The Supreme Court has begun to address the bankruptcy case of Purdue Pharma. The pharmaceutical company created OxyContin and heavily marketed the drug to doctors, contributing to the development of the opioid epidemic. While it is frequently referred to as a public health crisis, the opioid epidemic has wide-ranging impacts that result in it also strongly threatening the security of the nation through its impact on members of the military.
The epidemic began in the 1990s. Within the Army, opioid prescriptions quadrupled between 2001-2009 during Operations Enduring Freedom and Iraqi Freedom, and prescription drug misuse rose from 2%-11% from 2002-2008. Prescriptions of opioids have since declined within the military health system, with a 69% drop from 2017-2021, but the problem for those who still or previously received them continues to exist. Nearly $1 billion dollars is spent to care for prescription opioid abuse among active-duty members and veterans each year, and another $500 million on caring for those who abuse heroin.
Within the military, the full extent of the problem is hard to know due to the only source of information stemming from self-report. What is known is that the situation as it is generates a loss of expertise and life, and a military that is less prepared and less healthy. Three things interact when it comes to the problem of opioids and addiction in the military: the ages of many service members; the current policies and culture when it comes to drug use, addiction, and mental health; and the physical impacts of continual use.
Many service members are young adults, putting them at greater risk of misusing opioids than their older counterparts. Young, enlisted personnel are the most likely to experience both opioid misuse and fatal overdoses. Eliminating prescription painkillers is not an option: while efforts have been made to cut back on the number of prescriptions written, the reality is doctors in the Army, for example, are forced to make a choice between alleviating the pain of an injured soldier or not. Stricter policies about prescribing opioids do not help those already exposed. Combat exposure in the war on terror has been identified as one of the forces behind the opioid epidemic’s reach into the military, and not just for prescription pills. Heroin use is also higher among active-duty members who have seen combat. This results in the youngest members of the military having to endure a disproportionate risk of developing a substance abuse disorder.
Once an addiction is developed, the current policies and culture within the military can make it difficult for service members to seek help. Substance abuse problems are known to exist in the military, from drugs to alcohol to tobacco. Seeking help for opioids, however, can have the most consequences. The DOD’s zero-tolerance drug policy makes no distinctions between recreational drugs obtained illegally and prescription medications that were originally given by a doctor. This means that servicemembers who seek help under existing programs can be dishonorably discharged or sent to criminal trial. The culture and stigmas around mental health care in general within the military, with many members expressing concerns accessing it would end their careers, make the situation worse.
Not seeking help has impacts separate from continual impaired judgment. Whether via prescription or illicit means, the longer an opioid is used, the more likely it is that a tolerance to it will be developed. This requires using more of that drug to receive an effect or using a stronger one in its place. The more you consume, the greater the risk of overdose or loss of life. Within the military, both result from one opioid in particular: fentanyl. Fentanyl is also the primary opioid with a worsening problem despite fewer prescriptions for opioids being written. As a result, 88% of overdose deaths in 2021 involved fentanyl, along with half of the 332 drug and alcohol overdose deaths between 2017 and 2021.
Though policymakers and the DOD have worked to address the problem, more needs to be done. Steps taken to prevent addictions in the first place, such as the military health system prescribing fewer opioids, can be taken further. Funding additional research into the development of vaccines against the effects of heroin, for example, could help prevent the use of the most illegal opioids. Prescribing fewer opioids is not enough on its own to maintain the combat readiness of the military when many are already addicted. The risk of discharge or imprisonment serves as a barrier to seeking help, but it also can result in a loss of expertise in which the military has already invested. Drug use should not be without consequence, but the current zero-tolerance policy needs to be reassessed. Treating heroin use the same as a prescribed opioid ignores the circumstances by which service members develop their disorder and dismisses the responsibility the government has when its doctors recommended those highly addictive drugs be administered.
As the third decade of the opioid epidemic closes, awareness of the problem and its impacts exists, but the end does not yet seem in sight. Some efforts to address the problem do show promise, such as a treatment to prevent fentanyl overdoses. Yet, with new opioids ten times more powerful than fentanyl appearing in the illicit drug supply, efforts to address the problem are more important than ever. Addiction is a disorder, and its effects on the brain’s ability to make choices are not permanent. Reevaluating the zero-tolerance policy to discourage drug use and treat the problem while recognizing the role military medicine plays in some cases allows for improved security with a healthier, less impaired military.