{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T22:01:40Z","timestamp":1777500100862,"version":"3.51.4"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"Supplement_6","funder":[{"DOI":"10.13039\/100007188","name":"Uniformed Services University of the Health Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007188","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007188","name":"Uniformed Services University of the Health Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007188","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The USA is experiencing an opioid epidemic. Active duty service members (ADSMs) are at risk for opioid use disorder (OUD). The Coronavirus disease 2019 (COVID-19) pandemic has disrupted health care and introduced additional stressors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The Military Healthcare System Data Repository was used to evaluate changes in diagnosis of OUD, medications for OUD (MOUD), opioid overdose (OD), and opioid rescue medication. ADSMs ages 18-45\u2009years enrolled in the Military Healthcare System between February 2019 and April 2022 were included. Joinpoint Trend Analysis Software calculated the average monthly percent change over the study period, whereas Poisson regression compared outcomes over three COVID-19 periods: Pre-lockdown (pre-COVID-19 period 0) (February 2019-February 2020), early pandemic until ADSM vaccination initiation (COVID-19 period 1 [CP1]) (March 2020-November 2020), and late pandemic post-vaccination initiation (COVID-19 period 2 [CP2]) (December 2020-April 2022).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 1.86 million eligible ADSMs received care over the study period. Diagnoses of OUD decreased 1.4% monthly, MOUD decreased 0.6% monthly, diagnoses of opioid OD did not change, and opioid rescue medication increased 8.5% monthly.<\/jats:p>\n                  <jats:p>Diagnoses of OUD decreased in both COVID-19 time periods: CP1 and CP2: Rate ratio (RR)\u2009=\u20090.74 (95% CI, 0.68-0.79) and RR\u2009=\u20090.72 (95% CI, 0.67-0.76), respectively. MOUD decreased in both CP1 and CP2: RR\u2009=\u20090.77 (95% CI, 0.68-0.88) and RR\u2009=\u20090.86 (95% CI, 0.78-0.96), respectively. Adjusted rates for diagnoses of opioid OD did not vary in either COVID-19 time period. Opioid rescue medication prescriptions increased in CP1 and CP2: RR\u2009=\u20091.09 (95% CI, 1.02-1.15) and RR\u2009=\u20096.02 (95% CI, 5.77-6.28), respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Rates of OUD and MOUD decreased, whereas rates of opioid rescue medication increased during the study period. Opioid OD rates did not significantly change in this study. Changes in the DoD policy may be affecting rates with greater effect than COVID-19 pandemic effects.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usad245","type":"journal-article","created":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T15:15:13Z","timestamp":1699629313000},"page":"567-574","source":"Crossref","is-referenced-by-count":2,"title":["Opioid-Related Trends in\u00a0Active Duty Service Members During the Coronavirus Disease 2019 Pandemic"],"prefix":"10.1093","volume":"188","author":[{"given":"Ian S","family":"Sorensen","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, Maryland 20817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Apryl","family":"Susi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, Maryland 20817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Andreason","sequence":"additional","affiliation":[{"name":"Retired , Kensington, MD 20895, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Hisle-Gorman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kalyn C","family":"Jannace","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, Maryland 20817, USA"},{"name":"Departments of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Center for Rehabilitation Sciences Research , Bethesda, MD 20814, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jayasree","family":"Krishnamurthy","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Binny","family":"Chokshi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madeline","family":"Dorr","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, Maryland 20817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron S","family":"Wolfgang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"},{"name":"Department of Psychiatry, Yale School of Medicine , New Haven, CT 06511, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cade M","family":"Nylund","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,11,8]]},"reference":[{"key":"2023111015142744800_R1","article-title":"Key substance use and\u00a0mental health indicators in\u00a0the United States: results from the 2016 National Survey on\u00a0Drug Use and\u00a0Health","volume-title":"Substance Abuse and Mental Health Services Administration","author":"Ahrnsbrak"},{"key":"2023111015142744800_R2","article-title":"DOSE Dashboard: Nonfatal overdose data","author":"National Center for Injury Prevention and Control: Centers for Disease Control and Prevention"},{"key":"2023111015142744800_R3","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.108350","article-title":"The economic burden of\u00a0opioid use disorder and\u00a0fatal opioid overdose in\u00a0the United States, 2017","volume":"218","author":"Florence","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"2023111015142744800_R4","article-title":"Opioid use disorder","author":"Dydyk","year":"2022"},{"issue":"5","key":"2023111015142744800_R5","doi-asserted-by":"publisher","first-page":"1741","DOI":"10.1213\/ANE.0000000000002496","article-title":"Risk factors for\u00a0opioid-use disorder and\u00a0overdose","volume":"125","author":"Webster","year":"2017","journal-title":"Anesth Analg"},{"issue":"1\u20132","key":"2023111015142744800_R6","doi-asserted-by":"publisher","first-page":"e101","DOI":"10.1093\/milmed\/usy162","article-title":"Predictors of\u00a0postdeployment prescription opioid receipt and\u00a0long-term prescription opioid utilization among army active duty soldiers","volume":"184","author":"Adams","year":"2019","journal-title":"Mil Med"},{"issue":"1","key":"2023111015142744800_R7","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1080\/1533256X.2012.647586","article-title":"Military combat deployments and\u00a0substance use: review and\u00a0future directions","volume":"12","author":"Larson","year":"2012","journal-title":"J Soc Work Pract Addict"},{"issue":"12","key":"2023111015142744800_R8","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1097\/mlr.0000000000001782","article-title":"Naloxone prescribing associated with reduced emergency department visits in\u00a0the Military Health System","volume":"60","author":"Costantino","year":"2022","journal-title":"Med Care"},{"key":"2023111015142744800_R9","article-title":"Department of\u00a0Defense Instruction: 1010.04","author":"Department of Defense"},{"key":"2023111015142744800_R10","article-title":"Air Force Instruction 44-121: Alcohol and\u00a0Drug Abuse Prevention and\u00a0Treatment (ADAPT) Program","author":"Department of the Air Force"},{"key":"2023111015142744800_R11","article-title":"OPNAVINST 5350.4E: Navy Alcohol and\u00a0Drug Misuse Prevention and\u00a0Control","author":"Department of the Navy"},{"key":"2023111015142744800_R12","article-title":"Army Regulation 600-85: The Army Substance Abuse Program","author":"Department of the Army"},{"issue":"2","key":"2023111015142744800_R13","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1001\/jamapsychiatry.2022.4162","article-title":"social disconnection as a global behavioral epidemic\u2014a call to action about a major health risk factor","volume":"80","author":"Na","year":"2023","journal-title":"JAMA Psychiatry"},{"issue":"3","key":"2023111015142744800_R14","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19031749","article-title":"Changes in\u00a0access to health services during the covid-19 pandemic: a scoping review","volume":"19","author":"Pujolar","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"7","key":"2023111015142744800_R15","doi-asserted-by":"publisher","first-page":"e295","DOI":"10.1097\/JOM.0000000000001872","article-title":"A time-series analysis of\u00a0the association between occupational health policies and\u00a0opioid prescription patterns in\u00a0United States active duty military service members from 2006 to 2018","volume":"62","author":"Jannace","year":"2020","journal-title":"J Occup Environ Med"},{"key":"2023111015142744800_R16","article-title":"Opioid Prescriptions Decline Across the Military Health System","volume-title":"Military Health System and Defense Health Agency","author":"Aker"},{"key":"2023111015142744800_R17","article-title":"Defense health agency procedural instruction: number 6025.04","author":"Defense Health Agency"},{"key":"2023111015142744800_R18","article-title":"Department of\u00a0defense opioid prescriber safety training program","author":"Defense Health Agency"},{"key":"2023111015142744800_R19","article-title":"Provisional drug overdose death counts","author":"National Center for Health Statistics"},{"issue":"4","key":"2023111015142744800_R20","doi-asserted-by":"publisher","DOI":"10.7249\/RRA1193-1","article-title":"Assessing the quality of\u00a0outpatient pain care and\u00a0opioid prescribing in\u00a0the Military Health System","volume":"9","author":"Hepner","year":"2022","journal-title":"Rand Health Q"},{"issue":"3","key":"2023111015142744800_R21","doi-asserted-by":"publisher","first-page":"e156","DOI":"10.1097\/ADM.0000000000001096","article-title":"Struggling with recovery from opioids: who is at risk during covid-19?","volume":"17","author":"Keith","year":"2023","journal-title":"J Addict Med"},{"issue":"S1","key":"2023111015142744800_R22","doi-asserted-by":"publisher","first-page":"i56","DOI":"10.1136\/injuryprev-2019-043521","article-title":"Defining indicators for\u00a0drug overdose emergency department visits and\u00a0hospitalisations in\u00a0ICD-10-CM coded discharge data","volume":"27","author":"Vivolo-Kantor","year":"2021","journal-title":"Inj Prev"},{"key":"2023111015142744800_R23","article-title":"Joinpoint regression program, version 4.9.1.0","volume-title":"Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute"},{"issue":"3","key":"2023111015142744800_R24","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1002\/(sici)1097-0258(20000215)19:3&lt;335::aid-sim336&gt;3.0.co;2-z","article-title":"Permutation tests for\u00a0joinpoint regression with applications to cancer rates","volume":"19","author":"Kim","year":"2000","journal-title":"Stat Med"},{"key":"2023111015142744800_R25","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2022.103786","article-title":"Has the treatment gap for\u00a0opioid use disorder narrowed in\u00a0the U.S.?: a yearly assessment from 2010 to 2019","volume":"110","author":"Krawczyk","year":"2022","journal-title":"Int J Drug Policy"},{"key":"2023111015142744800_R26","article-title":"Opioid overdose deaths by sex","author":"Kaiser Family Foundation"},{"key":"2023111015142744800_R27","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.108849","article-title":"Racial\/ethnic disparities in\u00a0the use of\u00a0medications for\u00a0opioid use disorder (MOUD) and\u00a0their effects on\u00a0residential drug treatment outcomes in\u00a0the US","volume":"226","author":"Stahler","year":"2021","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"2023111015142744800_R28","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.34878","article-title":"Racial\/Ethnic disparities in\u00a0unintentional fatal and\u00a0nonfatal emergency medical services-attended opioid overdoses during the COVID-19 Pandemic in\u00a0Philadelphia","volume":"4","author":"Khatri","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"4","key":"2023111015142744800_R29","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1002\/bjs.11507","article-title":"Risk factors and\u00a0outcomes of\u00a0chronic opioid use following trauma","volume":"107","author":"von Oelreich","year":"2020","journal-title":"Br J Surg"},{"issue":"162","key":"2023111015142744800_R30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15620\/cdc:107641","article-title":"Prescription opioid use among adults with chronic pain: United States, 2019","author":"Dahlhamer","year":"2021","journal-title":"Natl Health Stat Rep"},{"issue":"7","key":"2023111015142744800_R31","doi-asserted-by":"publisher","first-page":"0","DOI":"10.1097\/CORR.0000000000001251","article-title":"Can predictive modeling tools identify patients at high risk of\u00a0prolonged opioid use after acl reconstruction?","volume":"478","author":"Anderson","year":"2020","journal-title":"Clin Orthop Relat Res"},{"key":"2023111015142744800_R32","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.jns.2018.01.018","article-title":"Socioeconomic class and\u00a0universal healthcare: analysis of\u00a0stroke cost and\u00a0outcomes in\u00a0US military healthcare","volume":"386","author":"Blattner","year":"2018","journal-title":"J Neurol Sci"},{"issue":"5","key":"2023111015142744800_R33","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1177\/0095327x09356166","article-title":"The pervasive role of\u00a0rank in\u00a0the health of\u00a0U.S. Veterans","volume":"36","author":"Maclean","year":"2010","journal-title":"Armed Forces Soc"},{"key":"2023111015142744800_R34","article-title":"FDA approves first over-the-counter naloxone nasal spray. Agency continues to take critical steps to reduce drug overdose deaths being driven primarily by Illicit Opioids","author":"U.S. Food & Drug Administration"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/Supplement_6\/567\/53076500\/usad245.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/Supplement_6\/567\/53076500\/usad245.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T15:15:20Z","timestamp":1699629320000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/188\/Supplement_6\/567\/7388267"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,1]]},"references-count":34,"journal-issue":{"issue":"Supplement_6","published-online":{"date-parts":[[2023,11,8]]},"published-print":{"date-parts":[[2023,11,8]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usad245","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,11,1]]},"published":{"date-parts":[[2023,11,1]]}}}