Chiarelli: “Prescription overuse has led to epidemic” - Navy News | News from Afghanistan & Iraq - Navy Times

Chiarelli: “Prescription overuse has led to epidemic”

Years of wholesale dispensing of prescription drugs have created an Armywide drug abuse epidemic - and the Army brass is blaming itself for letting it spiral out of control.

That's the conclusion of Army Vice Chief of Staff Gen. Peter Chiarelli, who set out to take a hard look at the Army's suicide problem.

What he found was the Army's suicides are tied to a larger ill - prescription drug use and abuse. Drugs are a key factor in many of the Army's suicides, accidental deaths and criminal investigations, according to the Army report released by Chiarelli on July 29.

And current efforts to detect and deter drug abuse are frequently failing, the report concluded.

"We face an Armywide problem," Chiarelli, the Army's vice chief of staff, wrote in an introduction letter to the sweeping 350-page report.

"What we witnessed firsthand were real indicators of stress on the force and an increasing propensity for soldiers to engage in high-risk behavior. This report validates a central conclusion risk in the force cannot be mitigated by suicide prevention alone," Chiarelli wrote.

Army doctors may be inadvertently contributing to the force's drug problem, the report concluded. Currently there is no time-limit placed on prescriptions usage. "As a result, the soldier may use, abuse or distribute the drug long after the medical condition for which the drug was prescribed has resolved," according to the report.

Two wars and the high-operational tempo have imposed severe stress on individual soldiers. But perhaps equally important is what the report calls "the lost art of garrison leadership" resulting from the Army's unyielding focus on prosecuting two wars.

"Make no mistake - these are leader concerns," Chiarelli wrote. "I call on each of you to thoroughly study this report and work together with me to promote health, reduce risk-taking behavior and impose good order and discipline in the force."

The report's findings included:

•About one-third of all soldiers are taking a prescription medication and 14 percent - or one in seven - of the entire Army population currently has a prescription for an opiate pain killer.

•Roughly one third of Army suicides involve prescription drugs.

•Prescription drugs have caused an estimated 139 Army deaths from 2006 through 2009.

•The rate of soldiers facing random drug tests has dropped from 94 percent in 2002 to 86 percent in 2009.

•Only 18 percent of Army drug test samples are actually tested for prescription drug abuse.

•About 38 percent of soldiers who tested positive for drugs in recent years had tested positive at least once before.

•About 30 percent of soldiers with drunken driving arrests and 40 percent of those testing positive for drugs were not sent to drug treatment programs, as regulations mandate.

The report contains dozens of vignettes spotlighting individual soldiers who were prescribed drug "cocktails," instances of where drugs contributed to suicides and accidental deaths, and examples of leadership failures to identify and track troubled soldiers.

Although Army rules call for a soldier to be forced out of the service after a second positive drug test, thousands of soldiers have remained in the force despite multiple violations. That's mainly due to the high operational tempo of recent years - someone comes up hot and no one has time to deal with it.

"It's not overlooking - it's that busy," one Army official said.

The Army estimates that about 25,000 soldiers have drug problems but have never been treated in the Army Substance Abuse Program.

The scope of the drug problem in today's Army is distinct from those linked to past wars. During the Vietnam era some 40 years ago, many troops were using illegal drugs like marijuana and heroin, which were both commonly found in Southeast Asia at the time. The Army's new report, however, places more emphasis on prescription drugs as a problem among today's troops.

Looking ahead

The report includes dozens of recommendations for Army leaders.

For example, the report suggests that increasing random drug testing to include 100 percent of the force could reduce drug use. More than 78,000 soldiers were not drug tested in 2009, the report said.

Sending drug-sniffing dogs into barracks would help identify drug use among troops, the report suggested.

Army doctors should impose a one-year expiration date on all prescriptions to prevent soldiers from continuing to obtain dangerous drugs after they are no longer medically necessary, the report said.

The Army medical command should research the link between anti-depressants and suicide. Although outside research has shown "contradicting" results, there is some evidence suggesting that anti-depressants - in particular Paxil, also known as paroxetine - may increase suicidal thoughts or behavior, particularly among young adults.

The Army should "conduct research to identify appropriate antidepressant medications that are beneficial to the treatment of depression and anxiety, but that will not increase risk for suicidal behavior," the report recommends.

The Army should create a new discharge code for soldiers with drug problems. Many of those soldiers are currently separated under Chapter 14, for general misconduct. A new discharge code specifically identifying those with drug problems would help commanders track the problem across their command.

Specifically, the new codes should include a Chapter 14a for alcohol misconduct, Chapter 14b for drug misconduct and Chapter 14c for other misconduct.

The report also recommends extending the window of time that commanders can invoke Chapter 11 (for entry-level misconduct) from soldiers' first six months to 18 months.

Federal privacy laws were cited as a problem. Health care privacy rules can limit military officials' ability to share information about troubled soldiers. For example, commanders cannot always get full access to a soldiers' health file, making it difficult to identify those in need of special supervision or attention.

Bolstering accountability for Army commanders is also a key recommendation. For example, commanders should be reprimanded if they fail to refer soldiers to drug treatment programs.

The report is unflinching in its critique of today's Army leaders.

"It confirms leaders have lost situational awareness; signs and symptoms are being ignored, Soldiers are taking more and more risks, and gaps in policies are allowing it to happen. Ultimately, it poses the question: 'Where has the Army's leadership in garrison gone?'"

Staff writers Brendan McGarry and Kelly Kennedy contributed to this report.