Rates of prescription opioid misuse are higher among service members than among civilians.92 Survey results suggest drug use among returning soldiers is often a coping strategy to treat arousal symptoms of post-traumatic stress disorder.93 Returning military personnel also experience higher rates of chronic pain and related medical use of opioid pain relievers compared to the civilian population. These data collectively suggest an unmet need for the assessment, management, and treatment of both chronic pain and opioid use disorder in this population.94
The Veterans Health Administration (VHA) acknowledges that treatment with opioid agonists (methadone or buprenorphine) is the first-line treatment for opioid use disorder and recommends it for all opioid-dependent patients. Notably, a 2015 revision of treatment guidelines for the U.S. Department of Veteran Affairs and U.S. Department of Defense shifted toward allowing these medications as a treatment option for active duty military members.95 Still, only about a quarter of patients with an opioid use disorder treated at VHA facilities receive medication.96 Barriers to opioid agonist medication among VHA providers include lack of perceived patient interest, stigma toward the patient population, and lack of education about opioid agonist treatment.97
In the past, lack of insurance coverage for opioid agonist medications was a barrier for use among active duty military; however, as of 2013, TRICARE included coverage for these medications, and a 2016 modification of TRICARE regulation included provisions for expanded coverage of opioid use disorder treatment.98 This expanded coverage removed annual and lifetime limitations on substance use disorder treatment allowed for office-based opioid treatment, and established opioid treatment programs as a newly recognized category of institutional provider under TRICARE.