The Prescription Drug Epidemic: Engaging the Enemy
On April 19, the Obama administration announced a new initiative designed to reduce prescription drug abuse. The plan, unveiled at the National Press Club in Washington, will involve a cooperative effort between four federal agencies: the Office of National Drug Control Policy (ONDCP), the U.S. Department of Health and Human Services, FDA, and DEA.
Epidemic: Responding to America’s Prescription Drug Abuse Crisis
Under the plan, education will be provided to patients and health care providers. The materials will include the risks and benefits of using opioids, who should use them, how they should be used, and how to dispose of unused medicines. Doctors will be expected to understand and educate patients on medication safety and patient responsibility. They will also be instructed on recognizing signs of addiction, misuse, and abuse.
Education is voluntary at the moment, but the committee seeks to make it mandatory for any physician involved in prescribing drugs like transdermal buprenorphine, transdermal fentanyl, and medications containing morphine, methadone, hydromorphone, oxymorphone, and oxycodone. Mandatory education would be required before a DEA registration number would be issued to physicians for prescribing narcotic substances.
The plan also addresses efforts to shut down pill mills and prevent doctor shopping. One of the most prevalent issues is the alarming number of opioid pills that are prescribed, often by doctors with little or no justification. Pill mills do a cash business, prescribing a huge number of pain pills with high street value to patients with no indication of pain.
Another issue is doctor shopping – patients with demonstrable, verifiable pain seeing a number of doctors for the same medications in reasonable prescription amounts. To identify and track pill mills and doctor shopping, some states have databases available to doctors. The plan aims to support the creation and expansion of these prescription drug monitoring databases.
The American Pharmacists Association (APhA) has announced its support for the government plan, acknowledging that pharmacist interaction is critical to the prevention of prescription medication abuse. Pharmacists are in a unique position in the medical team, with regular patient communication and a trust relationship that facilitates the opportunity for education and information in an informal setting.
Why is this necessary?
Between 1997 and 2007, opioid prescriptions have increased in strength—from an average of 74 mg to 369 mg per patient—and in number. Pharmacies filled 174 million prescriptions for opioids in 2000 and by 2009 that number rose to 257 million. Opiate overdoses, once mainly attributed to heroin abuse, are far more likely to be the result of prescribed opioids today.
What about Professional Ethics?
While the intentions are noble and the need for reducing black market drug sale is clear, is opening a medical tracking database to law enforcement a violation of HIPAA laws and a potentially slippery-slope issue? Are you comfortable with allowing this kind of access, which could have a broad-reaching effect on all patients and not just dishonest ones? What issues do you see arising from a prescription drug-monitoring database? Another common objection to these actions is that it could make it harder for people who really need pain medication to get what they need.