National Prescription Drug Action Plan

Yesterday, government officials proclaimed the formation of collaborative plan to address this nation’s problem with prescription opioid abuse and addiction. Speakers included Mr. Gil Kerlikowske, the director of the ONDCP (Office of National Drug Control Policy), Dr. Howard Koh, from the department of Health and Human Services (DHHS), Dr. Margaret Hamburg from the Food and Drug Administration ( FDA), and Ms. Michele Leonhart, administrator of the Drug Enforcement Administration (DEA).

 Speakers recited pertinent statistics regarding the state of opioid addiction and abuse in the U.S.  It’s now the faster growing public health problem in our country. Around 28,000 citizens died from unintentional drug overdose in 2007, the latest year for which data is available.  More people in the U.S. now die of unintentional drug overdose than gunshot wounds. In seventeen states and Washington D.C., unintentional overdose deaths outnumber deaths from motor vehicle accidents.

 The plan has four main points. First, both patients and prescribers of controlled substances will be provided with better education about these potentially dangerous medications. The drug manufacturers will be asked to develop educational products for both patients and providers for education, which will be reviewed by the FDA before approved for release. The medications included will likely include sustained-release oxycodone, oxymorphone, hydromorphone, and methadone. Fentanyl patches will also be included. The ONDCP is seeking to introduce legislation that will change the Controlled Substances Act in order to make training mandatory for doctors who prescribe long-acting opioids.

 Second, the national government will push the few remaining states that don’t have function prescription monitoring programs to put them in place, and to be able to share data with adjacent states.

 Third, the government will support more medication “take back” days in communities across the U.S. Citizens will be encouraged to bring old medication to community sites in order for proper disposal. Previous take back days have been very successful, with tons of pills collected and disposed. This will reduce the number of prescription opioid pills available for diversion. Surveys reveal that round 70% of the pills obtained by people misusing prescription medication for the first time are obtained from friends and family members, often without permission, from old prescription bottles.

 Fourth, state and federal agencies plan to crack down further on rogue doctors and clinics that are “pill mills.” This will require participation from state medical boards, law enforcement, and the DEA.

 At the end of this presentation, Karen Perry, founder of NOPE, told the story of her son, a bright young college student who died of an unintentional drug overdose. She described how his death affected her and his siblings. Her face was etched with the grief that can only come from such a profound loss

 The goal of this plan is to achieve a 15% reduction in prescription opioid misuse in this country by at within the next five years.

 I’m so pleased to see this announcement. Back in 2001, when I first started treating prescription opioid addiction, I was amazed at the numbers of people seeking treatment for this disorder. Studies since then have shown the situation has gotten much worse.

 There will be problems with this plan. Many doctors will not be happy they must have mandatory training in order to be able to prescribe some controlled substances (probably schedule II). Some will stand up on their hind legs and protest this new regulation, if it is passed by congress. But after seeing the prescribing habits of some of my brethren and sistren, it’s obvious we need this. We don’t get much education about appropriate prescribing of opioids, recognizing addiction, and referral for treatment. I’ve blogged before about this (see February 10th’s entry)

 I’ve been blathering on to anyone who will listen about the need for prescription monitoring plans (see prior blog entries for March 6, 8, and 31), so I’m delighted more attention is being paid to this. But I still worry about how states will communicate with each other. For example, my practice is close to South Carolina, yet that state has denied me access to their database. The only allow access to doctors licensed in South Carolina. I use the prescription monitoring program in my state both at the two Opioid Treatment Programs where I work and in my own office, where I see Suboxone patients. I’ve been using it since 2007.

I support the pill “take back” programs. While such events probably won’t do much for those with established addiction, they can help reduce the number of new users and experimental users. Remember, opioid overdose deaths don’t just happen to addicts. Youngsters experimenting with opioids can die from overdoses. In fact, new users dabbling with these pills, because they think they’re safer than “street” drugs, may be more likely to die because they don’t have any tolerance to opioids.

 We need good judgment and balance when shutting down pill mills. How can the DEA tell a pill mill from a legitimate pain treatment practice? I believe this is best done by other doctors. In this state, the medical board does investigations, which I feel is more appropriate than having investigations done by law enforcement. Law enforcement personnel just don’t have the training to tell the difference between appropriate care and careless prescribing with disregard for patients. Let other doctors do that. Granted, a few places will be so obvious that little investigation is needed.

 We don’t want the opioid pendulum to swing to the opposite side again, and become completely opioiphobic. These pain medications are addictive, but are also godsends in the right setting and used in the right way. Let’s take care not to throw out the good with the bad. The best people to set policy in this area are well-trained doctors who approach this issue with common sense and balance.

 Coming as late as it does in this epidemic, I could be negative and say the government has had an epiphany of the obvious. But I do know it takes time for all of these agencies to come together in a cooperative manner and form a plan of action. I’m just thankful that action is finally being taken.

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4 responses to this post.

  1. It is good to see that they are finally taking this problem seriously, but I still have a few concerns.

    As for providing “information” to the patients about how addictive opiates are, I don’t really see that this is going make much difference. Those who aren’t prone to abuse opiates are already terrified they are going to become addicted and those who are prone already know how addictive they are and that’s why they are seeking them out in the first place.

    I do like the idea of putting stricter guidelines on the pill mills and maybe even a national prescription monitoring system (if that is even possible.) As it is now, the states that have the prescription monitoring systemsin place don’t have enough staff on hand to monitor things like they should be so it is basically useless. I know for a fact this is the case in Louisiana as my husband deals in this area and sees first hand that the system is there and works, but there aren’t enough staff to stay on top of things and monitor it like it should be.

    Third, there is always going to be opiate abuse and addiction. No matter what happens, until a cure is found, you will always have addicts. We need to focus more on TREATMENT rather than just trying to make it harder for them to obtain these drugs of abuse or focusing on the punishment aspect.

    Just like anything else, no matter what rules and laws they put into effect, ppl will always find a way around those rule and laws to get what they are wanting. Instead of spending all the money, time and effort putting these ppl through the justice system, the jails and prisions, how about put that money to good use focusing on TREATING the disease?

    Again, I am so glad that the gov’t is finally seeing opiate addiction and abuse for the problem it has become instead of trying to ignore it or pretend it doesn’t happen here, but now we need to get the word out of exactly HOW addiction works (not the myths and misconceptions the public has been told all the years before) and coming up with a plan to treat it and one day hopefully CURE it.

    Reply

    • Well said.

      More than one study has shown that each dollar spent on addiction treatment saves at least $4, possibly more, in costs to society. Most of this is through reduced costs of incarceration. Investing into treatment just makes good sense both from a compassion point of view and a dollars and cents view.

      I don’t think everyone know how dangerous and addicting prescription drugs are. In a study done a few years ago, a shocking percentage of adolescents using opioids thought prescription drugs were safer than street drugs. I still have patients who enter treatment saying they didn’t think prescription drugs could be addictive. I think more education does help prevent new cases of addiction. You’re right though, education doesn’t help much after addiction has developed, unless it’s education about treatment options.

      Reply

  2. You know, I’m ashamed to say it, but I didn’t even think about the teenagers in that point of view. You are absolutely right about educating them on prescription meds and the fact that most of them think they are “safer” than street drugs just because they are legal medications. I know I originally started abusing them as a teenager (I was given them for enometriosis pain) and I thought that very same thing. I knew they made me feel good and I wasn’t depressed when I took them, but I thought it would be ok because they were given to me by a doctor. It wasn’t until many years later and I was severely addicted that I soon realized that there was no difference in what I was doing and someone who abused street drugs.

    Reply

  3. Doctors should periodically check prescriptions and it should be a surprise but mandatory and it would elevate a large quantity of “sellers”, I can’t count the amount of times I have heard “I make enough selling my pills then just buy min of what I need back for the month”.

    Reply

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