A new law will require the Pentagon to start compiling data in 2024 on overdoses within the ranks, and to make available to troops an antidote for opioid overdoses, as the U.S. continues to battle increasing casualties from the fentanyl crisis.

Previously, overdoses within the military -- fatal and non-fatal -- weren't systematically tracked. The Defense Department will now have to maintain information such as what substances were involved in an overdose, whether doctor-prescribed drugs were also involved in an overdose, and how many overdoses are deemed intentional or accidental, following the passage of the annual defense policy bill last month.

Pressure began to build in Congress to take action to combat the rising number of overdose deaths in the military following a 2022 Rolling Stone report^[1] that exposed a string of overdose deaths at Fort Bragg, North Carolina, now renamed Fort Liberty^[2], prompting Sen. Edward Markey (D-Mass.) and other lawmakers to push the Pentagon for information^[3].

Read Next: Defense Secretary Austin Diagnosed with Prostate Cancer that Led to Further Hospitalization for Infection^[4]

As a result of that request, the Pentagon determined that the number of military deaths involving fentanyl doubled between 2017 and 2021, mirroring escalating fatalities nationally as the drug has flooded the country.

Fentanyl is 50 times stronger than heroin and 100 times stronger than morphine. The synthetic opioid has been available since the 1960s^[5], mostly for extreme pain in cancer patients. Now, it's the leading cause of death^[6] for Americans between the ages of 18 and 49.

More than 330 service members died of drug overdoses in the five years before 2022. Ten percent of those deaths occurred on Fort Liberty alone, while 15,000 troops suffered non-fatal overdoses, the majority of which were accidental.

"Real security means guaranteeing that members of the military and their families can get resources and life-saving treatment necessary to stop the overdose crisis in its tracks," Markey said of the new law, in a statement emailed to Military.com last fall.

The new drug requirements, wrapped up in the annual defense bill^[7] that was signed by President Joe Biden on Dec. 22, represents the most significant recent effort to combat overdoses within the ranks, and come at a time when Illegal drugs, primarily fentanyl, are projected to be a top national security threat in 2024^[8].

The new annual report will also include information on overdose locations, demographics, whether the service member had previously sought mental health treatment, or if they'd previously been prescribed opioids, benzodiazepines or stimulants.

The surge in deaths is in large part because drug manufacturers began mixing fentanyl with other drugs to increase the intensity of a user's high. Because of fentanyl's extreme strength, it's often a lethal combination. Gold Star mother Carole De Nola prefers the term "poisoning"^[9] to accidental overdoses involving fentanyl given that users often don't know what's in the drugs they're using.

De Nola's only child, 23-year-old Ari McGuire, died of an accidental fentanyl poisoning while stationed at Fort Liberty in 2019.

"We should be dealing with this before a service member's about to overdose," she said, adding that the new law doesn't include any requirements on fentanyl awareness.

Many fentanyl victims are looking for recreational drugs, as opposed to regular drug abusers, and are unaware of fentanyl's proliferation.

Without education, "we're going to continue to get a passive response," De Nola said. "The Army^[10] will remain reactive, rather than proactive."

About seven in 10 fake prescription pills, including counterfeit Adderall and Xanax, contain a potentially lethal dose of fentanyl^[11], according to the U.S. Drug Enforcement Agency.

Some research points to the possible effects the opioid crisis may be having on dismal military recruiting efforts^[12] too, noting that the issue is particularly devastating to young men of military age and to states that have long been reliable military recruiting grounds.

The new drug requirements come as the U.S. enters what experts are calling the "fourth wave" of the opioid crisis^[13], first beginning in the late 1990s when drugmaker Purdue Pharma began manufacturing synthetic opioid painkillers and falsely labeling the drugs as non-addictive.

After the government tightened regulations on opioid accessibility, opioid users began turning to heroin during the second wave around 2010, stifled by the newly restricted access to prescription pain meds. The third wave followed a few years later, with the arrival of fentanyl on American streets.

Now, the fourth wave sweeping the nation is characterized by illegal drug makers combining fentanyl with other drugs, such as cocaine or counterfeit Xanax.

On top of the new tracking requirements, the military must come up with a plan by 2025 to ensure Naloxone, a lifesaving drug that can reverse an overdose, be made available to all troops. While she's glad to see Naloxone be made available, De Nola says the long timeline will be too late for military overdose victims.

The nasal spray version of Naloxone, known as Narcan^[14], is relatively easy to administer, and some U.S. cities have started placing it in publicly accessible vending machines^[15], in hopes of saving more lives.

"It's really just smart public health," said Professor Alex Bennett of the new legislation. Bennett serves as the director of New York University's Opioid Overdose Prevention Program, and his work often focuses on military veterans. The changes are overdue, he added, and can help prevent overdoses amongst veterans down the line.

"There's really a lot of drug naivete amongst military personnel," Bennett said, stressing that many veterans he's met don't understand the risks of mixing drugs, especially with alcohol, which can decrease a person's heart rate to the point of overdose.

Improving data collection in the DoD now can mean better drug intervention efforts for veterans, after they exit the service, Bennett added.

"We've been working with a lot of veterans who use substances while they're in the military," he said. "Transparency with data tracking like the kind the military is set to begin doing is a step in the right direction."

It's not yet clear how the DoD will make Naloxone available. Another harm reduction tool, fentanyl test strips, which check drugs for traces of fentanyl^[16], is not included in the new law. Additionally, the Naloxone that's distributed to troops is set to require a tracking system, which may deter some troops from seeking it out.

Substance abuse experts say that tracking data on military overdose victims could help the DoD prevent more deaths by identifying trends and patterns, so top brass could better allocate attention and resources.

"Closing your eyes to drug problems doesn't solve anything," Bennett said. "It just makes things worse."

-- Kelsey Baker is a graduate student at Northwestern's Medill School of Journalism and a former active-duty Marine.

Related: 'You Can't Fix the Problem If You're in Denial:' The Military's Surge of Fentanyl Overdoses^[17]

Defense Secretary Lloyd Austin was diagnosed with prostate cancer and underwent surgery in late December, which led to a secondary infection and his current hospitalization since Jan. 1 -- a series of serious health issues that remained undisclosed to the public, president and Congress until late last week, the Pentagon said Tuesday.

The information on Austin's ongoing medical issues was released by doctors at Walter Reed National Military Medical Center in Maryland, who said the defense secretary was diagnosed with prostate cancer in early December and "underwent a minimally invasive surgical procedure called a prostatectomy" on Dec. 22.

On Jan. 1, Austin, 70, developed severe abdominal, hip and leg pain, which led to another hospitalization and a diagnosis of a urinary tract infection and abdominal fluid that was impairing his small intestines, the statement from the doctors said.

Read Next: Marine Commandant Has Open-Heart Surgery Following Earlier Cardiac Arrest, Plans to Return to Duty^[1]

Overall, Austin's doctors said "his prostate cancer was detected early, and his prognosis is excellent." They also noted the infection that prompted his second hospitalization had cleared and said "he continues to make progress and we anticipate a full recovery, although this can be a slow process."

Austin and his staff did not notify the public or other key officials of either hospitalization until Friday, flouting convention and leaving the White House and Congress unaware that the Pentagon's top civilian leader was sidelined by serious medical issues.

After a weekend of speculation and revelations about how little top government officials knew about the status of a key cabinet secretary, Maj. Gen. Pat Ryder, the Pentagon's top spokesman, said that a series of issues and missteps -- including Austin's chief of staff coming down with the flu and his own failure to ask follow-up questions -- were to blame for the secrecy.

The lack of notification caused major political blowback -- including calls from some Republicans in Congress for Austin's resignation -- that the Pentagon was still wrestling with Tuesday.

Adding to the disclosure delays, John Kirby, the spokesperson for the White House's National Security Council, told reporters at a briefing Tuesday that President Joe Biden was unaware of Austin's cancer diagnosis until Tuesday morning -- even though the pair spoke over the weekend in a "good conversation on Saturday," according to Ryder.

However, Kirby was adamant that military operations were not impacted by Austin's hospitalizations and absence.

The statement from Walter Reed also offered more detail on the severity of Austin's medical issues throughout last week.

The fluid that collected in his abdomen "resulted in the backup of his intestinal contents, which was treated by placing a tube through his nose to drain his stomach," the statement said. It also noted that Austin "never lost consciousness and never underwent general anesthesia."

During his initial surgery for prostate cancer on Dec. 22, Austin was under general anesthesia, the doctors said in the statement. "Secretary Austin recovered uneventfully from his surgery and returned home the next morning," they said.

There has been no official explanation as to why Austin chose to not disclose his prostate cancer or the subsequent lack of communication by the Pentagon. But the defense secretary did say that he took "full responsibility for my decisions about disclosure." Broadly, though, prostate cancer is a diagnosis that many men feel reluctant to share.

Prostate cancer is the most frequently diagnosed malignancy in male U.S. military veterans, with 12,000 former service members affected each year. Roughly one in five veterans will be diagnosed with prostate cancer in their lifetimes, a rate twice that of the general population, according to Zero Prostate Cancer, a nonprofit organization that assists patients and families and advocates for research and treatments.

Austin spent 41 years in the Army^[2] before his retirement in 2016 at the rank of general. In that time, he was not only recognized for his leadership of soldiers during some of the key moments of the Global War on Terror but he would go on to serve as the Army's second-highest ranking officer and the head of U.S. Central Command, which is responsible for all military operations in the Middle East and Afghanistan.

Some veterans have a higher risk of developing prostate cancer as a result of environmental exposures. The disease has been linked to exposure to defoliants used during the Vietnam War and tied to service as an aviator or member of a ground crew, although no definitive link to a substance such as jet fuel has been established.

Other risks for the development of prostate cancer include age -- the illness is most common in men over 65 -- and ethnicity, with Black Americans having the highest incidence rate of all ethnicities, as well as genetic anomalies, diet, smoking and other factors.

Walter Reed National Military Medical Center in Bethesda, Maryland, hosts the Defense Department's Prostate Center of Excellence, treating patients and conducting research to prevent or treat the life-threatening spread of the illness. The facility offers state-of-the-art treatment for prostate cancer including minimally invasive surgery, image-guided radiation therapy and radiation implants designed to destroy the cancer cells.

The cause of Austin's complications from the initial surgery in December that led to his readmission to Walter Reed was not immediately apparent from the information provided by his doctors.

Hospital readmission rates -- a metric often used to assess the quality of care at U.S. hospitals and clinics -- are not publicly released for Walter Reed, but the facility has consistently, since 2017, received high marks from the National Surgical Quality Improvement Program for complications related to surgery, noted as "exemplary" in 2022.

Infections are the top reason in the U.S. that patients are readmitted to the hospital following a surgery, as was the case with Austin.

According to data posted on the hospital's website, Walter Reed has performed consistently to national standards for central line-associated blood infections -- those caused when bacteria enter a patient's bloodstream via a required hospital device access point -- and catheter-associated urinary tract infections. However, in 2014 and 2015, it performed worse than the national benchmarks for the latter.

For outpatient elective surgery, Leapfrog, a nonprofit hospital watchdog organization, gave the hospital its top ratings for staffing such procedures but its lowest ratings for performing safe surgery checklists every time one is performed.

Related: Inside the Pentagon's Failure to Notify the White House, Congress of Defense Secretary's Hospitalization^[3]