Blog | Tuesday, October 8, 2013

QD: News Every Day--Overdoses on prescription drugs double in past decade, as states juggle prevention programs

Drug overdose deaths—a majority of which are from prescription drugs—doubled in 29 states since 1999, even as states are widely divergent in implementing programs that could form a comprehensive public health effort, a report concluded.

The number of overdoses quadrupled in four states and tripled in 10 more, according to the report, Prescription Drug Abuse: Strategies to Stop the Epidemic, by the Trust for America’s Health.

Prescription drug related deaths now outnumber those from heroin and cocaine combined, and drug overdose deaths exceed motor vehicle-related deaths in 29 states and Washington, D.C. But only 1 in 10 Americans with a substance abuse disorder receives treatment. There has been a recent decline, the report states. The number of Americans abusing prescription drugs decreased from 7 million in 2010 to 6.1 in 2011, according to the National Survey on Drug Use and Health.

In scoring the states, the report noted:
• Appalachia and the southwest have the highest overdose death rates. West Virginia had the highest number of drug overdose deaths, at 28.9 per every 100,000 people, a 6-fold increase from 1999, when the rate was only 4.1 per every 100,000. North Dakota had the lowest rate at 3.4 per every 100,000 people. Rates are lowest in the Midwestern states.
• Fewer than half of states (22) have laws that require or recommend education for doctors and other health care providers who prescribe prescription pain medication.
• 32 states have a law requiring or permitting a pharmacist to require an ID prior to dispensing a controlled substance.
• While nearly every state (49) has a prescription drug monitoring program to help identify doctor shoppers or problem prescribers, these programs vary dramatically in funding, use and capabilities. For instance, only 16 states require medical providers to use them.
• Just over one-third of states (17 and Washington, D.C.) have a law in place to expand access to, and use of naloxone by lay administrators.
• Just over one-third of states (17 and Washington, D.C.) have laws in place to provide a degree of immunity from criminal charges or mitigation of sentencing for individuals seeking to help themselves or others experiencing an overdose.
• Nearly half of states (24 and Washington, D.C.) are participating in Medicaid Expansion, which helps expand coverage of substance abuse services and treatment. (ACP Internist addressed that haves and have-nots of expansion in its October 2013 cover story.)

Some of the key recommendations from the report include:
• Ensure responsible prescribing practices, including increasing education of health care providers and prescribers to better understand how medications can be misused and to identify patients in need of treatment.
• Increase understanding about safe storage of medication and proper disposal of unused medications, such as through “take back” programs.
• Improve, modernize and fully fund prescription drug monitoring programs, so they are real-time, interstate and incorporated into electronic health records, to quickly identify patients in need of treatment and connect them with appropriate care and identify doctor shoppers and problem prescribers.
• Make rescue medications more widely available by increasing access for at-risk individuals to naloxone and provide immunity for individuals and others seeking help.

A full list of all of the indicators and scores is available along with the full report online.

The number one most difficult patient to treat is the one with chronic pain, ACP Internist reported in May 2011, and always in the back of the physician’s mind is the potential for abuse. Many pain and substance abuse experts feel the situation demands a change of emphasis in the various guidelines that exist for opioid use, according to another article in that same issue. The American College of Physicians and ACP and Pri-Med have partnered to create a free online educational program to help clinicians safely prescribe opioids and manage patients with chronic pain. Online CME is available. Find out more.