News & Information - The Mercury - July 2009 Mercury

by Robyn Baer
Fort Sill Cannoneer

When people picture drug addicts, Soldiers don't usually come to mind. But the drug addict could be the guy standing next to you in formation and his drug of choice is often found in a prescription bottle, doctors said.

With wartime injuries and post-traumatic stress disorder on the rise, it's easier than ever for Soldiers to get hooked on pain relievers, tranquilizers, sedatives and stimulants.

“We often run into patients who have developed injuries while deployed, and they are often given pain killers. Patients with emotional disorders are often given (medication) to calm them. So, there's a clear overlap with our military community with the physical injuries and the anxiety and distress," said Dr. David Dodd, a psychologist with community mental health at Fort Sill, Okla.

"Those medicines they are prescribed, when the symptoms are acute, they are given in higher doses. That gives the patient the opportunity, very quickly, to abuse them. And then if you combine both, and we know a lot of people who have been injured physically also have psychological distress and disorders, they are so concerned about alleviating their pain and distress, that they're willing to do anything or take anything they can to feel better," Dodd added.

People who are abusing a drug, whether it's a prescription drug or a street drug, develop a tolerance to the drug, Dodd said. Tolerance is where the user must take more and more of the drug to get the same effect. For some drugs, it does not take very long for a tolerance to develop.

MAJ John Winningham, the primary-care manager for Warrior Transition Unit Soldiers at Fort Sill, said it's important to understand that there’s a science behind the "tolerance" lecture many patients get from their doctors.

He said with chronic pain, the more medication patients take, the more receptor buildup they get on the synaptic cleft for the opiatic receptors. That results in a down regulation of the receptors, or that the receptors don't absorb as much of the drug, so patients then need more medicine to achieve the same pain relief.

One sign of abuse is Soldiers showing up to appointments looking overmedicated or out of it. Drug-seeking behavior includes returning to the doctor claiming that they lost their medicine or that their medicine was stolen. Patients who seek multiple doctors are often abusing their medication. Refilling prescriptions early can also be a red flag. A history of dependency, to include alcohol and other drugs, is often a risk factor as well.

Certain drugs like Motrin and Ultram are non-narcotic alternatives to opiate pain killers. Being "allergic" to these alternatives can be a sign of drug seeking, Winningham said.

People who come in without a medical background, but who know their drugs as well as the doctor, often send up a red flag. Even marital problems can be an indicator, he added.

"It's hard," he explained. "You have to look for the red flags, and you have to look at the Soldier as a whole."

Dodd said sometimes Soldiers have a legitimate excuse for red-flag behavior, but that he looks for patterns.

"When it happens over and over again, that's a clear sign," he added.

To help prevent prescription drug dependence, Winningham said he tries to avoid prescribing commonly abused drugs.

"I always use the first rule of medicine—do no harm," he said. "It's a slippery slope with narcotics, and patients need to do their best to stay off these."

Winningham works closely with WTU Soldiers' case managers and platoon sergeants, forming a triad of care. The triad meets once a week to discuss all the WTU patients and their cases.

When Soldiers are identified as abusing prescription medication or other drugs, they get referred for treatment.

"We get them help," Winningham said. "We either get them into inpatient drug rehab ... or we send them to the Army substance abuse program, where the drug rehab is outpatient. Then we just watch them. The platoon sergeant just pulls them under his wing. They may do more home visits, make sure everything is all right at home. They may step up the awareness of that Soldier. They also have battle buddies to watch out for them."

Winningham said taking more medication that prescribed can be dangerous because it depresses thought processes.

"You do silly things," he said. "It alters your mentation to where you'll do things that you normally wouldn't do. That's the best-case scenario a lot of times. The worst-case scenario is that abusers depress the respiratory system to the point where they fall asleep and stop breathing. Central nervous system depression happens from overmedication with narcotics, especially if you mix it with alcohol. If you drink yourself into oblivion and then you take a couple of pills right before you go to bed,—boom, it's a cocktail for disaster."

"The misconception is that prescription drugs are safer than street drugs. Sure, you know what you're getting, but all drugs are dangerous, period," he added.

Winningham said the only way to be safe is to take prescription drugs exactly as prescribed.

"Read the little bottle and take exactly what the little bottle tells you to take, no more," he explained.

"You can take less, but no more than what the bottle says. If there are any changes to your medication, for instance being prescribed a new drug, let your doctor know since you don?t know how medications interact."

"They're labeled as prescription drugs for a reason, because there is a certain risk to taking some of these drugs," Dodd said. "Some of them have a very short half life, which means that they leave your system quickly. But others have longer half lives, which means that they won't clear your system very quickly and if you take too much of them, it can be lethal."

From the July 2009 Mercury, an Army Medical Department publication.