Prescription & OTC Drug Abuse in the Military

From the Napoleonic Wars of the early 1800s to the current battles in Iraq and Afghanistan, armed combat has often led to considerable advances in medical techniques and technologies (e.g., the concept of triage, improvements in the treatment of traumatic brain injuries, to name a few).

But when it comes to troops and drugs, the relationship between medicine and the military takes a decidedly more controversial turn. For example, during World War II, many soldiers on both sides of the battlefield used amphetamines to keep themselves going, and during the Vietnam era the U.S. Army battled an infamous increase in heroin addiction among deployed soldiers.

Today, some of the most pressing substance-abuse concerns in the U.S. military involve prescription and over-the-counter (OTC) medications. Some health officials contend that too many troops are being authorized to take antidepressants and sleeping pills, while others are worried about the illicit sharing of prescription drugs and the overuse of OTC meds by men and women in uniform.

AN OVER-RELIANCE ON ANTIDEPRESSANTS?
In a June 5, 2008 Time magazine article titled "America's Medicated Army," Mark Thompson wrote that military doctors are authorizing some drugs in unprecedented proportions, resulting in "a sizeable and growing number" of troops operating under the influence of prescription pills:

The day after Thompson's article appeared in Time, Damien McElory, a foreign correspondent for the English newspaper The Daily Telegraph, reported that more than 20,000 American service members are taking antidepressants, including 20 percent of the 115 Army soldiers who committed suicide in 2007.

Though no cause-effect determination has been made between antidepressants and military suicides, experts have expressed concerns in the past about an association between the drugs and an increased desire to kill oneself. On June 30, 2005, the U.S. Food and Drug Administration issued an advisory stating that adults who are being treated with antidepressants "should be watched closely for worsening of depression and for increased suicidal thinking or behavior."

The FDA has also expressed concern about Ambien and other sleep medications, sending letters to all manufacturers in December 2006 to request revised product labels with warnings against possible adverse side effects. The conditions the FDA was worried about included anaphylaxis (a severe and potentially fatal allergic reaction), angioedema (severe swelling of the face), and "complex sleep-related behaviors which may include sleep-driving, making phone calls, and preparing and eating food (while asleep)."

THE ILLEGAL SHARING OF PRESCRIPTION PILLS
In addition to service members who may be over-medicated by their doctors, the military is also keeping an eye on increases in the illicit sharing of prescribed drugs.

On June 15, 2007, the U.S. military leadership in Yonsan, South Korea, issued a press release warning service members against the misuse and sharing of prescription pills.

"What we're hearing is that a soldier's friend may have a prescription and they just share the medication," Richard Boyce, the garrison's prevention coordinator, said in the release. "We need our soldiers and civilians to know not to use someone else's prescription medication."

An article that appeared in Stars & Stripes newspaper 10 days after the release was issued reported that with more than three months remaining in the fiscal year, the area's drug bust tally was already more than double the annual average. Half of the area soldiers who violated the anti-drug policy had tested positive for marijuana, Stripes reported, with the other 50 percent caught abusing prescription medications such as OxyContin.

The military release noted that some commanders in the Korean area of operations were increasing random urinalysis testing from an Army-mandated minimum of 1 in 10 troops to 100 percent of the forces in their command, and quoted a substance abuse counselor who said that "in the eyes of the Army, taking a friend's prescription medication is the same as smoking marijuana."

David McNally, the public affairs specialist who wrote the release, advised personnel that testing positive for drugs "can be devastating to a military or civil service career."

INCREASES IN THE ABUSE OF OTC MEDICATION
Some substance-abusing soldiers are bypassing doctors altogether, opting instead to indulge on over-the-counter medications that are available for purchase in commissaries and convenience stores both on and off the installations where they live and work.

Eric Slavin, a Stars and Stripes reporter based in South Korea, detailed the misadventures of two uniformed OTC abusers in a July 2, 2008 article. Before they got clean, Pfc. Gary Cooper and Pfc. Stephen Wanser told Slavin, the roommates' regular weekend routine included downing 16 Coricidin Cough and Cold pills every Friday night, and repeating the action the following morning.

The result, the soldiers said, was a two-day daze that carried them through to Sunday night, when they would "crash" before reporting for duty Monday morning.

Coricidin Cough and Cold (or "Triple C" in abuser parlance) is rich in dextromethorphan (DXM), a cough-relieving drug that, when ingested in extreme doses, can trigger elevated moods, feelings of grandiosity, and hallucinations akin to those produced by LSD.

Though little documentation exists on the extent to which other soldiers emulated Cooper and Wanser's OTC abuse, Slavin explained that medical reports and sales statistics indicate the two were far from alone:

In a place where all soldiers receive free health care and prescriptions, Army and Air Force Exchange Service stores sold as many as 300 boxes of Coricidin and its generic equivalent in one week ...

By October, AAFES officials restricted sales of medicines with DXM to two boxes per month per service member, after consulting with medical officials. Average sales dropped 57 percent following the restrictions, according to a study conducted by Area I support psychiatrist Maj. Christopher Perry and Capt. Eugene Chung...

Prior to that, at least six DXM overdoses came through the emergency room within a year. The doctors say they think that's just a fraction of the abuse that's going on.

Cooper, who eventually kicked his addiction - and saved his military career - with help from the Army Substance Abuse Program, told Slavin that one of the biggest challenges he faced when abusing Triple C was finding it on area shelves before other soldiers knew it was available.

"You get to the store and pick it up right away, because that stuff would sell so fast," he said.

WARNINGS FROM WITHIN, OUTSIDE ARMED FORCES
Though the factors that push otherwise healthy and law-abiding individuals into substance abuse are as diverse as the abusers themselves, several experts both within and outside the military have cited the stresses associated with multiple combat deployments among the most likely causes of the uptick in prescription and OTC misuse among today's service members.

Mark Thompson's Time article referred to Col. Charles Hodge's March 2008 testimony before Congress, in which the Army psychiatrist reported that almost one-third of troops who are on their third combat tour are suffering from serious mental health problems. Hodge also told Congress that the time troops have at home between deployments (often less than 12 months) is not enough to allow them to "reset" and recover before returning to combat.

And in a March 19, 2007 commentary that appeared on the Huffington Post website, Tony Newman of the Drug Policy Alliance and author Asha Bandele predicted further drug problems for America's overwhelmed service members.

"Veterans, closed out of meaningful support when they return from the frontlines, seek relief of their symptoms through self-medication. Some get better. Tragically others do not," Bandele and Newman wrote. "One out of three returning Iraq War veterans is asking for mental health services. What is going to happen to all of the people who served their country and are now suffering from depression and suicidal thoughts? Many will end up using drugs, as many of us civilians do."

By Hugh C. McBride