FALLS CHURCH, Va. — Providers often prescribe opioids to patients dealing with severe pain. While effective for pain management, opioids can also be highly addictive. Patients can have adverse effects like overdose or death when an opioid is paired with other drugs or given to a patient with high-risk health conditions. As Aug. 31 is recognized as International Overdose Awareness Day, the Military Health System takes the time to recognize the importance of opioid safety. Service members operate in an environment where day-to-day performance is vital to defending the nation.
“Although the active duty population has significantly lower rates of opioid addiction and abuse than the civilian population, the Military Health System takes a proactive approach to combat opioid overuse, misuse, and diversion,” Air Force Maj. (Dr.) David Alt, deputy chief of User Acceptance and Analysis at the Defense Health Agency, said. “We hope to serve as a role model for pain management across the care continuum.”
This proactive approach led to a new tool within the military’s new electronic health record, MHS GENESIS. The Opioid Clinical Decision Support Tool screens a patient’s medical history before an opioid is prescribed. The tool looks at other opioid prescriptions, behavioral health history, co-prescription of sedatives like benzodiazepines, and laboratory drug tests. It then creates an alert that lets providers know about multiple high-risk conditions and allows them to modify the orders in real time.
Before this tool was implemented, providers received multiple overlapping alerts for the same issue. While useful for noticing prescription conflicts, Alt said the potential volume could lead to “alert fatigue” – health care providers receiving so many warnings that they become desensitized and potentially ignore them. He added the decision tool prevents this alert fatigue by consolidating all the opioid-related alerts onto a single screen, ensuring the provider gets the right information.
“The tool makes it easier for providers to do the right thing, and harder to do the wrong thing,” Alt said. “And ultimately that makes it safer for the patient.”
The tool already helps providers make critical prescription decisions. The tool’s morphine equivalent calculator helps providers judge how much of an opioid is needed to relieve pain – or put a patient at risk – regardless of the specific opioid prescribed. The tool also suggests additional prescriptions like naloxone, which can help reverse an opioid overdose.
Nearly 1,000 providers have used the tool since it went live in March 2020. The tool triggers, on average, 81 times a day across seven military medical treatment facilities.
“Providers have changed their prescribing behavior about 6% of the time,” Alt said. “This translates to 767 interventions since the tool was deployed in March and it’s only been rolled out to a small segment of the military population.”
The Opioid Clinical Decision Tool is one of many ways the Department of Defense looks at pain management, according to retired Army Col. (Dr.) Chester Buckenmaier, program director at the Defense and Veterans Center for Integrative Pain Management under the Uniformed Services University of the Health Sciences. Innovative practices like revising the pain rating scale and opioid safety resources like the Opioid Overdose Education and Naloxone Distribution program have helped the military increase quality of life for patients.
“It might be shocking to hear, but opioids are not bad,” Buckenmaier said. “As an Army anesthesiologist, I would never want to deploy without these tools. But you need to look at which situations stateside need opioids and manage how you’re prescribing them. I think the military is in a leadership position in developing those policies and tools.”
Alt hopes that the Opioid Clinical Decision Tool will be a valuable addition in helping the military safely manage pain for all patients.
“This tool will play a vital role in our ability to optimize opioid therapy, minimize patient risk, and address the epidemic of addiction that faces America,” Alt said.
Visit Health.mil for more information on opioid safety in the military.