Opioid Deaths Rise, CDC Recommends Sweeping Changes To Prescriptions
By Kelli M. Donley
Opioids – prescription pain pills – are being abused by Americans in increasingly dramatic numbers, alarming public health officials. overdose deaths involving these drugs, created to mimic the pain relieving qualities found in derivatives of the opium poppy Papaver somniferum, are now one of the leading causes of death nationally.
New research shows in 2010, 4.8 percent of Americans used opioids “nonmedically” – meaning more than the prescribed dose, or taking medication prescribed to someone else. This abuse of prescription pain medication costs insurance companies an estimated $72.5 billion annually in healthcare costs, including soaring rates of emergency room admittances due to overdosing.
Phoenix-based nurse practitioner Alma E. Celaya, FNP-BC, says she sees the results of such abuse daily.
“As a prescriber, I have seen the downsides of prescription pain pill abuse and how it can affect not only the abuser, but their friends and family,” she says. “It can cause impairment, preoccupation, arguments and confrontations with family, and a potential loss of employment – among other issues. As a practitioner, my main objective is to work with the patient to manage acute and/ or chronic pain and determine which medication, dosage, and frequency would best manage their pain. It is imperative to first obtain a detailed history to ensure that the patient does not have a prior history of drug seeking behaviors or dependence that can lead to further dependence, abuse, and/or addiction.”
Common names for prescriptions in this class of drugs include: oxycontin, morphine, Percocet, Percodan, and Codeine.
Data gathered in 2008, shows more than 36,000 deaths nation- ally attributed drug overdoses, with opioids responsible for 73.8 percent of the total. The same year, 39,000 Americans died in motor vehicle crashes, the leading cause of death in the united States. In 2007, Centers for Disease Control and Prevention (CDC) officials reported 100 Americans died daily due to overdoses. This number tripled since 1991.
Chris Byrd, a Phoenix-based pharmaceutical representative says policy change is necessary to control widespread opioid abuse.
“There absolutely needs to be more of an accountability process put into place,” Byrd says. “In Miami, it is notoriously easy to ‘doctor shop’ and even easier to find doctors who will prescribe narcotics on any whim, yet you almost have to sign your life away to get a decongestant. but you can walk in two clinics a mile apart from each other with morphine without so much as a second glance.”
Although there have long been cries from the public health community for opioid prescription reform, the numbers of injuries and deaths related to the drugs continues to rise precipitously. “The unprecedented rise in over- dose deaths in the united States parallels a 300 percent increase since 1999 in the sale of these strong painkillers,” write CDC officials. “These drugs were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined.”
“I always discuss the benefits and risks associated with the use of narcotic pain, such as addiction,” says Celaya. “I educate patients extensively on how medications should be taken and to never take more than prescribed without dis- cussing it with their prescribing provider — and to never take another individual’s pain medications. If I suspect a patient of abusing, I do confront them. A common goal of both the provider and patient is for the patient to be as pain free as possible with the least amount of pain medications and using other alternative modalities.”
Almost all prescription drugs involved in overdoses come from prescriptions originally; very few come from pharmacy theft. however, once they are prescribed and dispensed, prescription drugs are frequently diverted to people using them without prescriptions. More than three out of four who misuse prescription painkillers use drugs prescribed to someone else.
“Although we cannot prevent abuse we can educate and identify those who are at risk of developing abusive/addiction tendencies,” says Celaya. “having a patient sign a narcotic agreement and verbalize their understanding is imperative. Just as important is conducting random drug screenings to make sure they are only using what has been prescribed. holding them accountable and having them bring along a family member to their appointment who they feel accountable to, can help decrease abuse of pain medications. yet, another tool that some states offer is tracking what and where medications have been filled in the state.”
Jonathan Yates* never knew his father. his parents divorced soon after his birth because his father was repeatedly arrested for drug abuse. While his father’s drug of choice eventually became heroin, he would abuse prescription medications as well. Yates, who is now a father himself, says his father’s decision to abuse drugs forever changed the course of their family.
“I never had a father and son relationship with him,” says Yates. “I tried to understand this choice – that ruined his life and the lives of other people. he didn’t care. I have a half-sister who lived with him for 15 years and is currently a drug user. This addiction didn’t just affect them. I have since taken custody of my sister’s daughter. Think about if you drop rocks into a pool of water and the waves created. Drug abuse does the same. It’s never just you, when you start drug use. The decision to start will cause problems for a very long time.”
Dr. Tory McJunkin Describes Arizona Pain Specialists Protocol To Prvent Opioid Abuse
Q: How does APS work to prevent patients from abusing opioids?
A: Our opioid compliance program has 12-steps and was designed to protect patients from associated risks.
Q: What are the warning signs a patient should look out for if he/ she is worried about dependence?
A: Dependence occurs when the body becomes used to/tolerant to the effects of any opioid medication. Long-term opioids decrease pain by approximately 30-40%. It is important to set realistic goals for how much opioids can help one’s pain. Comprehensive care, including: physiotherapy, interventions, non-opioid medications, chiropractic care and acupuncture should be considered.
Q: What advice do you give to patients who are using opioids to prevent the drugs from being abused by others?
A: Lock-box, keep in a safe place, pillbox for each day and count pills each week.
“My children have questions about their grandfather and I tell them the truth,” he says. “he died alone in a dirty apartment on the west side of Phoenix. If he didn’t have me to claim his body it would have gone with those unidentified. In the end it was his heart that gave out. The people with whom he was sharing drugs with at the time of death stole his rings, clothes, pictures and any- thing else that could be taken.”
According to the CDC, 20 percent of prescribers – predominantly primary care and internal medicine physicians – prescribe 80 percent of all prescription painkillers.
“I can’t be naive and say there is an easy fix to this problem,” says byrd. “The
The CDC is recommending health- care providers prescribe opioid medications only in carefully screened and monitored patients, and only when other treatments have shown to be insufficient. officials are also recommending insurers create prescription drug monitoring programs to identify illegal prescribing. Policy to further limit reimbursement for such drugs is also being considered as a method to dis- courage healthcare workers from prescribing.
“It is imperative as a provider you establish good rapport with patients so they are willing to communicate with you, even when problems arise – such as addiction,” says Celaya. “If they trust you they are more likely to seek you help.”
*name has been changed to protect the family’s identity Sources: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm http://www.cdc.gov/homeandrecreationalsafety/rxbrief/