I recently took the time to read President Obama’s report Epidemic: Responding to America’s Prescription Drug Abuse Crisis (2011), published on the monthly blog of Dr. Nora Volkow, director of the National Institute on Drug Abuse. (Sept. 14, 2016) According to the president’s report, prescription drug abuse is the nation’s fastest-growing drug problem. While there has been a marked decrease in the use of such illegal drugs as cocaine, data from the National Survey on Drug Use and Health (NSDUH) show that nearly one-third of people aged 12 and older who used drugs for the first time in 2009 began by using a prescription drug non-medically. The survey found that over 70 percent of people who abused prescription pain relievers got them from friends or relatives, me included.
I started taking opioid pain medication for severe low back pain in 2004. The pain became debilitating, and I was approved for Social Security Disability Income in 2009. Being an addict and an alcoholic, I should have realized that one pill was too many and a hundred was not enough. At one point, I was seeing three different doctors and going to several different pharmacies in order to avoid suspicion. I could not keep up with my cravings. When I could no longer get enough pain meds through doctors and ERs, I started stealing medication from everyone in my family. I realized just the other day that I have been taking medication from loved ones since 1984 when I started helping myself to my mother-in-law’s Tylenol with Codeine. Although there have been periods where I was able to stop taking opiates, it started all over again about a year before my father died. Following a family intervention, I went to a rehab center for 21 days. I relapsed ten months after I left the rehab. I managed to get clean again until August 20 of this year when I stole oxycodone tablets from my mother. It appears I may have done irreparable damage to my relationship with her. Ironically, that was my greatest fear.
Although a number of classes of prescription drugs are currently being abused, the president’s 2011 action plan primarily focuses on the growing and often deadly problem of prescription opioid abuse. The number of prescriptions filled for opioid pain relievers (some of the most powerful medications available) has increased dramatically in recent years. From 1997 to 2007, the milligram-per-person use of prescription opioids in the U.S. increased from 74 milligrams to 369 milligrams, which amounts to 402 percent. In 2000, retail pharmacies dispensed 174 million prescriptions for opioids. By 2009, 257 million prescriptions were dispensed, which is an increase of 48 percent. Opiate overdoses, once almost always due to heroin use, are now increasingly due to the abuse of prescription painkillers.
A crucial first step in tackling the problem of prescription drug abuse is to raise awareness through the education of parents, youth, patients, and healthcare providers. Although there have been great strides in raising awareness about the dangers of using illegal drugs, many people are still not aware that the misuse or abuse of prescription drugs can be as dangerous as the use of illegal drugs, leading to addiction and even death. In addition, prescribers and dispensers, including physicians, dentists, and pharmacists, all have a role to play in reducing prescription drug misuse and abuse. Most receive little training on the importance of appropriate prescribing and dispensing of opioids to prevent adverse effects, diversion, and addiction.
Outside of specialty addiction treatment programs, most healthcare providers receive minimal training in how to recognize substance abuse in their patients. Most medical, dental, pharmacy, and other health professional schools do not provide in-depth training on substance abuse; often, substance abuse education is limited to classroom or clinical electives. Moreover, students in these schools only receive limited training on treating pain. A national survey of medical residency programs in 2000 found that, of the programs studied, only 56 percent required substance use disorder training, and the number of curricular hours in the required programs varied between 3 to 12 hours. A 2008 follow-up survey found that some progress has been made to improve medical school, residency, and post-residency substance abuse education; however, efforts have not been uniformly applied in all residency programs or medical schools.
Educating prescribers on substance abuse is critically important, because even brief interventions by primary care providers have proven effective in reducing or eliminating substance abuse in people who abuse drugs but are not yet addicted to them. In addition, educating healthcare providers about prescription drug abuse will promote awareness of this growing problem among prescribers, so they will not over-prescribe the medication necessary to treat minor conditions. This, in turn, will reduce the amount of unused medication sitting in medicine cabinets in homes across the country.
The president’s report indicates that all of this will take tracking and monitoring. Forty-three states have authorized prescription drug monitoring programs (PDMPs). PDMPs aim to detect and prevent the diversion and abuse of prescription drugs at the retail level, where no other automated information collection system exists, and to allow for the collection and analysis of prescription data more efficiently than states without such a program can accomplish. However, only 35 states have operational PDMPs. These programs are established by state legislation, and are paid for by a combination of state and Federal funds. PDMPs track controlled substances prescribed by authorized practitioners and dispensed by pharmacies. PDMPs can and should serve a multitude of functions, including assisting in patient care, providing early warning of drug abuse epidemics (especially when combined with other data), evaluating interventions, and investigating drug diversion and insurance fraud.
In summary, the president’s report states that research and medicine have provided a vast array of medications to cure disease, ease suffering and pain, improve the quality of life, and save lives. This is no more evident than in the field of pain management. As with many new scientific discoveries and new uses for existing compounds, the potential for diversion, abuse, morbidity, and mortality are significant. Prescription drug misuse and abuse is a major public health and public safety crisis. As a nation, we must take urgent action to ensure the appropriate balance between the benefits these medications offer in improving lives and the risks they pose. No one agency, system, or profession is solely responsible for this undertaking. We must address this issue as partners in public health and public safety. Therefore, ONDCP will convene a Federal Council on Prescription Drug Abuse, comprised of Federal agencies, to coordinate implementation of this prescription drug abuse prevention plan and will engage private parties as necessary to reach the goals established by the plan.