By Sandra Basu
WASHINGTON – The use of opioids has slightly decreased in the military, an Army official told lawmakers last month.
In 2011, up to 26% of all active duty servicemembers were on at least one opioid medication, with that number dropping slightly to 24% in 2013, according to Brig. Gen. Norvell V. Coots, deputy commanding general and assistant surgeon general for force projection.
At the same time, Coots said, the Army is seeing “a large upswing from 10% up to 28% utilization of alternative medicine.”
“All the statistics are showing now, with a big push for cultural change, with integration of these alternative medical modalities, that we are seeing a downturn in opioid use across the military, particularly across the Army,” he explained.
Coots made his comments at a Senate Committee on Veterans Affairs hearing. Along with VA and NIH officials, he addressed questions from lawmakers about how the agencies are working to reduce opioid use.
Calling overmedication “a very serious problem” facing the nation, Sen. Bernie Sanders (I-VT), chairman of the Senate Committee on Veterans Affairs, said the result is “significant numbers of people treated in the Department of Defense facilities, in VA facilities and in the private sector become dependent upon those medications intended to help them and ease their pain.”
Coots told lawmakers that an Army-led task force was chartered in 2010 to develop a “comprehensive, holistic and multidisciplinary pain-management strategy for the DoD.” The Army, he said, has been working to implement the Pain Management Task Force recommendations.
“Representatives from the Uniformed Services and VHA, the Pain Management Task Force examined staff education, clinical practice and the structure of pain management in military medicine, the VHA, and in civilian medicine” comprise the task force, Coots explained in written testimony.
When asked about the drop in opioid use, he acknowledged that it is “a small difference,” but said it “still represents a big cultural change and a move ahead.”Coots said employment of alternative pain modalities on the battlefield, as well as stateside, is a major factor.
“We are right at the beginning of this cultural shift and this cultural change,” he said.
Coots explained that the Army has been collaborating with several organizations with a common interest in expanding the utilization of complementary integrative medicine modalities. In addition, he noted that military clinicians and VHA are collaborating on a $5.4 million Joint Incentive Fund Project to field a standardized basic acupuncture training and sustainment model across DoD and VHA medical facilities.
Meanwhile, VHA Undersecretary for Health Robert Petzel told lawmakers that the VA estimates that 50% of veterans seeking care have some sort of pain, much of it musculoskeletal.
“We are prescribing opioids for somewhere around 650,000 veterans at this particular present time, which is a large number of people. We recognize that this is an issue that has to be addressed very directly,” he said.
VA officials cited progress in decreasing opioid use. Since implementing its Opioid Safety Initiative, VA has been able to reduce the number of veterans prescribed opioid medications by 50,000 over the last 18 months, VA officials told lawmakers.
“This program uniquely combines feedback to providers and facilities on their prescribing practices with education and training to ensure opioid pain medications are used safely, effectively and judiciously across our entire system,” Petzel said.
He also explained that VA is pursuing multiple approaches to address pain.
“There is growing evidence for the effectiveness of nonpharmacological approaches as part of a comprehensive plan for chronic pain. These include acupuncture, massage, chiropractic care, mindfulness meditation, exercise therapy, relaxation therapies and yoga. These are all being increasingly made available to our veteran patients,” he said.
Josephine Briggs, MD, NIH Director for the National Center for Complementary and Alternative Medicine (NCAM), told lawmakers the nation must find the “appropriate balance” between the benefits of opioids and their risks.
“Pain is a major health problem affecting over 100 million Americans. It is one of the main drivers of our horrific national epidemic of prescription drug abuse. As a physician, I am well aware that drugs, including opioids, are absolutely essential for the management of pain, but also of their serious side effects, including overmedication, dependency and even death,” she testified.
An increasing proportion of NCAM’s research budget is dedicated to studies examining promising non-pharmacological approaches for pain management, including mindfulness meditation, spinal manipulation, massage, acupuncture, and exercise forms, such as yoga and Tai chi, she explained in written testimony.
“Some of these approaches are already being recommended by the American College of Physicians and the American Pain Society in their guidelines for the diagnosis and treatment of low back pain. NCCAM is interested in better understanding how these interventions work, for what type of pain conditions, and the optimal methods of practice and delivery,” she noted.
Briggs also stated that a special working group recently was formed “to explore ways to foster rigorous research that will inform the use and incorporation of complementary approaches in military and veteran populations and promote collaboration among the VA, DOD, and NCCAM.”
“NIH and NCCAM are committed to partnerships with the VA and DoD to strengthen research to understand pain, to improve pain management and to reduce overmedication opioid dependency,” she told lawmakers.