During the fieldwork for the assessment of Wounded Warrior programs, we identified challenges pertaining to medication management practices. This follow-on assessment focused on DoD and Service policies and programs intended to manage the risks associated with Wounded Warriors who were prescribed multiple medications during the course of their treatment and recovery. Specifically, we examined the policies related to reducing adverse drug events such as unanticipated side effects, decreased drug effectiveness, accidental overdose, and death. We also examined the procedures related to disposing of medications that are expired or no longer needed for treatment. Misuse of unneeded medications can result in similar adverse drug events.
We found that the Department of Defense did not have overarching policies and procedures to ensure consistent medication management and reconciliation practices in the Wounded Warrior population. The Services have adopted policies at various command levels; however, there is wide variance across the Services in the policies and standards for medication reconciliation.
Additionally, Wounded Warriors did not have a reliable, safe, accessible, and accountable method to dispose of medications that were no longer needed for treatment. As a result, Wounded Warriors may be at risk for overdose or misuse of unneeded medications that could result in unnecessary hospitalization and death.
We recommend the Department of Defense create Military Health System policy to address the risks for Wounded Warriors who may use multiple medications in the course of their treatment; and the Services update policies to address the unique needs of the Wounded Warrior population. We also recommend the Secretary of Defense request the U.S. Attorney General expedite the Drug Enforcement Administration decision for issuance of authority for Department of Defense medical treatment facility pharmacies to conduct routine take-back of unnecessary prescription medication, and that the Services create implementation policy if that authority is given by the Drug Enforcement Administration. Finally, we recommend the Department of Defense develop additional education and information initiatives on the proper disposal of expired or unneeded medications.
Management Comments and Our Response
The Office of the Secretary of Defense, Army Surgeon General, and Navy Surgeon General provided comments to this report. Management concurred with all the recommendations. At the time of this publication, the Air Force Surgeon General had not provided management comments. We request the Air Force provide management comments to Recommendation A.2., by March 21, 2014. The full reproduction of the comments received is included in this report.