Tuesday, April 26, 2011

National Strategy to Reduce Prescription Drug Abuse

Nearly 500 people have taken our Attitudes about Psychiatry survey so far. If you haven't yet, [please do.]

The White House released its plan last week entitled "Epidemic: Responding to America's Prescription Drug Abuse Crisis" [LINK to pdf of this 10-page plan]. Below are some of the elements in this plan that is part of the National Drug Control Strategy (like that has worked so well :-/).

The areas of this plan involve education of prescribers and users, monitoring programs, making it easy to dispose of controlled dangerous substances (CDS for short), and enhancing enforcement. The plan establishes thirteen goals for the next five years, and also creates a coordinating body, the Federal Council on Prescription Drug Abuse, to oversee and coordinate it all.

If any of our readers have comments on specific items (I've numbered them for ease of reference), including unintended (or even intended) consequences, please chime in.

    1. require training on responsible opiate prescribing
    2. require Pharma to develop education materials for providers and patients
    3. require professional schools and organizations to include instruction on balancing use of opiates for pain while reducing abuse
    4. require state licensing boards to include relevant ongoing education in their licensure requirements
    5. help ACEP develop guidelines for opiate prescribing in the Emergency Department [this should be a big help]
    6. increased use of written patient-provider agreements
    7. facilitate public education campaigns, especially targeting parents
    8. encourage research on low-abuse potential treatments, epidemiology of substance abuse, and abuse-deterrent formulations
    1. encourage effective PDMP (Prescription Drug Monitoring Programs) in every state, including use of HIEs and connecting with federal health care systems (VA, DOD, IHS, DOJ), and expanding interstate operability of PDMPs
    2. support reauthorization of NASPER, which funds PDMPs
    3. explore provider insurance reimbursement for checking the PDMP database before writing CDS prescriptions [interesting...might work]
    4. reduce "doctor shopping"
    5. issue Final Rule on electronic CDS prescribing [finally!]
    6. increase use of SBIRT programs, including via EHRs (Electronic Health Records)
    1. expand on "take-back" programs (eg, allowing pharmacies to accept unwanted pills for disposal)
    2. develop DEA regs on CDS disposal and educate public on it
    3. get Pharma involved
    1. increase training for law enforcement personnel and prosecutors
    2. aggressive action against "pill mills" and inappropriate prescribers
    3. establish a Model Pain Clinic Regulation Law for states to use
    4. increase surveillance of prescription drug trafficking
    5. use PDMP data to identify "doctor shoppers" and do something about it
This is long enough, so I won't list the plan's thirteen goals; these begin on page 9.

While I am concerned that the enforcement aspects will continue to criminalize actions against people with addictions (which should be viewed more as a health problem rather than a criminal problem, IMO), the increased use of Prescription Drug Monitoring Programs to increase identification of and assistance for people with prescription drug abuse problems should be helpful. Recent articles about the diversion of opiates, even by elderly folks who are supplementing their fixed income by selling their Percocets to neighbors, make it clear how deep this problem is. Some of these interventions have a decidedly Big Brother feel to them. But people are dying, so something must be done.


Anonymous said...

Thanks, but no thanks. I enjoy enough stinkeye from my pharmacist, drug-benefit provider, Primary care doc and psychiatrist over 1 SSRI and 1 benzo.

Now Uncle Sam wants to help. Great.

"Keep fighting that war on drugs" should be the new "Keep f*cking that chicken."

moviedoc said...

"Something must be done."

Anybody heard about addiction treatment? Like buprenorphine?

Sarebear said...

I went to the doc on Monday with my daughter and we both have a bacterial lung infection, with HORRIBLE coughs. It used to be that he'd prescribe a cough syrup with codeine or something similar in it, but after asking if the cough kept us up at night (my clonazepam helps compensate, though I've increased the dose for the duration of this illness to what it was prescribed at, usually I take half the dose), but my daughter is up quite alot in the night coughing her head off and worse because of the cough.

My impression was that he was being VERY cautious with narcotic prescribing due to the way these things are monitored but that's just a guess on my part.

I'm afraid that other situations will also come up where the patients will end up suffering more because the docs won't want to prescribe to relieve symptoms.

word verify: tridose ha ha

Dinah said...

Dear Sarebear:

I used to keep a bottle of cough medicine with codeine on hand for those middle of the night coughs. The last time I asked the pediatrician for a refill, he told me that the latest studies show that codeine does not suppress coughs (or something to that effect)...counter to all I knew, but I looked it up, and so it was.

The codeine dose in cough medicine is quiet low, and it's not a chronically-renewing script so I don't think this is what the FDA is after. It's the high dose narcotics that people get from 4 different doctors and then die on from overdoses or sell that is the problem.

Sunny CA said...

I would rather leave the government out of it because extreme measures like these are sure to end up keeping people in pain from having treatment for their pain. I periodically have severe back pain and I am thankful my internist gives me Vicodin for it. I was given "muscle relaxants" and other types of pain medication for it in the past that did absolutely nothing for pinched nerve pain. When I have severe pain I can hardly stand to live in my body. I never take the medication unless I need it. I'd hate to not have access to it.

Sarebear said...

Thanks, Dinah, that's very good to know and now I am more informed!

a psychiatrist who learned from veterans said...

Being able to get Claims History with my eprescribing service is helpful. Maybe somehow this will make it easier to communicate with the feds about eprescribing.

Anonymous said...

Here's a great discussion


Specifically, note the discussion of Risk Benefit Ratios

What was that saying? Power corrupts and absolute power corrupts absolutely? I think that was it.

This has nothing to do with science, rationality, logic or mindfulness and everything to do with someone who has an axe to grind... that is how power works, in case you are wondering.

Someone in power gets a buzz up their butt, or gets offended by someone, and all hell breaks loose. It is called the "Hoover Syndrome."

Push down on oxycontin, up goes heroin, etc. Push down on heroin, up goes heroin, oxycontin, etc. Demand cannot be influenced by alleged supply, because supply will always find a way.

And, talk about deaths from misuse of drugs -- really? What was that about alcohol and nicotine being assigned to Schedule II?