When people picture drug addicts, Soldiers don't usually come to mind. But since the war on terrorism began, the drug addict could be the guy standing next to you in formation and his drug of choice is often found in a prescription bottle, doctors said.

With wartime injuries and post traumatic stress disorder on the rise, it's easier than ever for Soldiers to get hooked on pain relievers, tranquilizers, sedatives and stimulants.

Fort Sill's doctors remain watchful of Soldiers prescribed these medications, and the installation runs a proactive program of education to warn Soldiers of the risks involved with drug abuse.

"We often run into patients who have developed injuries while deployed, and they are often given pain killers. Patients with emotional disorders are often given sedatives to calm them. So, there's clear overlap with our military community with the physical injuries and the anxiety and distress," said Dr. David Dodd, a psychologist with Community Mental Health. "Those medicines they are prescribed, when the symptoms are acute, they are given in higher doses. That gives the patient the opportunity, very quickly, to abuse them. And then if you combine both, and we know a lot of people who have been injured physically also have psychological distress and disorders, they are so concerned about alleviating their pain and distress, that they're willing to do anything or take anything they can to feel better."

Dodd described drug abuse as the overuse of a drug to the point where it's causing social or occupational dysfunction. People who are abusing a drug, whether it's a prescription drug or a street drug, develop a tolerance to the drug, Dodd said. Tolerance is where the user must take more and more of the drug to get the same effect. For some drugs, it does not take very long for a tolerance to develop. Abuse also includes using prescription drugs for recreational purposes, not taking them as prescribed and sharing medication.

Dr. (Maj.) John Winningham, the primary care manager for Warrior Transition Unit Soldiers, said it's important to understand that there's a science behind the "tolerance" lecture many patients get from their doctors. He said with chronic pain, the more medication patients take, the more receptor buildup they get on the synaptic cleft for the opiate receptors. That results in a down regulation of the receptors, or that the receptors don't absorb as much of the drug, so patients then need more medicine to achieve the same pain relief.

"We're not just making this up, there is a science behind it, and it's proven," Winningham said.
According to U.S. Department of Education's Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention, young people are more likely to abuse prescription drugs. Outside of marijuana, prescription drugs are the most abused drugs for the younger crowd. Up to 25 percent of college students reported using prescription drugs illicitly, so it's not a stretch to believe that those statistics correlate to some degree to young Soldiers, especially since more Soldiers are prescribed the drugs for conditions they come home with on redeployment.
"I can't say that I've necessarily seen it here, but I can understand why," Winningham said. "The older somebody is, the more apt they are to have those life skills, coping mechanisms and support structure to adapt to the stresses of combat and things of that nature."

He said pain is a subjective thing, but there are some red flags that indicate a Soldier could be abusing prescription drugs.

Some of the signs of abuse are Soldiers showing up to appointments looking overmedicated or out of it. Drug seeking behavior includes returning to the doctor claiming that they lost their medicine or that their medicine was stolen. Patients who seek multiple doctors are often abusing their medication. Refilling prescriptions early can also be a red flag. A history of dependency, to include alcohol and other drugs, is often a risk factor as well.

Certain drugs like Motrin and Ultram are non-narcotic alternatives to opiate pain killers. Being "allergic" to these alternatives can be a sign of drug seeking, Winningham said.

People who come in without a medical background who know their drugs as well as the doctor often send up a red flag. Even marital problems can be an indicator, he added.

"It's hard," he explained. "You have to look for red flags, and you have to look at the Soldier as a whole."

Dodd said sometimes Soldiers have a legitimate excuse for red-flag behavior, but that he looks for patterns.

"When it happens over and over again, that's a clear sign," he added.

To help prevent prescription drug dependence, Winningham said he tries to avoid prescribing commonly abused drugs.

"I always use the first rule of medicine do no harm," he said. "It's a slippery slope with narcotics, and patients need to do their best to stay off these."

He said he doesn't want to release Soldiers from the Army with a drug dependency issue. "You don't want to send them out to flail rather than succeed."

Winningham is not the only person in the medical channel who is concerned about prescription drug abuse.

He works closely with WTU Soldiers' case managers and platoon sergeants, forming a triad of care. The triad meets once a week to discuss all the WTU patients and their cases.
When Soldiers are identified as abusing prescription medication or other drugs, they get referred for treatment.

"We get them help," Winningham said. "We either get them into inpatient drug rehab, like at Red River, or we send them to the Army Substance Abuse Program where the drug rehab is outpatient. Then we just watch them. The platoon sergeant just pulls them under his wing. They may do more home visits, make sure everything is all right at home. They may step up the awareness on that Soldier. They also have battle buddies to watch out for them."

Though they may seem harmless, abusing prescription drugs can be lethal.

Winningham said taking more medication than prescribed can be dangerous because it depresses thought processes.

"You do silly things," he said. "It alters your mentation to where you'll do things that you normally wouldn't do. That's the best case scenario a lot of times. The worst case scenario is that abusers depress the respiratory system to the point where they fall asleep and stop breathing. Central nervous system depression happens from overmedication with narcotics, especially if you mix it with alcohol. If you drink yourself into oblivion and then you take a couple pills right before you go to bed, all the sudden, boom, it's a cocktail for disaster.

"The misconception is that prescription drugs are safer than street drugs. Sure, you know what you're getting, but all drugs are dangerous, period."

He said the only way to be safe is to take prescription drugs exactly as prescribed.

"Read the little bottle and take exactly what the little bottle tells you to take, no more," he explained. "You can take less, but no more than what the bottle says. If there are any changes to your medication, for instance being prescribed a new drug, let your doctor know since you don't know how medications interact."

"They're labeled as prescription drugs for a reason, because there is a certain risk to taking some of these drugs," Dodd said. "Some of them have a very short half life, which means that they leave your system quickly. But others have longer half lives, which means that they won't clear your system very quickly and if you take too much of them, it can be lethal."