Introduction.
A study by Junge et al.1 revealed that the proportion of military members who received a prescription opioid in the Military Health System (MHS) declined from 2.7% in 2017 to 1.3% in 2020; data were drawn from the month of August only, during each year. These data provide important information about recent trends in opioid prescribing in the MHS; yet, a lower monthly prescription opioid rate does not necessarily imply the annual rate is low.2 Further information is needed to compare annual MHS prescription opioid receipt trends to those reported in previous studies,3–5 and to extend knowledge about the annual proportion of military members receiving prescription opioids in recent years. We evaluated trends in receipt of any prescription opioid during the year among military members in the MHS during 2016–2021, by Service, component, and deployment history. We also examined annual trends in receipt of ≥7 annual opioid days-supply.6
Methods.
Data were from the Substance Use and Psychological Injury Combat Study Next-Generation cohort, which includes over 1.68 million military service members with 24-months of continuous TRICARE eligibility between federal fiscal years 2016–2021. Demographic, TRICARE eligibility, and pharmacy data were from the MHS Data Repository; deployment records were from the Defense Manpower Data Center. Prescription opioid data included opioids commonly prescribed in outpatient settings inclusive of tramadol; exclusions included liquid and injectable formulations, and medications used to treat addiction. We examined annual prescription opioid trends (i.e., any; and ≥7 annual days-supply, calculated by summing the days-supply of each year’s prescriptions), by patient characteristics, Service (Army, Marines, Air Force, Navy), component (Active, National Guard, Reserve), and number of deployments since 2001 (0, 1, ≥2). When calculating rates, we required that members have 9+ months of TRICARE eligibility in a given fiscal year to be included in the denominator. Because the SUPIC database contains information on all military members meeting criteria during the study period, we report prevalence and trends and not statistical tests, as there is no random sampling from a larger population that might lead to Type I or Type II errors.
Results.
Characteristics of military members who did and did not receive a prescription opioid are reported in Appendix Table 1. Annual prescription opioid receipt rates declined from 24.0% in 2016 to 12.2% in 2021, a 49% reduction (Appendix Table 2). Receipt of ≥7 annual opioid days-supply declined from 10.5% in 2016 to 4.2% in 2021, a 60% reduction. The Army had the highest prevalence of prescription opioid receipt and ≥7 annual opioid days-supply, compared to other Services (Figures 1–2). Active component members had a higher prevalence of receiving a prescription opioid through 2019, compared to National Guard and Reserves members; receipt of ≥7 annual opioid days-supply did not vary much by component. Members with ≥2 deployments had a higher prevalence of receiving ≥7 annual opioid days-supply, compared to those with no or 1 deployment.
Figure 1. Percentage of military members receiving a prescription opioid in the Military Health System during 2016–2021, by service, component, and deployment history.
Figure 2. Percentage of military members receiving ≥7 annual opioid days-supply in the Military Health System during 2016–2021, by service, component, and deployment history.
Discussion.
From 2016 to 2021, trends in annual prescription opioid receipt in the MHS declined by over 49% and ≥7 annual opioid days-supply decreased by 60%. The annual exposure calculated in this analysis was 8.5–10.3 times higher than one month exposure from 2017–2020 reported by Junge et al.1 For example, 23.0% of military members received a prescription opioid during 2017, compared to 2.7% in August 2017. Consistent with Junge et al.,1 Army (relative to other Services) and active component members (relative to National Guard and Reserves) had a higher prevalence of receiving a prescription opioid; yet we did not observe much variation in prevalence of opioid receipt by deployment history. By examining receipt of ≥7 annual opioid days-supply, we contribute new information that Army soldiers (relative to other Services) and those with ≥2 deployments (relative to <2) had a higher prevalence of ≥7 annual opioid days-supply receipt. Limitations include the lack of observation of prescriptions filled outside the MHS under other health insurance, which may be more common among National Guard and Reserves members, and prescriptions received during deployments. In this Brief Report we focus on population-level trends and do not examine factors associated with opioid receipt. Future research should examine if the observed shifts in opioid prescribing practices shifted equitably across military members, geographically across facilities, and by clinical specialties. In addition, future research should consider additional measures of prescription opioid prescribing (e.g., morphine milligram equivalents).
Supplementary Material
Financial Support:
This study was funded by the National Center for Complementary and Integrative Health (NCCIH; R01AT008404 Larson/Adams).
Abbreviations:
- MHS
Military Health System
Footnotes
Conflicts of Interest: The authors do not have conflicts of interest to report.
Disclaimer and Human Subjects Review: The views expressed are solely those of the authors and do not reflect the official policy or position of the Uniformed Services University, US Army, US Navy, US Air Force, the Department of Defense, the US Government, the National Institutes of Health, or the Veterans Health Administration. Approval for this study was granted by the Brandeis University Committee for Protection of Human Subjects, and the Uniformed Services University Institutional Review Board. This study used secondary existing data only and did not require written informed consent. Clearance for publication was provided by the Uniformed Services University. Our Department of Defense Data Sponsor is Jesus Caban, PhD.
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