JACKIE WALORSK! scan ous re Bone he Dec, a ay Se ‘COMMITTEE ON ARMED SERVICES ea contr Congress of the United States Mn aa House of Representatives ‘Blashington, DE 20515-1402 ‘COMMITTEE ON AGRICULTURE ‘COMMITTEE ON VETERANS’ AFFAIRS December 7, 2015 ‘The Honorable Ash Carter Secretary USS. Department of Defense 1000 Defense Pentagon Washington, DC 20301-1000 Dear Seeretary Carter: ‘Throughout my district, the state of Indiana, and around the country, the scourge of addietion is painfully impacting ‘many hard working families. With so many struggling with addictions to both preseription (such as opioids) and, non-prescription drugs (such as pseudoephedrine products converted to methamphetamine), the growing cost of this, problem in lives and resources is too high to be ignored. (Our Armed Forces are not immune from the issues confronting our society, including drug abuse. While drug abuse is significantly lower in the military, many of our service members and their dependents stil struggle with addiction to prescription opioid pain medications. According to a March 2013 revised report from the National Institute of Drug Abuse, 1! percent of service members reported misusing prescription drugs, up from 2 percent in 2002 and 4 percent in 2005. Prescriptions for opioids written by military physicians quadrupled between 2001 and 2009. While this significant inerease is certainly related to the frequeney of services members deploying in support of combat ‘operations in Iraq and Afghanistan, this isan issue that the Department must continue addressing. Beyond the immediate health concerns of our service members and their families, drug addiction and abuse also presents a significant readiness challenge for the total force. ‘Therefore, I would like to see your Department serve as a model of how to be part of the solution to America’s drug abuse epidemic. As you likely know, the Food and Drug Administration recently issued guidance urging companies to develop abuse-deterrent opioids and the Obama Administration launched a major initiative to address drug abuse in October. Because drug abuse is becoming more widespread, I would like to know how the Department of Defense plans to stay ahead of these issues and minimize the impact of drug abuse in the lives of Service Members and their families. | would like better insight how your Department is addressing drug abuse and activities related to drug abuse, specifically as it relates to access to certain medications that can be abused — notably prescription opioids, and products that may be used in the production of methamphetamine, like pseudoephedrine. To gain a better understanding of this issue, please provide written answers to the following questions: 1. What safeguards does the military have in place to address over prescription of opioids? What kind of ‘taining does the military have regarding the appropriate methods of prescribing prescription painkillers?Can you provide me with eurent and historical data regarding the presribing of opioids through TRICARE to all personnel (including aetive duty and retired)? 2, Do TRICARE formularies prioritize abuse-deterrent formulations of prescription opioids over those opioids that do not have abuse-deterrent technologies? 3. Does TRICARE cover non-prescription pseudoephedrine products? a, I TRICARE covers pseudoephedrine products, does it prioritize coverage of products with abuse-deterrent technologies? If'so, how? If not, why not? b. I TRICARE does not cover pseudoephedrine products, how do service members access these medications? Does the military provide any discounts or other incentives (financial or otherwise) for the purchase of pseudoephedrine products? 4, Are pseudoephedrine products available on bases - Post / Base Exchanges, Commissary, or otherwise? a. I'so, is access to these products limited? For example, do purchasers acquire these medications from the pharmacy and are the purchases logged to enforce quantity restrictions?” ‘5, Several states have made it illegal to purchase pseudoephedrine products without showing an ID. I have two questions along those lines: 4. First it has been reported that many so-called “smurfs” are using fake IDs to make multiple pseudoephedrine purchases or multiple purchasers may be buying pseudoephedrine on behalf of someone collecting it for local meth manufacturing, Can you describe the precautions your Department has instituted to mitigate the creation and use of Fraudulent IDs? bb. Second, ifan installation is located within a state that has a prescription-only pseudoephedrine law of other laws governing access to pseudoephedrine, will the installation comply with that state law or are sales of these products exempt from these laws? ‘Thank you for all you do in service to our nation and thank you for your prompt attention to these questions. Please provide a response to these questions by December 18, 2015, incerely, aces [atyeste: Jackie Walorski Member of Congress