This commentary is written in response to the White House report entitled “Epidemic: Responding to America’s Prescription Drug Abuse Crises,” which states that, “Prescription drug abuse is the Nation’s fastest-growing drug problem.”
There is indeed a crisis of prescription drug abuse in America, and the White House is appropriately trying to focus the public health spotlight on this multifaceted and challenging problem. Unfortunately, because the medications are ubiquitous and so many people are involved, there is no easy solution. Prescription painkillers are routinely among the most commonly prescribed medications, making them available in most American households, and easier to obtain than alcohol for most adolescents. There are reports of “pharm parties,” where kids steal whatever pills they can find from their parents and relatives, mix them all together in a bowl, and take them at parties.
Drug-seeking patients can trick and pressure providers to provide painkillers to them. It can take longer to explain why a patient should not get them than it does to just write the prescription. I’ve even had one patient demand that he had a constitutional right to pain alleviation. In addition to using the newly created electronic prescription drug monitoring program (PDMPs) databases where available, providers should sign narcotic use contracts with their patients. There are many problems from non-medical use of the medications beyond just addiction, including the commission of crimes to obtain them, impaired driving, and lower productivity in work settings.
The White House Plan suggests that many different organizations, including government agencies and the house of medicine, must work together to educate everyone involved, make it harder to get the drugs, easier to dispose of them properly, and easier to track them electronically. Although it may conjure in some a second “War on Drugs,” and even if success will be achieved one patient or pill at a time, we all must rise to the occasion and address this crisis.
-Brian Caveney, MD, JD, MPH, Editor-in-Chief, Occupational Injuries and Illnesses (LexisNexis)
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A Summary of “Epidemic: Responding to America’s Prescription Drug Abuse Crises”.
The White House states that, “Prescription drug abuse is the Nation’s fastest-growing drug problem.” The report cites a survey that found that nearly one-third of persons 12 years of age and older who used drugs for the first time in 2009 began by using a prescription drug non-medically. That same survey found that over 70 percent of persons who abused prescription pain relievers got them from friends or relatives. Another survey concluded that prescription drugs are the second most-abused category of drugs, exceeded by only marijuana.
While acknowledging that various categories of prescription drugs are being abused, the report’s “action plan” focuses mainly on the problem of prescription opioid abuse. It notes that, from 1997 to 2007, the milligram per person use of prescription opioids in the U.S. increased from 74 milligrams to 369 milligrams. Similarly, the 174 million prescriptions for opioids dispensed by retail pharmacies in 2000 grew to 257 million in 2009.
The report sets forth a “Prescription Drug Abuse Prevention Plan” that includes action in four major areas: education, monitoring, proper disposal, and enforcement.
Education: The report proposes initiatives for education of: (1) healthcare providers, and (2) parents, youth, and patients. Under the first category, it suggests federal legislation to require that physicians, dentists, and others authorized to prescribe undergo training on responsible opioid prescribing practices as a precondition of DEA registration to prescribe controlled substances. By the same token, this proposal includes a requirement that drug manufacturers develop educational materials to train practitioners on the appropriate use of opioid pain relievers. Also, it proposes that medical and healthcare boards require education curricula in health professional schools and continuing education programs to include instruction on the safe and appropriate use of opioids to treat pain while minimizing the risk of addiction and substance abuse. Under the category of educating parents, youth, and patients, it proposes to enlist all stakeholders to promote an evidence-based public education campaign on the appropriate use, secure storage, and disposal of prescription drugs, especially controlled substances, as well as to require drug manufacturers to develop educational materials for patients on these topics.
Monitoring: Noting that 43 states have already authorized prescription drug monitoring programs that aim to prevent abuse of prescription drugs at the retail level, 35 of which have operational programs, the report states that such programs appear to be a promising approach but that more work is needed to determine how to maximize their effectiveness. It promotes a combination of federal, state, and local action, including programs enlisting electronic media for identifying particular areas of prescription drug abuse (e.g., issuance of the final rule on DEA electronic prescribing of controlled substances) and working with Congress to pass legislation to authorize the VA and the Department of Defense to share patient information on controlled substance prescriptions with state prescription drug monitoring programs.
Disposal: Pointing out that one survey found that more than seven million Americans reported using a prescription medication for non-medical purposes in the past 30 days, the report states that a comprehensive plan to address prescription drug abuse must include proper disposal of unused, unneeded, or expired medications. While the DEA recommends disposal via flushing for certain opioid pain relievers that can pose life-threatening risks from accidental ingestion, environmental considerations lead the report to recommend against flushing for most drugs. Instead, most drugs should be disposed of in sealed plastic bags with filler such as coffee grounds or kitty litter. It notes that the administrative process to establish the DEA medication disposal rule is underway.
Enforcement: The report states that a major enforcement initiative is being undertaken against “a small group of practitioners who abuse their prescribing privileges,” including pain clinics and prescribers who are not prescribing within the usual course of practice and not for legitimate medical purposes. Toward this end, the report proposes the writing and dissemination of a model pain clinic regulation law.
Read the report at http://whitehousedrugpolicy.gov/publications/pdf/rx_abuse_plan.pdf
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