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Drug-monitoring innovations help providers help their patients

Two Military Health System innovations are helping to ensure best practices for patients with pain, and for patients who’ve been diagnosed with post-traumatic stress disorder. (U.S. Air Force photo by Senior Airman Curt Beach) Two Military Health System innovations are helping to ensure best practices for patients with pain, and for patients who’ve been diagnosed with post-traumatic stress disorder. (U.S. Air Force photo by Senior Airman Curt Beach)

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Innovation | Substance Abuse | Posttraumatic Stress Disorder | Pain Management | Opioid Safety

FALLS CHURCH, Va. — Two Military Health System innovations are helping to ensure best practices for patients with pain, and for patients who’ve been diagnosed with post-traumatic stress disorder.

The MHS Opioid Registry utilizes cutting-edge technology for data management and reporting to identify patients who’ve been prescribed opioids, said Chris Nichols, the Defense Health Agency’s program manager for Enterprise Intelligence and Data Solutions. Clinical pharmacy professionals, physicians, and other authorized providers can use the patient lookup capability to proactively monitor and manage patients, and intervene as appropriate.

Opioids such as oxycodone, hydrocodone, codeine, and morphine are prescribed to relieve pain. But they are highly addictive, health care experts say, and overuse can lead to death.

The rates of opioid addiction and overdose deaths are lower in the military than among the general population, said Vice Adm. Raquel Bono, DHA director, during a House Armed Service Committee hearing in June on Military Health System reform. Still, she said, the MHS has a role to play.

“Our beneficiaries are no strangers to chronic pain,” Bono said.  “While our primary focus is on our own patient population, we’re also cognizant of the larger public health crisis surrounding opioids. As health professionals and public servants, we have an obligation to help confront that crisis.”

The MHS Opioid Registry was launched in December 2016 and released to all sites in 2017.  Data in the registry includes more than 200 variables including demographics, medications, morphine equivalence daily dose, results of urine drug testing, and opioid risk factors. In the future, MHS Opioid Registry users will also be able to evaluate and track alternative non-opioid therapies for pain management.

Nichols said a registry that’s accessible by both DoD and VA providers and staff is currently under development.

The PTS Provider Prescribing Profile was developed by the DHA’s Pharmacy Operations Division. It lists all providers at military treatment facilities who are treating patients with PTSD or acute stress disorder, said Sushma Roberts, Ph.D., a clinical psychologist and senior program manager for DoD/VA Integrated Behavioral Health, Clinical Communities Support Section, Clinical Support Division. The tool also documents the medications providers are prescribing. 

From February 2000 to June 2018, about 230,000 active-duty service members were diagnosed with PTSD, Roberts said, adding that 75 percent were diagnosed following a deployment of 30 days or longer. 

The clinical practice guideline released in 2017 recommended against prescribing benzodiazepines for PTSD patients, Roberts said. Benzos, also known as tranquilizers, act on the brain and central nervous system to produce a calming effect. People can easily develop a tolerance to benzos, health care experts say, needing higher doses and increased frequency to achieve the same effects. People also may suffer withdrawal symptoms, including insomnia, irritability, anxiety, panic attacks, and seizures.

 “Benzos aren’t necessarily bad,” said Army Lt. Col. Dennis Sarmiento, a psychiatrist and chair of the DHA’s Behavioral Health Clinical Community. “There are indications for their use. Short-term, they can help with anxiety, panic, and sleep. Treating such symptoms can help providers engage patients in care and better establish or reinforce rapport.”

But medications other than benzos are recommended for treating PTSD because they’re more effective, Sarmiento said. For example, antidepressants such as Zoloft, Paxil, Prozac, and Effexor raise the brain’s level of serotonin, a chemical that reduces symptoms of depression and anxiety. 

They also can be used with trauma-focused psychotherapy, Sarmiento said. Those therapies include talking or writing about traumatic events, or learning and practicing meditation or deep-breathing exercises to manage anxiety.

Sarmiento notes that throughout the MHS, benzo prescriptions have been on a downward trend since peaking in 2012.

According to the tool, the number of benzos prescriptions for MHS beneficiaries diagnosed with PTSD dropped from 1,922 in the first quarter of fiscal year 2017 to 1,622 for second quarter of FY 2018.

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