Examining Opioid Misuse within a Military Ambulatory Care Setting

Purpose: The objective of this study was to identify military and civilian beneficiaries at risk for opioid misuse. The number of active service members and civilians were identified utilizing the military health system population health portal, which is a clinical decision reporting tool that contains the morphine equivalent daily dose and opioid-induced respiratory depression scoring. The clinical decision support tool is a 2-stage logistic regression machine learning model used to assist clinicians in identifying a patient’s cumulative intake of any drugs in the opioid class over 24 hours.

Background/significance: Prescription opioids continue to be the leading cause of poisoning death in the United States and represent more deaths than heroin and cocaine combined. In the United States, over 64,000 drug overdose deaths were estimated in 2016, with over 20,000 of those deaths related explicitly to fentanyl.1 In 2013, 78.5 billion dollars was spent on opioid treatment, and overdose in the United States and the rates are steadily increasing.2 Less than one percent of active duty service members are addicted to opioids, and the overdose death rate among active duty service members is 2.7 out of 100,000.3

The military health system (MHS) provides complex care to a diverse populace that includes military dependents and retirees, so the problem is multifactorial and does not correlate to just active-duty personnel. It is pertinent that we examine every aspect of this complex problem. Most patients that are on long-term opioid therapy are 45 years of age and older and are representative of the dependent and retiree population.3 The goal of this project provided comprehensive education to providers, nurses, and non-licensed clinical staff. Additionally, during the time of the study, services were expanded to provide non-pharmacological alternatives to patients in efforts to prevent and manage patients who present with specific risk factors that are related to opioid misuse.

This project utilized military health system population health portal (MHSPHP) to identify patients that are at risk for opioid misuse; opioids have become a leading cause of unintentional injury death, even more than motor vehicle accidents or firearm fatalities, according to 2016 state data. Nationwide, the Centers for Disease Control and Prevention reports that overdose deaths related to prescription opioids have quadrupled since 1999.4 Nurses can play an essential role in reducing these deaths, as well as addiction problems, through their assessments and monitoring of patients.

Materials and methods: A total of 27 out of 100 patients met criteria for the study from January 2018 to October 2018. Of the 27 patients identified there were no Naloxone co-prescriptions ordered, only 4 out of 27 patients had case management referrals placed, and there was no education taught to the providers.
Results: Of the 27 patients selected for the study, case management referrals increased by 85%, Naloxone prescriptions increased by 66%, and current primary care manage visits increased by 13%.

Conclusion: Nurses are trained on the importance of opioid misuse, and they are well-positioned to play a leading role in assessing, diagnosing, and managing patients battling addiction.