title: Widespread Use of Prescription Nonsteroidal Anti-Inflammatory Drugs Among U.S. Army Active Duty Soldiers.
abstract: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain and inflammation by inhibiting prostaglandin synthesis. There is a high incidence of musculoskeletal injuries in the military, which would validate the widespread use of NSAIDs. This study determined the amount and specific types of NSAIDs being prescribed to U.S. Army active duty soldiers.
  
  
  
  This study was a quantitative study which utilized an existing database of de-identified data; therefore, institutional review board approval was not required. Data pertaining to NSAID prescriptions issued to active duty soldiers for fiscal years 2006, 2011, and 2014 were obtained from the Department of Defense Pharmacy Data Transactions Service data warehouse, which contains all outpatient prescriptions. The data include the number of soldiers receiving NSAID prescriptions (i.e., utilizers) as well as the number of prescriptions given for each specific NSAID.
  
  
  
  In 2006, 2011, and 2014, the numbers of active duty utilizers were 348,031, 435,364, and 418,579, respectively. For the entire active duty Army, the percentage of soldiers who were receiving NSAID prescriptions was approximately 69% in 2006, 77% in 2011, and 82% in 2014. The number of NSAIDs prescribed was 740,090 in 2006; 898,291 in 2011; and 857,964 in 2014. Celecoxib, the only cyclooxygenase-2 inhibitor prescribed in the United States accounted for 2.4% of these NSAID prescriptions in 2006, 6.3% in 2011, and 7.1% in 2014. During all 3 years, the number of prescriptions filled was almost twice the number of utilizers, indicating that many individuals were receiving more than one prescription. Female soldiers received almost twice the number of prescriptions per individual as male soldiers. The use of over-the-counter NSAIDs, which are widely available, was not accounted for in this study; therefore, total NSAID use is likely higher than reported.
  
  
  
  The vast majority of U.S. Army active duty soldiers are being prescribed NSAIDs. These data raise concerns because of the potential adverse effects that NSAIDs have on gastrointestinal, renal, and cardiovascular function, as well as bone health. Additional studies are warranted to determine the actual amounts of NSAIDs being used and the specific conditions for which they are being prescribed.
authors.affiliation: Military Performance Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA 01760.
authors.forename: Leila A
authors.initials: LA
authors.lastname: Walker
authors.affiliation: Military Performance Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA 01760.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Zambraski
authors.affiliation: Team Unissant (SRA International), Pharmacy Analytics Support Section, Defense Health Agency Pharmacy Operations Division, 7800 IH-10 West, San Antonio, TX 78230.
authors.forename: Roger F
authors.initials: RF
authors.lastname: Williams
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D016208:Databases, Factual; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006801:Humans; D008889:Military Personnel / Q000706:statistics & numerical data*; D055553:Prescription Drugs / Q000627:therapeutic use*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D055553:Prescription Drugs