Efforts working to curb long-term opioid use in military, study finds 

Researchers have found “significant reductions” in the use of long-term prescriptions of opioids after surgery among patients in the Military Health System, according to a new report.

A study published Wednesday in the Lancet Regional Health journal found a 38% reduction in the risk of long-term prescription opioid use for patients receiving surgery in 2020-2022, compared to 2017-2019.

“This is a really positive story for the health care system,” Dr. Andrew Schoenfeld, who led the study, told Military Times. He is an orthopedic surgeon at Mass General Brigham and is a professor at Harvard Medical School.

And lessons learned from the Defense Department’s specific initiatives, such as the DOD/VA practice guidelines and other approaches related to opioid prescriptions, could potentially have a greater impact on the civilian sector, the authors noted.

Overall, the rate of long-term prescription opioid use was reduced to 6% of patients after they received surgery in 2020-2022, compared to 11% in 2017-2019. The researchers define long-term as continuous, uninterrupted opioid use for six months or longer following surgery. They studied around 200,000 patients in each of those time periods.

Rates were significantly better in military treatment facilities than in care received in the private sector under Tricare.

“This represents an opportunity for further investigation to better understand the factors associated with superior reductions in long-term prescription opioid use in the direct care setting,” the authors wrote.

There’s been a concerted effort across the U.S. health system since 2013 to fight the opioid crisis, including efforts to minimize the number and strength of medications issued to stave off problems that could lead to long-term opioid use. This study doesn’t address those who had opioid prescriptions before their surgery or those using illegal drugs.

But, as the researchers noted, the impacts of the efforts have not been adequately measured, and this study looks at one element: reducing long-term opioid prescriptions.

“This investigation represents one of the largest and most comprehensive longitudinal assessments of opioid use following surgery,” the researchers stated in their article. And given the representative nature of the military system’s patients included in the study, “We believe these results are reflective of national trends and that approaches developed by the [Military Health System] may effect greater change on a broader front if applied to the civilian health system,” they wrote.

These reductions may indicate increased familiarity and comfort with the clinical practice guidelines from the Centers for Disease Control and Prevention and the Defense Department among medical providers and patients, the authors noted.

Researchers from Mass General Brigham in Boston identified individuals ages 18-64 in the Military Health System data repository insured through Tricare who received one or more prescriptions for a class II or III opioid following one of 14 common surgical procedures, such as appendectomies and cataract surgeries, among others. Researchers noted the most common surgery during both time windows was spine surgery.

They analyzed Tricare claims data for 410,326 surgical events for individuals undergoing one of 14 common surgical procedures in 2017-2019 and 2020-2022. There were 196,099 surgeries in 2017-2019 and 214,227 in 2020-2022.

When examining all Military Health System patients who received any of the 14 common surgical procedures during those time times, they found that the risk of long-term prescription opioid use was “significantly lower” in the direct care setting — military treatment facilities — than for Tricare patients in the private sector.

According to the numbers provided in the article, 6% of patients in military treatment facilities experienced long-term opioid prescription use after surgery in the 2017-2019 time frame; compared to 13% of patients in the private sector, based on Military Times calculations. Those are based on the raw numbers and not adjusted for other factors.

By the 2020-2022 time frame, the numbers had decreased to 2.4% for long-term opioid use for those in military treatment facilities, compared to 6.5% for those in private sector care.

These results come as the Military Health System is taking steps to move more military beneficiaries back into the military treatment facilities for their care, as opposed to the private sector care, reversing their efforts over a number of years to move patients to private sector care.

But the overall findings show that regardless of whether the care is received in the military treatment facilities or the private sector, the odds of long-term opioid prescriptions has decreased over the period from 2017 to 2022 in the Military Health System, Schoenfeld said.

Patients who had prior surgery within six months of an eligible surgical procedure or had an active cancer diagnosis within one year of the surgery date were excluded from the study.