Introduction
Currently, prescription opioids (PO) remain the primary option for treating most cases of acute and chronic pain in the United States despite the associated risks and a lack of long-term sustainability. As a result, the nationwide opioid crisis has been among the most pressing socioeconomic and healthcare issues for several decades, with governmental efforts to solve the problem being largely ineffective. Acute and chronic pain, especially as a result of traumatic injuries and medical interferences, remain the primary reasons for opioid prescription (Gazelka et al., 2020).
Until recently, the United States government did not impose any restrictions on opioid prescriptions and distribution, which made them widely acceptable in the market and widely promoted by medical professionals. As a result, opioid prescriptions have quadrupled in the past decade. At the same time, no significant improvements have been observed in terms of the prevalence of pain or disability on a national level (Gazelka et al., 2020). The opioid crisis remains a growing concern, jeopardizing the well-being of millions of Americans.
While certain efforts were made to curb the supply of opioids, they have been inefficient in solving the primary issue of the absence of alternatives. Data from the Centers for Disease Control and Prevention (CDC) suggest that over 17% of the United States population filled at least one opioid prescription in 2017, with the number continuing to increase since then (Gazelka et al., 2020). The primary issue associated with opioid medications is their high dependence and abuse potential, which often leads to a significant deterioration in individuals’ overall health and well-being, including fatal overdosing (Che & Roth, 2021).
The opioid crisis has resulted in dramatically increased healthcare costs for vulnerable populations, with military veterans being among the most affected (Begley et al., 2022; Silva & Kelly, 2020). According to Tam et al. (2020), the prevalence of prescription opioid misuse in veterans and service members can reach 77.9%, which marks it as a major population-level concern. The specific nature of veterans’ injuries and the long-standing practice of using prescription opioids in the Army to treat any pain have resulted in a surge of opioid addiction cases among veterans.
Aside from physiological specifics, the psychological stress associated with military service and transition to civilian life increases the likelihood of drug abuse. From 2004 to 2012, the percentage of veterans prescribed an opioid increased from 18.9 to 33.4, while over one-third of those receiving opioid prescriptions after 2012 did so for chronic use (Tibbitts & Cowan, 2021). Research shows that such trends are strongly associated with an increased risk of opioid use disorder and opioid-related mortality (Tibbitts & Cowan, 2021). Simply restricting access to prescription opioids has proved ineffective and even counterproductive in the long term. A potential solution would require providing access to effective alternative pain management methods, which include a broad range of non-opioid medications.
Discussion
Current State of Care and Outcomes
Initially, governmental efforts to reduce the prevalence of PO dependence and abuse were focused on limiting the supply of the drugs. For example, state-level Prescription Drug Monitoring Policies aimed to deter patients from obtaining opioids from doctors, eventually reducing the opioid prescription rate (Tibbitts & Cowan, 2021). However, the limited supply did not align with the unchanged demand, resulting in a sharp increase in the illicit drug trade. The resulting surge of overdosing among opioid users is associated primarily with a lower quality of illegal drugs, resulting in a 53.2% increase in veteran overdose mortality rate between 2010 and 2019 (Begley, 2022).
Later, the government shifted its attention to reducing mortality, introducing outpatient naloxone prescriptions to reduce overdose mortality rates (Sandbrink et al., 2020). These efforts have shown some positive results, but their key issue is focusing on the results rather than on the fundamental issue of opioid dependency. As Begley et al. (2022) note, while overall rates of veteran overdose deaths have declined, psychostimulant and synthetic opioid use are still on the rise. Therefore, the need for effective alternatives for pain management remains a crucial healthcare issue.
Personal Position and Supporting Evidence
As the evidence provided above demonstrates, a lack of access to adequate and safe alternative non-opioid pain management medications remains the key issue in the veteran opioid crisis. Therefore, this position paper focuses on identifying existing and potential pharmacological alternatives for prescription opioids that would help prevent new cases of opioid dependency among American veterans and service members. Research suggests that promoting access to non-opioid pain management alternatives can reduce the risks and damage associated with current levels of legal and illicit opioid access (Abouk et al., 2023).
For example, various over-the-counter and prescription non-opioid pain medications, such as ibuprofen (Motrin), acetaminophen (Tylenol), aspirin (Bayer), and steroids, can be effective and safe in many cases of chronic and acute pain management (Callahan, n.d.). The guideline paper by Gazelka et al. (2020) also suggests that non-steroidal anti-inflammatory medications can effectively substitute opioids in acute and chronic pain management, while tricyclic antidepressant medications can help with moderate pain levels.
These studies show that existing non-opioid alternatives can and have been effectively implemented in a variety of contexts, prompting their adoption by the Veterans Affairs healthcare programs. A study by Sabesan (2020) supports these recommendations, showing a successful reduction in opioid consumption and excellent pain management in patients who received combined pharmacological therapy involving gabapentin, acetaminophen, and ketorolac. Additionally, research by Abouk et al. (2023) suggests that cannabis-based medications can be effective pain relievers, potentially reducing prescription and synthetic opioid misuse by veterans.
Notably, patient education is a critical aspect of all pharmacological interventions. These pieces of evidence directly support the paper’s position, providing a basis for the practical implementation of effective non-opioid pain management methods. The data is based on scientific evidence and a significant success rate among different populations, indicating the potential effectiveness of this approach in reducing and preventing veteran opioid dependency. Implementing this approach at the strategic level would help alleviate major healthcare costs for individuals, communities, and organizations while improving health outcomes for this vulnerable population.
The Role of an Inter-professional Team
Any major shifts in clinical practice require systemic changes in procedures and roles, requiring coordinated efforts from a multi-professional team. On an organizational level, administrators must facilitate the adoption of non-opioid pain relievers as an industry standard by influencing relevant decision-makers, including state governments and nationwide healthcare organizations. Pharmacology experts are required to evaluate the existing non-opioid alternatives and their feasibility for veterans, given the population’s physical and psychological specifics. Pharmacologists’ input would help physicians tailor therapy to each patient’s needs, ensuring optimal outcomes.
In terms of patient education, which is an essential part of a comprehensive pain management strategy, physicians and nurses are crucial. These professionals must first educate themselves on proper prescribing practices and requirements and then provide the necessary knowledge, skills, and motivation to patients. By explaining the correct dosages, potential side effects, and other information associated with non-opioid medications, these professionals can facilitate an improved sense of self-efficacy.
Alternative Views
Contrary to the proposed position, some perspectives insist on the need to focus on improving the safety of opioid treatment rather than on shifting to safer alternatives. As the paper by Sandbrink et al. (2023) suggests, the Department of Defense and the Department of Veteran Affairs still view opioid pain management as a flawed yet the only effective and proven approach. Recognizing the growing overdose mortality among veterans, even despite a reduction in prescriptions, the authors nevertheless disagree on the need to introduce non-opioid alternatives. While the effectiveness of traditional approaches is undeniable, their long-term sustainability is questionable, especially amid the ongoing crisis.
Similarly, the Centers for Disease Control and Prevention has published guidelines for prescribing opioid drugs in which the authors do not support the need for a complete transition to non-opioid alternatives (Department of Defense Inspector General, 2020). Instead of recognizing the inherently flawed nature of long-term opioid treatment, the authors focus on tapering rather than complete withdrawal. In general, while the government has been trying to address the veteran opioid crisis for many years, the chosen approaches seem ineffective in solving the core issues.
Conclusion
Veterans have been on the precipice of the nationwide opioid crisis due to the specific nature of their pain management needs and the flawed prescription policies in the Military and nationwide. Relatively recent changes in opioid prescription rules have substantially reduced the prescription rates in healthcare institutions. Still, the resulting surge in illegal drug trade has facilitated a rapid increase in overdose deaths.
The proposed solution for better and safer pain management among veterans involves moving away from opioid-based medications to non-opioid alternatives that have shown their efficacy and safety. A multi-professional medical team is required to implement this change in practice. Despite the government’s reluctance to reduce the use of opioids in pain management, especially among veterans, the proposed solution must be thoroughly assessed and potentially implemented, considering its potential positive impact on the population’s health.
References
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