Assessing psychoactive pharmaceuticals and transitioning pharmacological fatigue countermeasures into operational environments.

Herein we summarize a discussion on the topic of how psychopharmaceuticals for potential military operational use may be evaluated based on their effects on performance and safety, and introduce two manuscripts: the first (Caldwell and Caldwell; 1) addressing the operational use of fatigue countermeasures; and the second (Rowland; 3) discussing the potential operational use and limitations of ketamine as a field analgesic. Fatigue countermeasures are usually employed by a relatively small number of military members engaged in sustained or continuous operations when sleep is not an option. Clinical treatments are available at any time as required to treat medical conditions. The issue of importance for the operational community, with regard to both clinical use of psychopharmaceuticals and performance maintenance through fatigue countermeasures, should be whether the medication impairs operationally relevant performance, assuming the disorder for which the medication is prescribed does not in itself prohibit operational duties. Applied research paradigms are generally discussed for assessing and transitioning pharmaceutical compounds from the laboratory to the operational environment. Tier 1 focuses on quantifying the impact of stressors and interventions in healthy members of the general population, while Tier 2 testing would use military or operationally matched volunteers in simulated or actual field environments. The section papers address two areas of operational relevance--the Caldwell and Caldwell paper presents guidelines for the use of fatigue countermeasures, and the Rowland paper discusses the potential effects of ketamine, an agent intended to replace morphine as a battlefield analgesic, on cognition.