Skip main navigation

Military Health System

Hurricane Milton & Hurricane Helene

Emergency procedures are in place in multiple states due to Hurricane Milton & Hurricane Helene. >>Learn More

Surveillance Snapshot: Trends in Opioid Prescription Fills Among U.S. Military Service Members During Fiscal Years 2007–2017

Image of U.S. Air Force Tech Sgt. Ryan Marr, 18th Medical Group pharmacy craftsman, processes prescriptions, June 8, 2018, at Kadena Air Base, Japan. The pharmacy processes and fills prescriptions for hundreds of different medical needs. (U.S. Air Force photo by Staff Sergeant Jessica H. Smith) Merriam/Released). U.S. Air Force Tech Sgt. Ryan Marr, 18th Medical Group pharmacy craftsman, processes prescriptions, June 8, 2018, at Kadena Air Base, Japan. The pharmacy processes and fills prescriptions for hundreds of different medical needs. (U.S. Air Force photo by Staff Sergeant Jessica H. Smith) Merriam/Released)

This snapshot highlights unadjusted metrics of opioid prescription fills among active duty and retired service members using data from the Pharmacy Data Transaction Service of the Military Health System (MHS). The metrics described include

  • the percentage of active component, reserve component, and military retirees who filled at least 1 opioid prescription (therapeutic class = opiate agonist) in a given year (Figure 1, Table);
  • the median number of fills per year among those with at least 1 fill (Table); and
  • the percentage of opioid fills that exceeded 90 daily morphine milligram equivalents (MMEs) (Figure 2).a

Despite decreasing fill rates in recent years, nearly 1 in 4 active duty and retired service members had a filled opioid prescription in 2017 (Figure 1). Active duty and activated Guard/Reserve members who received an opioid prescription had a median of 2 fills per patient in 2017, while retirees had a median of 7 fills per patient (Table). Moreover, a higher percentage of retirees' opioid prescriptions were for high-dose prescriptions (as determined by MMEs)1,2 compared to active duty and activated Guard/Reserve, although rates were not adjusted for age (Figure 2). While increased duration and prescriptions greater than 90 MME per day are not necessarily problematic in and of themselves, both are risk factors for potential misuse and may be indicators of potentially concerning prescribing practices.3 These findings highlight the importance of tracking opioid fills in the MHS, monitoring patients with opioid prescriptions, expanding surveillance efforts to assess prescription practices, and limiting opportunities for opioid misuse and abuse. Despite substantial rates of opioid prescription fills, opioid use disorders are diagnosed infrequently among service members in the MHS (0.2% prevalence from 2010–2015).4 It is important to emphasize and sustain initiatives such as the Defense Health Agency's Opioid Prescriber Safety Training Program as well as regulatory guidance5 aimed at facilitating the responsible use of this important facet of pain management.

aDaily MME = (strength per unit) x (number of units/days' supply) x (MME conversion factor).1,2,5

Author affiliations: Psychological Health Center of Excellence, J-9 Research and Development Directorate of the Defense Health Agency (Mr. Peters, Dr. Kincaid, Ms. Quah, Ms. Greenberg, Dr. Curry); Salient CRGT, Inc. (Mr. Peters, Dr. Kincaid, Ms. Quah, Ms. Greenberg)

References

  1. Centers for Disease Control and Prevention. Opioid oral morphine milligram equivalent (MME) conversion factors. https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Opioid-Morphine-EQ-Conversion-Factors-Aug-2017.pdf. Accessed 24 June 2019.
  2. Centers for Disease Control and Prevention. Calculating total daily dose of opioids for safer dosage. https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf. Accessed 24 June 2019.
  3. Centers for Disease Control and Prevention. Vital signs: opioid prescribing. https://www.cdc.gov/vitalsigns/pdf/2017-07-vitalsigns.pdf. Published July 2017. Accessed 24 June 2019.
  4. Office of the Secretary of Defense. Report to Congress on prescription drug abuse. https://health.mil/Reference-Center/Reports/2016/04/15/Prescription-Drug-Abuse. Published March 2016. Accessed 24 June 2019
  5. Defense Health Agency. Procedural Instruction 6025.04. Pain Management and Opioid Safety in the MHS. 8 June 2018.

Percentages of active duty and retired service members with 1 or more opioid prescription fills, fiscal years 2007–2017

Percentages of opioid prescription fills exceeding 90 daily MMEs, active and retired service members, fiscal years 2007–2017

Summary of percentages of beneficiaries with 1 or more opioid prescriptions, of median numbers of prescription fills per patient per year, and of percentages of opioid prescription fills that exceeded 90 daily MMEs, fiscal years 2007–2017

You also may be interested in...

Report
Jun 1, 2024

MSMR Vol. 31 No. 6 - June 2024

.PDF | 2.66 MB

This 508-compliant PDF of the June 2024 issue of MSMR comprises the first part of the annual burden of morbidity issue, featuring an overview of absolute and relative morbidity burdens attributable to various illnesses and injuries among U.S. active component service members in 2023; with reports on both hospitalizations and ambulatory care visits ...

Report
May 1, 2024

MSMR Vol. 31 No. 5 - May 2024

.PDF | 3.55 MB

The May 2024 MSMR features a report on mortality surveillance of active duty U.S. soldiers from 2014 to 2019; followed by three related reports on respiratory investigations, surveillance and forecasting, on: an outbreak of influenza and SARS-CoV-2 at the Armed Forces of the Philippines Health Service Education and Training Center, September–October ...

Report
Mar 1, 2024

MSMR Vol. 31 No. 3 - March 2024

.PDF | 1.34 MB

The March 2024 MSMR features a comparison of 2018 estimates from the HRBS and the PHA on tobacco and nicotine use among the U.S. military active component; followed by a report on coverage of HIV PrEP among active duty service members in 2023; supplemented by a Surveillance Snapshot of HIV PrEP prescriptions in 2023 in the active component; then a ...

Report
Oct 1, 2023

MSMR Vol. 30 No. 10 - October 2023

.PDF | 1.29 MB

The October 2023 Medical Surveillance Monthly Report (MSMR) provides a review of the incidence of colorectal cancer among active component service members from 2010 to 2022; followed by a study of force protection risks in AFRICOM, INDOPACOM, and SOUTHCOM due to rapid diagnostic test failures for P. falciparum malaria from 2016 to 2022; then an update ...

Report
Sep 1, 2023

MSMR Vol. 30 No. 9 - September 2023

.PDF | 1.30 MB

The September 2023 MSMR provides the annual update of routine screening for antibodies to HIV among the active and reserve components of the U.S. Armed Forces; followed by a serological survey of Ross River virus (RRV) infection among U.S. Marine expeditionary forces who train in Australia; followed by a Surveillance Snapshot of the 10 leading ...

Report
Aug 1, 2023

MSMR Vol. 30 No. 8 - August 2023

.PDF | 1.02 MB

The August 2023 MSMR provides the most recent data from the active surveillance program for acute respiratory disease and Group A Beta-Hemolytic Streptococcus among U.S. Army basic trainees; then summarizes the case report of an extensively resistant E. coli in a returning traveler at Hawai'i's Tripler Army Medical Center; followed by a Surveillance ...

Report
Jul 1, 2023

MSMR Vol. 30 No. 7 - July 2023

.PDF | 1.30 MB

This continuation of the June issue, which published the annual quantification of health care provided by the Military Health System, continues with the impacts of various illnesses and injuries in 2022 among deployed service members; medical evacuations out of theaters of military operation; health care provision to non-service member MHS ...

Skip subpage navigation
Refine your search
Last Updated: July 11, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery