their dependents fill prescriptions in community pharmacies, it is important for DoD to partner with community efforts to identify those individuals who are abusing prescription drugs. During its site visit to Fort Belvoir, the committee heard that physicians at the military treatment facility routinely checked the locally available state-run PDMPs before dispensing controlled substances.2 However, the extent of this practice among military physicians is unknown. The committee therefore recommends that DoD providers routinely check any locally state-run PDMPs before dispensing prescription medications that have abuse potential. As the state-run PDMPs or other related community efforts are further developed, DoD should consider investigating the potential value of sharing its pharmacy data with those programs and efforts.
With regard to prevention programming, DoD and the branches should focus on adapting and testing efficacious developmentally focused universal, selective, and indicated prevention initiatives for children and families, including broader child development programs that do not address substance abuse specifically. Branch policy makers and commanders in charge of units should develop procedures that routinely include family members in evidence-based prevention programs at the entry, predeployment, and postdeployment stages for active duty members and at entry for members of the reserve component until they become active. The military branches, through their respective surgeon general or Command structure, should coordinate the sharing and use of evidence-based programs and models of standardized annual training of program implementers and their supervisors. Several evidence-based programs that are already being disseminated across branches (e.g., Families OverComing Under Stress [FOCUS], New Orientation to Reduce Threats to Health from Secretive Problems That Affect Readiness [NORTH STAR]) appear to have been disseminated as part of a research trial rather than DoD or branch policy. Standardized training models are included in the Alcohol and Drug Abuse Managers/Supervisors (ADAMS) and Culture of Responsible Choices (CoRC) programs,
2 Personal communication, Ben Krepps, M.D., Director of the Pain Clinic at Fort Belvoir Community Hospital, November 15, 2011.