The United States consumes 83 percent of the world’s oxycodone and 99 percent of its hydrocodone, according to a 2010 International Narcotics Control Board report. These are all generally classified as potent painkillers and sedatives and used for a wide variety of medical needs such as pain control, anxiety and depression.
In 2006, local firm EcoNorthwest studied the dollars-and-cents effect of such abuse. Its study noted total direct economic costs from substance abuse in Oregon totaled approximately $5.9 billion in 2006. These costs fell into the following three categories:
- $813 million in healthcare costs related to alcohol and drug abuse programs.
- $4.2 billion in lost earnings as a result of foregone productivity by users who die prematurely, are sick, fail to come to work, or are incarcerated as a result of alcohol and drug abuse, and by victims of crimes committed by drug and alcohol abusers.
- $967 million in other costs such as violent, property, and consumption-related crimes; expenditures on alcohol and drug enforcement laws, criminal justice, and social welfare programs; and property damages attributed to motor vehicle crashes and fires.
Oregon health providers and leaders, as well as policy makers, should well pay attention. A July, 2014 study by the Centers for Disease Control and Prevention showed Oregon is 4th in the U.S. for long-lasting opioid prescriptions, 16th for high-dose opioid prescriptions, and in the top half for overall opioid prescribing.
In running a pain management medical practice in Hood River, I see the harder side of how patients deal with chronic, life altering pain issues. Sometimes the outcome is addiction to and abuse of the very pain relieving medications designed to help them.
Last week, CNN announced the Federal Drug Administration’s approval of a new “smart pill.” It is among the emerging technology medical research and development companies are introducing that renders certain pain medications − those that are highly addictive and often abused such as opioids and benzodiazepines − completely inactive when their form is altered.
If altered or abused, such smart pills can also be developed to have unpleasant side effects; to alter the timed release; and to only be ingestible when taken orally. Such formulations can go a long way to preventing continued abuse and ostensibly, addiction.
The good news is that health providers and advocates in Oregon are working together in an attempt to prevent prescribing protocols that allow or require switching or substituting prescriptions of new abuse deterrent medications with lower cost but addictive opiate and benzodiazepine prescription medications.
Two weeks ago, the American Academy of Physical Medicine and Rehabilitation, which represents pain management specialists and physiatrists such as me, developed suggested guidelines on responsible opioid prescribing practices for chronic pain patients.
Such guidelines are not only timely for Oregon, they reinforce what I and many health providers do every day: Balance risks and benefits; screen and triage for substance use disorders, psychological disorders, and addiction; monitor patients closely, including their clinical toxicology outcomes; prioritize patients’ function and quality of life; and provide a personalized plan of care.
It’s going to take a team to resolve Oregon’s problems of abuse. We know that besides the correct prescribing methods, the best way to help those who are addicted or abuse such medications, is to ensure both the decline of abuse opportunities and to increase the use of these smart pills. This can be done at the pharmacy counter. This can be addressed by ensuring prescribers note “Dispense As Written,” when issuing a prescription or electronic prescription order.
We are asking health leaders, prescribing providers and ask state policy makers to follow the CDC’s report by examining prescribing practices to better control the possibility of abuse and overprescribing, so we all ensure continuity and cautiousness of care.
David Russo, D.O., is a physician with Columbia Pain Management, P.C. in Hood River. He cited the following sources:
www.econw.com/our-work/publi-cations/ — EcoNorthwest
www.cdc.gov/mmwr/preview/ - Centers for Disease Control and Prevention as released July 4, 2014