Tuesday, November 8, 2011
Don't blame doctors for prescription drug overdoses
The overdose death rate from prescription opioids, referred to as "narcotics," has reached "epidemic levels" in the U.S., according to a report just released by the Centers for Disease Control and Prevention (CDC). The report further states that the intentional misuse and abuse of popular opioids such as OxyContin, Vicodin, methadone and others now cause more deaths than those caused by heroin and cocaine combined.
Dr. Thomas Frieden, CDC Director, told reporters that "Narcotics prescribed by physicians kill 40 people a day." He continued by stating, "Prescription painkillers are meant to help people who have severe pain. They are, however, highly addictive."
The report states that increased prescribing of pain medications by doctors is a significant cause of this growing number of deaths. However, the situation is far more complicated than this report presents. Poor pain management and prescription drug abuse has become a catch-22 in the U.S.
On one hand, the Institute of Medicine estimates that 116 million American adults suffer daily from chronic pain. This is considerably more than all the people with heart disease, cancer and diabetes in the U.S. combined.
The medical community has recognized the devastating consequences of unrelieved pain, and is taking steps to treat this enormous medical problem. Opioids are a valuable treatment option in the management of chronic pain, so it unsurprising that increasing efforts to treat this problem has resulted in increased use of all analgesics, including opioids. Having more opioids in circulation increases the risk of abuse and diversion, hence the catch-22.
The CDC report shocks the reader with statistics: 40 people in the U.S. die every day from opioids (over 14,000 a year). However, we know that approximately 17,000 people die every year from nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin) or naproxen (Aleve) and others. The inappropriate prescribing of any medication can lead to adverse consequences, even death.
Where are the people who use a prescription pain medication for a non-intended use getting them from? The 2010 National Survey on Drug Use and Health questioned persons aged 12 and older in 2009-2010 and got the following responses:
--55.0% obtained free from a friend or relative
--11.4% bought from a friend or relative
--4.8% took from a friend or relative without asking
--4.4% got from a drug dealer or stranger
--7.1% some other source
--17.3% prescribed by one doctor
Less than 20% of pain medications used in some unintended fashion are prescribed by one doctor. The reasons for the increase in deaths from pain medications is due to many factors, not just increased prescribing by doctors. In our zeal to curb this alarming problem, let's not throw the baby out with the bathwater, leaving legitimate pain patients holding the bag and suffering needlessly.
What can we do to turn this trend around? Let's look as some possibilities:
--First, doctors do need to develop skills to help detect adults who are not legitimate pain patients, or who are at risk for pain medication abuse or diversion. There are screening tools doctors can use to help predict people likely to use the pain medication in a manner other than intended.
--Doctors can prescribe opioids in "abuse-deterrent" tablets and capsules designed to make it harder to crush or chew.
--If states find doctors that are writing prescriptions for pain medications simply for profit, they should be dealt with in the legal system.
--Many states have a prescription monitoring program where doctors can see all the prescriptions written for an individual in the past by any prescriber. These state monitoring programs should include all controlled substances, not just opioid prescriptions.
--States and communities need to develop efficient "take-back" programs for medications no longer needed, most especially for pain medications.
--Education is critically important for prescribers, other health care providers, and patients, families and caregivers. Dr. Lynn Webster suggests the following six steps to protect yourself and your family from opioid misuse:
1) Never take a prescription painkiller unless it is prescribed for you.
2) Do not take pain medication with alcohol.
3) Do not take more doses than prescribed.
4) Use of other sedative or anti-anxiety medications can be dangerous.
5) Avoid using prescription painkillers to facilitate sleep.
6) Lock up prescription painkillers.
To learn more about these tips and other information to help curb the misuse and abuse of prescription pain managers, visit the American Pain Foundation website to learn about the PainSafe Alliance. Last, your community pharmacist is in an excellent position to review all your medications to make sure they are safe to be taken together, and that the best pain medications have been selected to treat your pain.
We need to take the competing problems of chronic pain and prescription pain medication misuse seriously, and to not worsen the plight of legitimate pain patients in our zeal to reduce the abuse of these medications.
This post by Mary Lynn McPherson, PharmD, appeared at Get Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
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