The report by the Government Accountability Office (GAO) recommends that the Secretary of Defense direct the Army to monitor prescribing practices in order to detect medications that are discouraged under PTSD treatment guidelines. Those guidelines caution against the use of antipsychotics and benzodiazepines, a class of sedatives, because of their ineffectiveness and potential risk.
“The Army does not monitor the prescribing of medications to treat PTSD on an ongoing basis,” says the report, led by the GAO’s director of health care, Debra Draper. “Without such monitoring, the Army may be unable to identify and address practices that are inconsistent with the guideline.”
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Army needs to improve monitoring of antipsychotic drugs, GAO says.
The Department of Defense did not dispute the GAO recommendations, but argued that it has worked to reduce antipsychotic prescribing. Army officials cited an analysis showing that the proportion of service members with PTSD who were prescribed such drugs fell from 19 percent in 2010 to 10 percent in 2014. The Army issued a policy in 2012 that required military hospitals to review their prescribing practices for atypical antipsychotics, but the policy expired in 2014 and did not apply to benzodiazepines, the report says.
The GAO noted that the Veterans Health Administration (VHA) actively tracks the prescribing of benzodiazepines and antipsychotics for veterans with PTSD, and requires VA facilities with higher-than-average prescribing to develop and implement plans to reduce those rates.
In a separate recommendation, the GAO urged that the VHA clarify a 2015 policy instructing its health providers not to discontinue mental health medications when active-duty service members shift into VA care. VA providers had “varying interpretations of which medications are covered by this policy,” the GAO found, posing a danger that some providers might be “inappropriately discontinuing mental health medications . . . which could increase the risk of adverse health effects for transitioning service members.”
In a response to the report, Robert L. Nabors, chief of staff to VA Secretary Robert McDonald, said the agency would issue written guidance to its providers clarifying the types of medications covered by the 2015 policy.
The GAO report found that the defense department, which is responsible for the care of active-duty troops, has a wider variety of psychiatric, pain and sleep medications in its formulary than the VHA does. VHA officials told the GAO that safety, efficacy, and cost were factors in determining which medicines to include in their formulary. For example, they said, the VHA formulary includes only two sleep medications because of concerns about the appropriateness of some drugs for the treatment of insomnia.
A breakdown of psychiatric drugs used by the defense department shows that the highest percentage of prescriptions filled for active-duty service members in 2014 were for the antidepressant Trazodone (8.5 percent of all psychiatric prescriptions), followed by the stimulants Amphetamine/dextroamphetamine (8.2 percent) and the antidepressant Bupropion (7.1 percent).
