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Invited Commentary
August 2014

Pain and Opioids in the Military: We Must Do Better

Author Affiliations
  • 1Samueli Institute, Alexandria, Virginia
  • 2Uniformed Services University of the Health Sciences, Bethesda, Maryland
JAMA Intern Med. 2014;174(8):1402-1403. doi:10.1001/jamainternmed.2014.2114

In the documentary movie Escape Fire,1 a battle-weary and combat-wounded soldier falls out of his bunk during a medical evacuation flight from Afghanistan to Washington, DC. Disoriented from an overdose of opioid and psychoactive medications previously prescribed for his wounds, pain, and loss, he later embarks on a journey of self-healing in an effort to get off of the drugs. Unfortunately, he is not alone. In a study by Toblin et al2 of one of the Army’s leading units published in this issue of JAMA Internal Medicine, 44.0% of the soldiers had chronic pain, and 15.1% regularly used opioids. Even accounting for the ready availability of military care, these rates are much higher than the estimates of 26.0% and 4.0%, respectively, in the general civilian population. While chronic pain and opioid use have been a long-standing concern of the military leadership, this study is among the first to quantify the impact of recent wars on the prevalence of pain and narcotic use among soldiers. The nation’s defense rests on the comprehensive fitness of its service members—mind, body, and spirit.3 Chronic pain and use of opioids carry the risk of functional impairment of America’s fighting force.

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