Plans to combat painkiller abuse

By Dr. Ananya Mandal, MDApr 19 2011

This Tuesday, the Obama administration announced a plan to fight prescription drug abuse, warning that accidental fatal overdoses now exceed the combined deadly overdoses from the crack epidemic of the 1980s and black tar heroin in the 1970s.

According to this new plan it would help combat the nation's fastest-growing drug problem includes boosting awareness of the dangers of prescription drug abuse among patients and health care providers, cracking down on “pill mills” and “doctor shopping,” and requiring drug manufacturers to develop education programs for doctors and patients.

“Too many Americans are still not aware of the misuse and abuse of prescription drugs and how dangerous they can be,” said Gil Kerlikowske, the White House director of national drug-control policy. Kerlikowske revealed that accidental drug overdoses are now the leading cause of accidental death in 17 states - ahead of car crashes. They account for seven a day in Florida, one of the epicenters of the epidemic and the source of much of the drugs. In Broward County alone, more than 1 million pills are dispensed every month, according to the Broward Sheriff's Office.

According to the federal Centers for Disease Control and Prevention, overdose deaths from painkillers have risen from less than 4,000 in 2000 to more than 11,000 in 2007, the most recent statistics available. Cocaine deaths went from about 3,000 in 2000 to more than 5,000 in 2007; for heroin, the numbers have remained steady at around 2,000 each year.

This new plan would urge every state to develop a prescription drug-monitoring program and encourages them to share the information with other states. Thirty-five states already have such monitoring programs in place, Kerlikowske said. It would include convenient ways to remove and dispose of unused and expired medication from the home. Kerlikowske noted that seven out of 10 prescription drug abusers obtained their drugs from friends or relatives. A national "take-back" effort last September netted more than 121 tons of prescription drugs in a day, he said. Another take-back day is scheduled for April 30, Drug Enforcement Administration head Michele M. Leonhart said.

The plan also urges the drug control policy office and the DEA to rise up in enforcement of laws by targeting training to states with the highest need. Law enforcement agencies and the lawmakers who represent them have long complained that clinics where pain medication often is dispensed without prescriptions, or "pill mills," contribute heavily to the prescription drug epidemic.

Kerlikowske said his office would ask Congress for an increase in funding for drug prevention of $123 million and for treatment of $99 million for 2012, to train primary health care providers to intervene in emerging cases of drug abuse and to expand and improve specialty care for addiction. The Food and Drug Administration will require the makers of a certain class of drugs – “extended-release and long-acting opioids” - to work together to develop an education plan to help doctors and patients.

This announcement followed Kerlikowske's testimony last week before a House Energy and Commerce subcommittee about the destructive underground prescription-drug network that weaves its way up from Florida's pain clinics to Kentucky's Appalachian mountain communities. Ninety-eight of the top 100 doctors in the country dispensing oxycodone - the generic form of OxyContin - are in Florida, mostly in Miami, Tampa and Orlando, it was heard.

According to a study by the Substance Abuse and Mental Health Services Administration, there was a fourfold increase nationally in treatment admissions for prescription pain-pill abuse during the past decade. The increase spans every age, gender, race, ethnicity, education, employment level and region. The study also shows a tripling of pain pill abuse among patients who needed treatment for dependence on opioids.

“To say we are going to do away with the problem in five years, we cannot do that,” said Dr. Roland Gray, medical director of the Nashville-based Tennessee Medical Foundation and a Food and Drug Administration adviser on addiction issues. “I think they are headed in the right direction.”

Danny Webb, the sheriff of Kentucky's rural Letcher County, said he would welcome a 15 percent drop in misuse of prescription drugs. “Anything would help, because we're drowning in it up here in eastern Kentucky,” Webb said.

In Florida, Miami DEA chief Mark R. Trouville said he expects some physicians to be indicted based on a recent undercover probe involving 340 pill purchases. “We're trying to make a statement that if you think you're sliding by in a gray area, you're not, and we're coming,” Trouville said.

The medical director of Covidien, which makes some of the drugs the federal effort targets, expressed support for the government's strategy. Dr. Herb Neuman said an alliance of medical and patient safety groups has been working to educate patients and help physicians with responsible prescription methods. “Access to these medications must be limited to patients suffering from chronic pain and possessing a valid prescription,” Neuman said.