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New programs warn about mixing medicines, alcohol

Jul 18, 2008
BY Jon Connor - Army News Service  

FORT HOOD, Texas (Army News Service, July 16, 2008) -- Recently, fans of actor Heath Ledger, 28, were shocked to hear of his accidental death from prescribed medications, and decades ago, the world was in awe over the deaths of actress Marilyn Monroe, 36, and singer Elvis Presley, 42 - similar to Ledger's in that they were overdoses from prescribed medications

Closer to home, the Army Family was deeply saddened of the death of Sgt. Robert Nichols, 31, a Warrior in Transition at Brooke Army Medical Center at Fort Sam Houston, Texas, last January.

Nichols died of a mix of prescribed medications that shut down his respiratory system, according to an addiction medicine specialist and member of the American Society of Addiction Medicine. The autopsy revealed that Nichols had 11 drugs in his body.

With more than 12,000 warriors in transition across the Army, and many of them taking prescribed medications, officials said there is the potential for abuse or overdose of medications with similar outcomes.

Army medical officials are concerned about the possibility of abuse and overdose and hospital staffs continually work to identify those Soldiers that are high risk for intentional or unintentional medication abuse.

Strategies being employed to address this concern include: education of soldiers, family members, and staff related to medication misuse; evaluating potential safety related issues in the prescribing, dispensing, and administering of high-risk medications; and research in the area of behavioral health and associated conditions (such as pain, anxiety, and depression).

The Army's Office of the Surgeon General recently directed that warriors in transition set goals in their treatment plan and play an active role in their rehabilitation process to prevent intentional or accidental overdoses from medications used in their treatment.

Alcohol is now prohibited in Warrior Transition Battalion living quarters at Rough Rider Village at Fort Hood, Texas. WTB Soldiers must sign a statement stating they were briefed about the dangers of alcohol in general and mixing their particular medication with alcohol.

Another concern is those Soldiers receiving multiple medications, said Janique Parnell, supervisory social worker for the WTB. One way to decrease accidental overdoses is through "scrubs." This is an interface between nurse case managers, primary care managers, leadership such as squad leaders, first sergeants, and company commanders, to discuss the status of their Soldiers and determine who might be a candidate of high-risk behavior, Parnell said.

WTB clinical staff members give classes on pain management, addiction, personal goal setting, nutrition, weight management, and having experts talk about "life threatening aspects of their medications," Parnell added.

The Carl R. Darnall Army Medical Center's pharmacy is aware of a range of behaviors for Soldiers seeking access to drugs and is in the process of hiring five additional clinical pharmacists to support the increased workload.

Nancy Radebaugh, a Darnall clinical pharmacist, said pharmacists pay attention to things like a Soldier's behavior while at the pharmacy; asking for medication refills earlier than the prescriptions state; requesting a stronger dosage; or attempting to access multiple providers outside of Fort Hood.

"These are all indicators that something probably is not right," Radebaugh said. .

"We strongly encourage Soldiers in the WTB to contact their chain of command, chaplain, or any member of their healthcare-management team to discuss any concerns of the medications they are taking. It is also important to watch out for their fellow soldiers by reporting any misuse by other unit members," Radebaugh said.

The ability to eliminate or at minimum decrease a "drug misadventure" incident is crucial in the care of WTB Soldiers, Radebaugh said. "We're rattling the cages everywhere to flush people out," she said.

Darnall staff members have also made requests to the Department of Defense and the Department of the Army to support the funding of innovative research related to medication abuse and misuse.

Five ongoing studies or initial research concepts within Darnall's Department of Pharmacy alone are specific to Warriors in Transition.

One study, A Review of Drug-Related Overdoses Among a Military Population, proposes to review variables associated with overdoses among a military population to identify factors that may be modified to improve overdose prevention strategies.

Another, Towards a Continuum of Care Between the Department of Defense and Veterans Affairs Healthcare Systems, would evaluate the degree to which risk factors for non-compliance with conventional management for Post Traumatic Stress Disorder and /or Traumatic Brain Injury impact treatment outcomes.

Dr. Toby Cooper, a pharmacist with Darnall's Family Medicine Clinic and primary investigator on these studies, emphasized the importance of such studies to "determine what the high risk factors are for young Soldiers" adding" it is important to identify risk factors for potential medication abuse and misuse, objectively, rather than relying on perceptions or mislead judgments."

Soldiers with PTSD and TBI resulting from combat service in the current Global War on Terrorism "may become the largest health-related issue in the 21st century in terms of both financial costs and those affected," said Cooper, citing a recent study of PTSD and TBI.

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