Introduction
The opioid epidemic has taken away several lives in the last two decades. The use of prescription opioid for chronic and acute pain management has contributed to the crisis by making the drugs readily available to the masses. Opioid use has negative consequences to its users and communities, including a high risk of addiction, drug overdoses, reduced life expectancy, and rising fatalities (Weiner et al., 2017). Regrettably, there are specific groups of the society, which are more exposed to opioid use than others such as those in injury prone jobs like the military and construction. In addition, poor families, street children, and individuals who experienced childhood trauma are also potential candidates for opioid addiction. The research question to be studied is: How do military injuries influence opioid prescription and eventual addiction?
The theory of investigating the causation and correlation of the variables is that active duty service people acquire injuries that often lead to chronic pain, requiring opioid treatment. As more militants are injured and retiring with pain conditions, opioid prescriptions will rise, exposing the users to addiction and all the related outcomes. There is evidence that active duty militants also experience psychological trauma and brain injuries, forcing opioid prescriptions to manage their conditions. However, nobody is immune to opioid addiction and the military people end up with opioid abuse symptoms after prolonged use.
Since military injuries cause the prescription of opioid drugs, they are the reason why addiction is increasing among veterans. The perception that opioids were not addictive allowed doctors to freely prescribe the medicine for pain management to ordinary patients and military service men (Kolodny, 2020). Conversely, addiction cases and overdose deaths from the opioid epidemic increased sharply. Almost every injured soldier receives an opioid prescription as the main pain management drug.
Literature Review
Existing literature indicates that almost every injured service member receives an opioid prescription for managing acute and chronic musculoskeletal pain. This review of previous literature features specific themes related to military injuries, opioid treatment, and addiction. These include types of injuries and conditions in the group, high opioid prescription rates, discontinuation of treatment and cessation, substitution with other painkillers, and increased probability of addiction and overdose.
Active duty service members suffer serious injuries during combat and training sessions. According to Hoover et al. (2021), musculoskeletal injuries and brain trauma are common during active combat and military training. Most of the pain develops from acute to chronic and persists in veterans away from active duty (Cesur et al., 2019; Hoover et al., 2021). The severe pain experienced from these injuries requires strong painkillers for quick stabilization, hence the inclination towards opioid prescription.
The war against terrorism has placed many service members into active combat, leading to higher injury rates. Dalton et al. (2021) provides evidence that opioids are the most used painkillers in the military. The increased need for strong painkillers forces synthetic painkillers to be prescribed to one in every three military officers in active duty every year (Cesur et al., 2019; Dembek et la., 2020; Hoover et al., 2021). Tossaint et al. (2021) also found that nearly every injured service member was prescribed for opioid treatment. Therefore, opioids are the most used painkillers for pain management in active duty militants.
While opioid can be used to stabilize and manage pain quickly, discontinuation does not guarantee that patients will cease usage. Dasgupta et al. (2018) state that opioids are preferred as quick and easy fixes for mental issues and pain relief. Beyer et al. (2021) established that patients who received opioid treatment while hospitalized filled for another prescription in the next three to six months. This trend indicates that doctors cannot limit treatment with opioid to prevent addiction and enhance cessation, especially when the pain is chronic. Even when discontinuation is done early in the treatment, it does not aid cessation among military members (Toussaint et al., 2021). Active duty members and veterans are prescribed more opioids than civilian populations, increasing the potential for addiction (Cesur et al., 2019; Dalton et al., 2021). Hence, discontinuing opioid treatments does not help military members to prevent addiction.
Opioid can be substituted with other painkillers for pain management in the military. However, Cesur et al. (2019) found that opioids are used as the primary painkillers and are rarely substituted for military and veterans. Tetrodotoxin and ketamine are some of the non-opioid substitutes being considered for combat injuries (Cesur et al., 2019). However, substitution with non-opioid painkillers and opioids with less negative effects have not been readily accepted in the military. Therefore, opioid treatments continue to take the first priority among military members and veterans.
Since military service members are more prone to injuries, are highly prescribed opioids, and develop more chronic pain than the general population, their risk of addiction is higher. Atkins and Bohnert (2022) established that active-duty members and veterans have double overdose rates compared to civilians. Persistent pain in veterans also forces them to rely on opioids to live a functional life. Wounded combat also receives higher doses of opioids than the general population, increasing addiction and overdose chances (Cesur et al., 2019). Atkins and Bohnert (2022) also found that veterans and combat in treatment exhibited symptoms of addiction and abuse. Although 96% of participating veterans discontinued opioid treatment in six months, 91% were reintroduced not much later, hindering cessation (Atkins & Bohnert, 2022). When soldiers suffer brain trauma and injuries, opioids are the first line of treatment for pain relief and management (Hoover et al., 2021). Therefore, high prescription, repeated injuries, and chronic pain places the military population at exceptionally high chances of opioid overdose and addiction.
Theoretical Argument
Injuries during combat and training will be the independent variable as they are the cause of increased opioid addiction, which is the dependent variable. The rationale behind this causation and correlation is that nearly all the injured veterans are treated using opioids, which increases addiction among military members. The research of Dalton et al. (2021) found that opioids are widely used among veterans as they are injured in training and combat. The researchers also established that injuries increased when US soldiers were deployed in the Global War against Terrorism. Therefore, as more and more soldiers were injured, opioid prescriptions increased. The study of Beyer et al. (2021) found that continued opioid treatment is linked to long-term opioid abuse, which is recognized clinically. Hence, veterans who persistently use opioids for pain management are eventually addicted to the drug. The hypothesis is that injuries in active combat are directly proportional to opioid addiction because these injuries lead to chronic pain and their first line of painkillers are opioids.
The reasons for this causation include the high probability of injuries in combat, choice of opioids as the main painkillers, development of chronic pain that requires continued management and increased addiction rates of opioids. Injuries during training might be limited but they cannot be controlled in active combat, as experienced during the deployment to the Global War on Terrorism (Dalton et al., 2021; Dembek et al., 2020). Cesur et al. (2019) state that all the wounded combats and veterans are only treated with opioids and substitution with non-opioids or less harmful opioids is not considered. Research has confirmed that continued use of opioids will eventually cause clinical abuse and addiction (Toussaint et al., 2021). Therefore, the correlation is based on established facts that increasing injuries will require persistent use of opioids, which finally increases addiction rates among veterans. My theory expands on existing theories by directly linking injuries in the military to opioid addiction because previous studies have not explored such a direct correlation.
Research Design
I will use existing measures for all the variables: injury occurrence as the independent variable and opioids addiction as the dependent variable. Both variables will be measured on an ordinal scale because they have evaluative connotations. I will use a retrospective cohort study of military service members who received treatment for various war injuries. Data will be extracted from the Military Health System Data Repository for a period of five years. The relevant records must show ballet injured soldiers and their health records during the time, and after leaving the active military duty. Important demographics will be collected such as age, ethnicity, marital status, and sex. Using the diagnosis recorded, I will rate the injury type and source using the ninth and tenth revisions of the International Classification of Diseases. Pharmacy data for the selected records must be obtained for the identification of opioids.
Normality assessment of the data will be done using descriptive statistical analyses, including the mean, median, and standard deviation. The unit of analysis is individuals because data records will be for soldiers who were injured in battle. I will use regression to identify the relationship between the independent and dependent variables. Since I will use the variable ‘injuries’ to predict another variable ‘opioid addiction,’ I will use multiple regression. However, the omitted variable bias must be avoided during the analyses by factoring in other important factors. The confounding variables include previous opioid use, history of drug abuse, childhood trauma, and the existence of mental conditions. These would affect the opioid use and addiction of the soldiers.
In addition to regression, the chi-squared test will be effective in testing the hypothesis because the variables ‘opioid addiction’ and ‘injuries’ are categorical. The variables’ distributions will be displayed in a cross table to identify similarities or differences in their distributions. I will test the relationship using a predetermined significance level to accept or reject the null hypothesis of my study. Once it is rejected, the study will indicate that injuries during combat have a relationship with opioid addictions in the target population.
Conclusion
The research will seek to establish the correlation between veterans’ injuries and opioids addictions among this population. The hypothesis is that increasing injuries at battlefields are leading to increasing opioid addictions in the military. The results from the study would provide evidence that treating war injuries using opioids is more disastrous than beneficial as the lives of veterans are destroyed by addiction and overdose. They would also influence policymaking for the management of pain during combat. Scientific proof that opioid addictions among veterans begin with injury treatment in combat fields will quicken the research on alternative drugs for such treatment. Therefore, the research, if enacted, will reduce opioid addiction cases and overdose fatalities.
References
Atkins, D., & Bohnert, A. S. (2022). The work–opioid connection: What do construction workers and military veterans have in common? American Journal of Public Health, 112(S1), 33-35.
Beyer, C. A., Poltavskiy, E., Walker, L. E., Pettey, W., Suo, Y., Redd, A., & Gundlapalli, A. (2021). Persistent opioid use after combat injury and subsequent long-term risk of abuse: A retrospective cohort study. Annals of Surgery, 274(6), 957-965.
Cesur, R., Sabia, J. J., & Bradford, W. D. (2019). Did the war on terror ignite an opioid epidemic? National Bureau of Economic Research.
Dalton, M. K., Manful, A., Jarman, M. P., Pisano, A. J., Learn, P. A., Koehlmoos, T. P., & Schoenfeld, A. J. (2021). Long-term prescription opioid use among US military service members injured in combat. Journal of Trauma and Acute Care Surgery, 91(2S), 213-220.
Dasgupta, N., Beletsky, L., & Ciccarone, D. (2018). Opioid crisis: no easy fix to its social and economic determinants. American Journal of Public Health, 108(2), 182-186.
Dembek, Z. F., Chekol, T., & Wu, A. (2020). The opioid epidemic: Challenge to military medicine and national security. Military Medicine, 185(5-6), 662-667.
Hoover, P., Johnson, D., Wu, T., French, L. M., & Caban, J. (2021). Risk factors associated with the prescription of opioids among service members following a first mild traumatic brain injury. The Journal of Head Trauma Rehabilitation, 36(5), 345-353.
Kolodny, A. (2020). How FDA failures contributed to the opioid crisis. AMA Journal of Ethics, 22(8), 743-750.
Toussaint, M. N., Watkins, E. Y., Kc, U., & Werwath, T. (2021). Surveillance of substance abuse and dependence: US Army Soldiers, January 2016-December 2019. Army Public Health Command Aberdeen Proving Ground Md.
Weiner, S. G., Malek, S. K., & Price, C. N. (2017). The opioid crisis and its consequences. Transplantation, 101(4), 678.