Department Monitors Substance Abuse Trends

WASHINGTON — Octo­ber 25 starts Red Rib­bon Week for drug aware­ness, and this year Defense Depart­ment offi­cials hope to shed light on what may be a dis­turb­ing new trend in sub­stance abuse by ser­vice­mem­bers, accord­ing to the department’s direc­tor of health pro­mo­tion and pre­ven­ta­tive ser­vices pol­i­cy.

While ille­gal drug use has held sta­t­ic for sev­er­al years, accord­ing to the department’s annu­al Sur­vey of Health Relat­ed Behav­iors Among Active Duty Per­son­nel, the mis­use of pre­scrip­tion drugs and legal sub­stances is grow­ing. In 2005, the sur­vey showed an uptick in ser­vice­mem­bers’ mis­use of legal sub­stances such as pre­scrip­tion drugs, inhalants, and com­pounds known as “design­er drugs” mar­ket­ed on the Inter­net often as herbal reme­dies, Lynn Pahland said in a Sept. 28 inter­view with Amer­i­can Forces Press Ser­vice.

Unsure whether the increased report­ing reflect­ed real use or was a mis­in­ter­pre­ta­tion of ques­tions, the depart­ment refined the ques­tions for the 2008 sur­vey, but the uptick remained, Pahland said, and close­ly aligned with a major civil­ian drug use sur­vey by the U.S. Cen­ters for Dis­ease Con­trol.

Pahland’s team at Mil­i­tary Health Affairs imme­di­ate­ly com­mis­sioned a research project to find out the moti­va­tion behind the answers. The results are expect­ed lat­er this month, she said.

“It’s a huge con­cern, it’s a nation­al con­cern,” Pahland said. “Any kind of drug use or health choice that leads to the impair­ment of a mil­i­tary per­son leads to the degra­da­tion of readi­ness.”

Under­scor­ing that nation­al con­cern, Gil Ker­likowske, the Oba­ma administration’s drug con­trol pol­i­cy direc­tor, yes­ter­day called pre­scrip­tion drug abuse “America’s fastest-grow­ing drug prob­lem.” He issued the state­ment after Con­gress passed the Secure and Respon­si­ble Drug Dis­pos­al Act, a law designed to curb mis­use of pre­scrip­tions through bet­ter dis­pos­al of unused or expired pre­scrip­tions.

“Pre­scrip­tion drug abuse is America’s fastest-grow­ing drug prob­lem, and one large­ly fed by an unlike­ly source — Amer­i­cans’ med­i­cine cab­i­nets,” Ker­likowske said in the state­ment. The new drug dis­pos­al law “will save lives by pro­vid­ing patients with safe, envi­ron­men­tal­ly sound ways to dis­pose of unused or expired pre­scrip­tion drugs.”

The mil­i­tary study will close­ly exam­ine trends among ser­vice­mem­bers and try to pin­point caus­es and pos­si­ble pre­ven­tion pro­grams, Pahland said. “The mil­i­tary absolute­ly comes from the U.S. pop­u­la­tion, but there also is a very spe­cif­ic type of indi­vid­ual who comes into the mil­i­tary,” she said.

Mil­i­tary Health Affairs’ health pro­mo­tion and pre­ven­ta­tive ser­vices office works close­ly with oth­er fed­er­al agen­cies to iden­ti­fy emerg­ing drug trends and devel­op poli­cies and pre­ven­tion tac­tics, Pahland said. “We pop­u­late each other’s work groups and com­mit­tees, and share data with oth­ers,” she said. “Our pri­ma­ry focus is to use every resource with our col­leagues in oth­er agen­cies and in acad­e­mia to iden­ti­fy, study and track drug use.”

The health-relat­ed behav­iors sur­vey, which asks active-duty ser­vice­mem­bers to report their behav­iors anony­mous­ly, “real­ly gives us a good snap­shot of people’s atti­tudes and behav­iors, so we can react to the data and improve our pro­grams,” she said.

The mil­i­tary has hun­dreds of drug aware­ness and pre­ven­tion pro­grams at all lev­els, from the Office of the Sec­re­tary of Defense to the com­mand lev­el and below, Pahland said. One of those pro­grams is the Mil­i­tary Health System’s par­tic­i­pa­tion in the Nation­al Fam­i­ly Partnership’s Red Rib­bon Week, held the last week of Octo­ber each year to high­light drug pre­ven­tion efforts. The non­prof­it part­ner­ship was cre­at­ed in 1980 to curb a ris­ing tide of drug use by young peo­ple.

Under the theme, “I Am Drug Free,” Mil­i­tary Health Affairs will host an Oct. 22 cer­e­mo­ny in the Pentagon’s Hall of Heroes that will rec­og­nize six mil­i­tary pro­grams deemed the best for drug aware­ness.

As with its drug pre­ven­tion pro­grams, the mil­i­tary has numer­ous reg­u­la­tions and poli­cies against drug abuse, includ­ing legal sub­stances, cov­ered in the Uni­formed Code of Mil­i­tary Jus­tice, Defense Depart­ment per­son­nel poli­cies, as well as those of the ser­vices, Pahland said. In some cas­es, instal­la­tion com­man­ders issue rules against cer­tain legal sub­stances, and work with local offi­cials to curb the use of ‘herbal’ com­pounds, she said.

Regard­less of the dupli­ca­tion and var­i­ous sources, it is clear that even the mis­use of legal sub­stances is banned for all ser­vice­mem­bers. As one exam­ple, DoD Direc­tive 1010–3.4 includes in its def­i­n­i­tion of drug abuse, “The wrong­ful use, pos­ses­sion, dis­tri­b­u­tion, or intro­duc­tion onto a mil­i­tary instal­la­tion of a con­trolled sub­stance, pre­scrip­tion med­ica­tion, over-the-counter med­ica­tion, or intox­i­cat­ing sub­stance (oth­er than alco­hol).”

The pol­i­cy goes on to say that “wrong­ful” means: “with­out legal jus­ti­fi­ca­tion or excuse, and includes use con­trary to the direc­tions of the man­u­fac­tur­er or pre­scrib­ing health-care provider, and use of any intox­i­cat­ing sub­stance not intend­ed for human inges­tion.”

But mil­i­tary lead­ers and depart­ment offi­cials know ser­vice­mem­bers are abus­ing legal sub­stances, some­times with dis­as­trous con­se­quences. Offi­cials with the Armed Forces Med­ical Examiner’s office report instances in the past year of ser­vice­mem­bers dying from sniff­ing, or “huff­ing,” inhalants.

Mil­i­tary mem­bers have sniffed glue, paint thin­ner, and gas­es such as Fre­on, butane, propane, and heli­um, all of which are known to cause dis­ori­en­ta­tion, eupho­ria and oth­er symp­toms, Navy Lt. Cdr. Sean Swiack­ows­ki, deputy med­ical exam­in­er, said in a recent inter­view with The Pen­ta­gon Chan­nel. “We’ve seen in the past year or two just how preva­lent it has become,” he said.

Design­er drugs such as syn­thet­ic mar­i­jua­na, mar­ket­ed as “spice,” or “K‑2,” and salvia divi­no­rum, a vari­a­tion of the sage plant known as “salvia,” also have caught on in recent years, accord­ing to Defense offi­cials. The com­pounds are legal in most states, inex­pen­sive, and have not shown up on ran­dom drug tests, although that may soon change as tests are improved, Pahland said.

But they also can be dan­ger­ous. “A lot of these prod­ucts are made in garages and homes, so you don’t have qual­i­ty con­trol,” Army Col. Tim­o­thy Lyons, chief of tox­i­col­o­gy in the med­ical examiner’s office, said. “Each pack­age, even under the same name, has dif­fer­ent lev­els of com­pounds. So you real­ly just don’t know what you’re get­ting.”

Pahland, Swiack­ows­ki, and Lyons agree that igno­rance of the dan­gers of such sub­stances is a big prob­lem. Many are mar­ket­ed as herbal reme­dies and com­pared to prod­ucts like St. John’s Wart, pop­py seeds, and chamomile tea, and ser­vice­mem­bers often buy them think­ing it will be a safe way to relax, Pahland said.

“I’ve talked to quite a few peo­ple who said they did not know this was some­thing harm­ful,” she said.

Too many ser­vice­mem­bers still are reluc­tant to seek med­ical atten­tion for prob­lems like depres­sion and anx­i­ety, and may be self-med­icat­ing, Pahland said.

“Espe­cial­ly in the mil­i­tary, we have peo­ple who are used to being self-suf­fi­cient who might inter­pret depres­sion as a weak­ness,” she said. “But we cer­tain­ly do not.”

Health Affairs is look­ing at var­i­ous pol­i­cy options to pre­vent sub­stance abuse, Pahland said, includ­ing the dif­fer­ent method­olo­gies used in dis­pens­ing pre­scrip­tions and track­ing the move­ment of those pre­scrip­tions.

“One of the most impor­tant things is that the entire Depart­ment of Defense has as a focus on the well-being of our forces,” she said. “So there many, many areas in DOD that are look­ing to bet­ter pro­tect our per­son­nel.

“The main thing, from my per­spec­tive, is: don’t take a drug you’re not pre­scribed, or that you know noth­ing about,” she said. “These things seem rou­tine, but they’re so very impor­tant.”

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)

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