Faced with rising abuse of prescription drugs, the Army has limited how many painkillers a soldier can get at one time and is threatening disciplinary action for troops caught violating the restriction.

Army data requested by The Associated Press shows the number of soldiers referred for opiate abuse treatment has been growing steadily for at least a decade, a time when increasing numbers of troops have returned from Iraq and Afghanistan with combat or training injuries that can cause chronic pain. The Veterans Administration says more than 50 percent of Iraq and Afghanistan veterans report pain issues as they leave active duty military service.

The Army put limits on painkillers in November by restricting most Schedule II controlled substances, which include narcotics, opiates and amphetamines, to just 30-day prescriptions.

Previously, some prescriptions had been available for 60 or 90 days and the average was 40 days. The policy makes an exception for medications for attention deficit hyperactivity disorder and it affects anyone who fills a prescription at an Army hospital or pharmacy, including military spouses, children and retirees.

In June, the Army followed with a policy that soldiers found using the restricted drugs six months after they were prescribed could be disciplined, too. The force carries out random drug tests among active duty soldiers.

Col. Carol W. Labadie, the pharmacy consultant and pharmacy program manager for the Army Surgeon General, said the changes are intended to improve medication safety and encourage soldiers to see their doctors more often if they are having chronic pain.

"In today's society, more prescriptions are getting written and abuse is high across the world, whether it is the military or the civilian side," she said.

According to Army data provided to AP, referrals for opiate abuse increased from 87 in fiscal year 1998-99 to 703 referrals in fiscal year 2008-09. There were more than 670 referrals from October 2009 through June 2010, the latest figures available. Opiates include common pain drugs such as oxycodone, sold under the brand name Oxycontin, and hydrocodone, also known as Vicodin.

Soldiers are referred to the Army Substance Abuse Program based on a commander's recommendation, such as when a soldier tests positive on a drug test.

By limiting the prescriptions to 30 days, the Army is encouraging providers to give patients the smallest amount of medication needed for an acute condition, like a sprained ankle, Labadie said.

It also lowers the risk of abuse by reducing the number of unused prescription drugs, she said.

"When it is sitting around, it's fair game," she said. "When you're not taking the medications, you don't realize someone else has been taking the medications until it's too late."
Soldiers can get painkillers for longer than 30 days only if they get the prescription renewed by their physician.

Under the new six-month rule, a soldier who tests positive for a drug that he hasn't had a prescription for in the last six months gets sent to a medical review officer, who determines if it was a legal use or if the soldier was abusing the drug, Labadie said. The soldier's commander determines whether a soldier faces punishment or is referred to the Army's Substance Abuse Program.

"A lot of times the soldier may realize they have a problem but are reluctant to say anything, and, when they do get caught, then the opportunity is there to step up and get help," Labadie said. "It does help us identify people who want to get help."

Drug abuse in the military can lead to charges under the Uniform Code of Military Justice, a dishonorable discharge or even criminal charges.

As thousands of soldiers have returned from Afghanistan over the past year, the number of prescriptions filled at Blanchfield Army Community Hospital has been rising, said Maj. Paul Kassebaum, who has been serving as the pharmacy chief at the hospital during the deployment.

"With most of the soldiers back from deployment, we are probably going to average around 70,000 outpatient prescriptions a month," Kassebaum said.

Only a small percentage of Fort Campbell patients will be affected by the new rules on controlled substances, he said.

"Patients are going to see their doctors more often to get their prescriptions written, and that's a good thing," Kassebaum said. "When you are on a strong medication like that, it's good to have more follow-up with your provider."

The Army is also trying to reduce the risk of negative interactions between different drugs by requiring pharmacists to do a review of all medications when a person has four or more prescriptions that include a controlled substance.

The increased surveillance of medications was initially developed for injured and ill soldiers assigned to Warrior Transition Units, specialized units developed in the wake of an investigation into poor outpatient treatment at Walter Reed Army Medical Center.

"What we found with our wounded warriors was when we did a more comprehensive medication review, we had less adverse events and less harm happening," Labadie said.