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Category Archives: Editorial
The numbers are staggering: in the United States, the number of overdose deaths from prescription opioids has more than tripled in the past decade, resulting in nearly 15,000 fatalities in 2008 alone and now accounting for more than 40 deaths every single day – not to mention the fact that estimated annual health care costs from this epidemic are as high as $72.5 billion.
How did we get here?
In the latest issue of Emergency Medicine News, Dr. Leon Gussow, a physician and editor of The Poison Review blog, examines how opioid analgesics – once feared as dangerous medications with high risk for addiction and overdose – became the drug class most frequently prescribed in the U.S., with four million patients a year receiving scripts for these powerful medications.
Here’s an interesting editorial by two doctors weighing in on the recent debate over the extent to which doctors’ prescriptions are contributing to the alarming surge of drug overdose deaths across the nation. They note that while many legitimate pain patients are rightly given opioid prescriptions, their pain often persists — possibly from hyperalgesia, a hypersensitivity to new pain caused by those very opioid prescriptions. Between tolerance and hyperalgesia, they say, patients often need escalating doses of opioids just to feel pain-free, increasing the chances of overdose. In their opinion, “conscientious and well-trained doctors are partly to blame for the rapidly rising death rate among Americans from prescription pills.”
Physicians’ prescribing practices have recently come under fire in California, where an investigation by the Los Angeles Times found that a small group of doctors four southern California counties had written prescriptions for a number of patients who later overdosed and died. Reporters identified a total of 3,733 deaths from prescription drugs from 2006 through 2011 in Los Angeles, Orange, Ventura and San Diego counties. In 1,762 of those cases — 47% — drugs for which the deceased had a prescription were the sole cause or a contributing cause of death, reporters found.
In many areas of the nation struggling with prescription painkiller addiction, measures are being implemented to tighten licensing board rules on treating pain patients. In Washington state, this crackdown has prompted a number of doctors and clinics to stop taking new chronic pain patients who are already on opiates, and in some cases to cut off current pain patients, according to this article. While the new rules don’t apply to patients with injuries, surgery, cancer or people who are dying, there has already been pushback. Some doctors say the rules are too burdensome, while pain patients say they’re being denied the medicines they have come to rely on. Others say the stricter rules will drive desperate pain patients to seek illegal pills on the black market or try risky alternatives.
But the real point of contention here seems to be one of perception. Pain patients don’t like to be perceived as “junkies” – “it’s no fun to go down to one of these druggie centers and stand in line with all these guys with tattoos and pee in a bottle,” one man says in the article. And yet, the perspective of these so-called “junkies” isn’t included. I can guarantee that if it were, this would be a different story. The 25-year-old kid who got started on Oxy at 15 doesn’t want the junkie life to be his reality, any more than the pain patient wishes to be in pain (or, if they admitted it, to be hooked on these powerful medications).
More than one in five teens who have been prescribed controlled medications like OxyContin end up misusing the drugs, and these kids are more likely than others to abuse other substances and to start giving or selling drugs to their peers, according to a new study on teens and controlled medications in the August issue of Archives of Pediatrics.
Disturbingly, instead of focusing on the fact that 18 percent of the nearly 3,000 teen respondents said they had used at least one prescribed controlled medication during the past year, the lead author of the study said it was important to note that the majority of secondary school kids who are prescribed opioids and other controlled medications don’t abuse them, according to this article in HealthDay News. “The field doesn’t want to go back to having so much fear associated with these medications that we then underprescribe them,” said Sean Esteban McCabe, according to the article.
I get the whole glass-half-empty-or-glass-half-full thing when evaluating statistics. But this type of thinking is the result of the push in the late 1990s by organizations like the American Pain Society to convince U.S. doctors that they weren’t adequately treating pain and were under-prescribing opioid pain medications due to a misguided fear of causing addiction. (For a fantastic sum-up of the history of the pain management movement, visit Dr. Jana Burson’s pain pill addiction blog.)
Last week, President Barack Obama released a survey on prescription drug abuse that called for new measures in prevention, including enlisting pharmaceutical companies to train doctors on prescribing practices for narcotic drugs.
This call for action comes a couple of years too late – after all, the prescription drug abuse epidemic has been raging since the late 1990s. Nevertheless, it’s nice to see a real attempt by the White House to address the growing problem of prescription drug abuse.
First, the good news: the major goal of the plan is to cut the abuse rate by 15 percent by the year 2015 through doctor and patient education. The plan also proposes a strategy to increase state-run prescription drug monitoring programs, which are currently active in 35 states.
Prescription monitoring systems provide an online database for pharmacists and doctors to research patients’ past and current prescriptions – an effective tool to prevent doctor shopping. However, most databases are limited to information within a single state and are not mandatory for drug prescribers to check when writing or filling a prescription.
Watchdog Editorial: Severe penalties, strict rules for doctors needed to curb prescription abuse epidemic
With prescription painkiller abuse rampant among teens and adults alike, everyone’s trying to escape the blame-game. From pharmaceutical companies to government agencies, it seems the responsible parties are more willing to throw money at the problem than address the underlying causes. It’s time to take a closer look at one of the most elemental factors in this disturbing trend: addicted patients and the doctors who get them that way.
Accountability on the rise?
Last week, three U.S. doctors were accused of over-prescribing highly addictive painkillers such as OxyContin that have been linked to patient overdoses and even deaths. While it’s not unprecedented for doctors to be held accountable for such occurrences, it is unusual. And the fact that three similar, unrelated incidents took place last week makes us wonder: are doctors’ over-zealous prescribing practices finally getting the attention they deserve?
It’s significant that in each case, neither the doctors nor those receiving the prescriptions were found to be illegally distributing the drugs. In other words, the doctors were careless with their prescription pads, and the patients were uneducated in the dangers of the drugs they were taking.
You may remember Watchdog contributor Jaime Messina, who blew the whistle on OxyContin way back in 2003 as a student at Northeastern University – a full four years before Purdue shelled out $634.5 million for lying about the painkiller’s addictive qualities. Here, she weighs in on “OxyMorons,” a new film about Oxy’s devastating effects in the Boston area.
Last Tuesday I had the opportunity to view the film “OxyMorons,” a low-budget indie film that portrays the life of an OxyContin dealer in the small community of Charlestown, Mass. The film – which is written by, starring and about Johnny Hickey – takes place in the early 2000s, when the Oxy addiction epidemic in Massachusetts was first starting to rear its head. Hickey, who has since cleaned up his life, was able to write an excellent screenplay based on his experiences. As someone who has been aware of and has personally seen the devastation OxyContin can cause, I was excited to hear that such a film was produced, and I highly anticipated its limited release at a theater in Revere, Mass., just north of the town in which it takes place.
Jaime Messina was no stranger to OxyContin. Growing up in her hometown of Watertown, Mass., the prescription painkiller was everywhere: to use it to get high, all you had to do was ask around at a party, or raid your parents’ medicine cabinet. She didn’t think much of it – it was just the way things were. Even though Oxy was all around her, Jaime managed to keep her distance from the drug. But that all changed once she graduated from high school and began attending Northeastern University.
Alarmed at the number of OxyContin-related deaths in her home state, Jaime dedicated an entire semester of her sophomore year studying the issue of Oxy abuse. During that time alone, five kids from Watertown died of Oxy overdoses.
“The threat that OxyContin poses to Massachusetts is not improving or even hitting a plateau,” Jaime wrote in a paper summarizing her research, adding that the skyrocketing rates of OxyContin misuse in the state resembled the beginning stages in places where Oxy abuse had already become rampant, such as rural areas of Maine.
Jaime also noted in her paper that OxyContin’s maker, Purdue Pharma, had used “overly aggressive and misleading” marketing techniques to promote its product, directly leading to rising death rates and increases in Oxy-related crime.
Though Saturday’s DEA-sponsored Prescription Drug Take-Back Day could potentially affect the dissemination of the highly addictive painkiller OxyContin, future success of the initiative hinges on local efforts and public awareness. A little funding would be nice too.
Chances are that most people with unused prescription drugs received conflicting information on the best way to dispose of them, reports Media Health Leaders.com. The U.S. Food and Drug Administration and Office of National Drug Control Policy recommend tossing the pills in the toilet or trash, while the U.S. Environmental Protection Agency and U.S. Fish and Wildlife Service state that the chemicals from flushed drugs are harmful to the environment and end up in our drinking water.
“I believe this event has done a lot to help people throughout the country understand the need to get rid of these medications,” says April Rovero, who founded the National Coalition Against Prescription Drug Abuse after her son, Joey, died in December 2009 from a lethal combination of alcohol and misused prescription medication.
The increased attention paid on prescription drug abuse combined with the possibility of doctors becoming more hesitant to prescribe certain pain medications may cause hoarding of unused pills rather than their return at events such as today’s national Prescritpion Drug Take-Back initiative, according to this blog posted by Time Magazine’s Healthland. Unlike the handgun buyback program, which offers money for returned firearms, the drug take-back offers little incentive for those who might be saving their painkillers such as OxyContin for an emergency or future use. What’s more, the blog cites two studies that show the majority of people who abuse painkillers did not become addicted during pain treatment and the majority of those admitted into rehab for prescription drug abuse had previously been treated for addiction.
To read more about today’s take-back program, go here.