医学研究所呼吁美军更新物质使用指南

医学研究所(IOM)日前发布报告，认为美国国防部有必要更新其实践指南，以应对现役军人中日益增多的酒精和药物的误用和滥用。

IOM受美国国会委托撰写的这份长达350页的报告，建议军方更加重视预防，采取循证项目，提高医疗的可及性，以及增加医疗人员并向其提供恰当的培训。

美国国防部在声明中表示，感谢IOM在评估军队医疗系统物质滥用项目和政策方面的工作。“如果的确存在需要改进的事项，我们将会努力使其完善。确保我们的军人健康幸福是最重要的。”

根据IOM 的研究数据，2008年大约有20%的现役军人报告称存在酗酒问题，高于1998年的15%。大量饮酒者的比例也从1998年的35%增至2008年的47%。与此同时，在过去10年间，军人中的处方药使用率也明显上升，与平民中的情况相似。2002年仅有2%的现役军人报告曾误用处方药，而这一比例在2008年已骤升至11%。2009年，军医开具了近380万份止痛药处方，这几乎是2001年处方量的4倍。

IOM报告撰写委员会主席、宾夕法尼亚大学成瘾研究中心主任Charles P. O’Brien博士建议，应当向军队医务人员提供如何识别和处理成瘾的培训，并将这类培训的对象扩展至医学院学生。

该报告还建议TRICARE(负责向军人及其家庭提供健康保险的机构)更新其物质使用障碍(SUD)相关指南。IOM认为这些指南并未纳入多种已成为标准实践的循证治疗手段，并且不允许长期使用某些成瘾治疗药物。

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By: NASEEM S. MILLER, Internal Medicine News Digital Network

WASHINGTON – The Department of Defense needs to update its guidelines and practices in order to address the rising rates of alcohol and drug misuse and abuse among the active duty personnel, according to a report released Sept. 17 by the Institute of Medicine.

The 350-page report, mandated by Congress, recommends that the military increase its preventive efforts, adopt evidence-based programs, increase access to care, and increase its health care workforce, while providing them with appropriate training.
 
"I can’t say I was surprised at anything," Dr. Charles P. O’Brien, chair of the committee that wrote the report, said in an interview. "Maybe what was surprising was that some of the guidelines haven’t been changed in 20 years, and I think they need to be updated right away."

In a statement, the Department of Defense (DoD) said, it appreciates the Institute’s work in assessing substance abuse programs and policies in the military health system. "We are in the process of analyzing [the] findings and recommendations, but most importantly, we want to do the right thing for the service member.

"If there are areas in need of improvement, then we will work to improve those areas. The health and well-being of our service members is paramount."

Roughly 20% of active duty personnel reported engaging in heavy drinking in 2008, compared with 15% in 1998. Binge drinking rates increased from 35% in 1998 to 47% in 2008, according to the IOM study. Meanwhile, of prescription drug use rates increased among the military personnel over the past decade, the study points out, mirroring the increase in the civilian population. Only 2% of active duty personnel reported prescription drug misuse in 2002. That rate increased to 11% in 2008.

Meanwhile, military physicians wrote nearly 3.8 million prescriptions for pain medications in 2009, almost four times as many as they prescribed in 2001, according to the IOM report.

Training of military health care professionals is among the recommendations in the report. During a press briefing announcing release of the report, Dr. O’Brien said providing training on how to recognize and deal with addiction should extend to medical schools.

The report also recommends that TRICARE, which provides health insurance to service members and their families, needs to update its substance use disorder (SUD) guidelines. The program, the IOM noted, does not include several evidence-based therapies that are currently considered standard practice, and it does not allow for long-term use of certain medications used for treatment of addiction.

"If the DoD fails to make these needed changes to the TRICARE SUD benefits in a timely manner, the committee recommends that Congress consider taking action to mandate such DoD policy changes," the authors wrote.

The report also identifies several barriers to access, including gaps in insurance coverage, stigma, lack of confidentiality, and fear of negative consequences.

The study not only recommends that branches provide optional confidential treatment, but also offer routine screening for unhealthy alcohol use; and reduce reliance on residential and inpatient care; and add capacity for outpatient care, using a chronic care model.

"Recommendations are clear and they’re doable. There’s nothing that’s impossible," said Dr. O’Brien, director of the Center for Studies of Addiction at the University of Pennsylvania, Philadelphia. "If they would follow these recommendations, we would see a big improvement."