The non-medical use of prescription medicines continues to increase, and deaths associated with unintentional overdoses of these continue to outpace those of traffic fatalities.
We’re dying from self-medication gone wrong.
According to the Centers for Disease Control and Prevention (CDC), the people most at risk for a fatal overdose from prescription medicines are the approximately 9 million Americans who take opioid analgesics chronically for pain and another 5 million who take these medicines for non-medical reasons, either without a prescription or a specific medical need. Opioid analgesics include narcotic pain medicines like methadone, oxycodone and OxyContin®, and hydrocodone/acetaminophen, which is also known as Vicodin®, Lortab® and Norco®.
Of particular concern to the CDC are people who seek medical care from multiple doctors or who take large amounts of opioid analgesics every day. While these 2 groups represent only 10% of Americans who take opioids regularly they account for 40% of the prescription overdoses that involve an opioid.
How can we stop the carnage?
One way to reduce the deaths from prescription drug overdoses is to get better control over the medicines that are causing them. This includes opioid pain medicines like methadone, oxycodone, hydrocodone with acetaminophen, and anti-anxiety medicines like alprazolam (Xanax®) and lorazepam (Ativan®).
Before these medications get into the hands of the person who will overdose with it, a prescription first has to be generated by a doctor or medical provider who is authorized to prescribe it and then sent to a pharmacy who then dispenses it to the patient or the patient’s agent. As pharmacists, we consider ourselves the guardians of these powerful and potent agents, and take seriously any attempts to procure it for non-medical use.
In some communities, pharmacists used an informal network of phone calls or faxes between their store, other pharmacies and doctor’s offices in order to give others a “heads up” about questionable activities involving prescription medicines. Information was sent along a “grapevine” about patients who were getting multiple prescriptions for the same thing from different physicians, dentists and hospital emergency rooms, who have altered their prescriptions by making 10 tablets into 100, or tried to call in their own refills for pain or anxiety pills.
Pharmacists also encouraged their local physicians to use this informal “drug alert” system to report stolen prescription pads or to inquire whether a patient had received any controlled substance prescriptions from providers other than themselves.
Today, there is even more need to share information between pharmacies and doctors to help identify potential misuse, overuse or diversion of controlled substances, particularly that of opioids and anxiety medications. Opioids which are narcotic analgesics and medications like alprazolam (Xanax®) used for anxiety are also referred to as “controlled substances” because they have a higher level of “control” on their prescribing and dispensing by the Drug Enforcement Administration (DEA) than other types of prescription drugs, such as those for diabetes or blood pressure.
Prescription drug monitoring programs (PDMPs) are statewide databases that collect information about prescriptions dispensed for controlled substances in order to make that information accessible to pharmacists and physicians to help guide medical care decisions. PDMPs are designed to allow doctors to review which prescriptions for controlled substances have already been dispensed to a particular patient and when, in order to provide better care and avoid overprescribing.
Washington State’s PDMP is an online database called Prescription Review. It includes a person’s name, date of birth, address, each controlled substance prescription dispensed, the medical provider who prescribed it, the date it was written, the date it was dispensed and the pharmacy which dispensed it. For additional information about Prescription Review go to: http://www.doh.wa.gov/PublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/PrescriptionMonitoringProgramPMP/PublicFAQ.aspx.
The real power of using PDMPs to reduce overprescribing will be seen when all 50 states have online, searchable PDMPs that connect to each other. You can find out more about PDMPs from www.pmpalliance.org or http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm.
That all sounds well and good, just control the amount of opiods that people with chronic pain use and the problem of chronic pain will be solved, wrong!!! What happens when a person has pain that is not relieved by the amount that their PCP is “allowed to prescribe”, or has episodes of increased pain on some days? Are you advocating that a person who is not pain free just stay home on a heating pad, or whatever? It seems ironic that the government wants to control the number of pills a person uses each month, but also wants people to hold down jobs so they can pay taxes, etc. Its obvious from your article that you have never suffered from severe arthritis or back problems, or you wouldn’t be so willing to tie MD’s hands.
The dosing limits you refer to are not from the Prescription Monitoring Program described here but from a law called ESHB 2876 passed by the Washington State Legislature in 2010. ESBH 2876 specified dosing limits on narcotic pain medicines prescribed by primary care providers such as family medicine doctors, physician assistants and nurse practitioners. There are 4 important exceptions to that dosing limit: the young, the elderly, those being treated for cancer and people whose pain and level of functioning has not changed.