7 Recent Efforts to Combat the Opioid Abuse Problem

A recent Center for Disease Control report found more Americans died from overdosing on opioid pain relievers — including hydrocodone, methadone, oxycodone and oxymorphone — than from overdosing on heroin and cocaine combined.

In 2008, more than 36,000 people died from drug overdoses in the United States, and more than 20,000 of those were due to prescription drug overdose. Opioid pain relievers were involved in more than 14,000 deaths — more than 70 percent.

Efforts to combat what has been called an epidemic have been varied and spearheaded by state governments, medical societies and individual companies. Here are eight recent initiatives to prevent prescription opioids from being misused.

1. New York City launched a task force to combat prescription drug abuse. New York City has experienced a 10-fold increase in the use of prescription opioids over the past 20 years, according to a Wall Street Journal report. The number of opioid-related ER visits doubled from 2004-2009, and 25 percent of unintentional drug overdoses were attributed to opioids in 2009. To combat this increase, New York City Mayor Michael Bloomberg is launching a task force that will connect healthcare and law enforcement officials to combat the city's prescription drug problem. City officials determined 21 pharmacies account for one-quarter of oxycodone Medicaid reimbursement in the city. These findings could lead to criminal charges against the pharmacists and prescribing physicians. The task force's first recommendations are expected in January.

2. CVS stop filling some prescriptions for painkillers in Florida. The state of Florida has been at the forefront of much of the discussion about the prescription drug problem. According to federal estimates, Florida physicians prescribe 10 times more oxycodone than other states. The Florida attorney general's office says that nearly 1,000 pain management clinics — not all of them so-called "pill mills" — operate in Florida.

Last month, CVS retail pharmacies told some Florida physicians it will stop filling the prescriptions of "potent and addictive drugs," according to a Reuter's report. CVS's public relations director Michael DeAngelis told Reuters that letters had been sent to a small number of physicians informing them of the decision. A copy of the letter appeared online and said the pharmacy would stop filling prescriptions for schedule II narcotic controlled substances, which include morphine and oxycodone.

3. American Medical Association increases guidance for physicians on prevent misuse and abuse of prescription opioids. At its interim meeting, where an educational session on the growing opioid abuse problem drew a standing-room only crowd, the AMA House of Delegates directed the association to promote physician training and competence on the proper use of controlled substances. The AMA will also encourage doctors to use screening tools from the National Institute on Drug Abuse and state prescription drug monitoring programs to identify patients likely to abuse prescription drugs. All states but Missouri and New Hampshire have laws on the books, but 12 states have not provided funding.

The delegates asked the AMA Council on Science and Public Health to report on the effectiveness of current drug policies and how to prevent fraudulent prescriptions at the June 2012 Annual meeting. The council will also determine whether prescription-monitoring programs should include veterinarians, hospitals, opioid treatment programs and Department of Veterans Affairs facilities.

4. FDA releases draft of opioid continuing education. The FDA released a draft of guidelines for the continuing education of prescribers of long-acting and extended release opioid drugs last month. The blueprint, a basic outline and core message the FDA thinks should be conveyed to prescribers, is open to stakeholder comment. The blueprint includes information on assessing patients, initiating treatment, modifying or discontinuing treatment, managing treatment and counseling patients and caregivers on the safe use of opioids. A final blueprint will be published to the FDA website for use by providers of continuing education in creating courses for the safe prescribing of opioids.

5. North Carolina hospitals stop prescribing and refilling pain medicine in ER for chronic pain. New Hanover Regional Medical Center and Cape Fear Hospital, both in North Carolina, have stopped prescribing or refilling opioids for chronic pain in the emergency room and instead are referring patients to primary care physicians. The new policy at New Hanover Regional Medical Center went into effect on Nov. 1. Patients who arrive at the ER asking for refills of opioids or anxiety and depression medication will be referred to primary care physicians. The hospital will assist patients in connecting with a primary care physician if they do not already have one. If the patient arrives in the ER with chronic pain, they will be treated with non-opioid pain medication.

Hospital officials said this is part of a nationwide trend and hope it will curb overdoses as well as ensure patients have a primary care physician who can provide ongoing medical support. Patients who come to the ER with an emergency medical condition such as an individual injury or illness, ER physicians can prescribe a limited amount of medication.

6. New state opioid regulations target physicians. New state regulations are moving away from regulating just "pill mills" to setting up restrictions for physicians practicing pain management. An AMA report found some of the strictest regulations are in Washington and Ohio. A new Washington law, which passed in July and which will go into effect in January, requires physicians and patients to sign "patient contracts" that require mandatory, periodic urine screenings as well as provides guidelines for evaluating and treating patients with chronic noncancer pain. In Ohio, physicians working at clinics where more than 50 percent of patients are prescribed opioids are required to complete 20 hours of pain medicine continuing education every two years. Physicians who own pain clinics in Ohio must register with the medical board comply with patient-tracking requirements and undergo site inspections.

More states could follow Washington's lead. The AMA reports officials in Florida, Maine, Minnesota, New Mexico, Tennessee, Utah and West Virginia are watching to determine if the program in Washington succeeds.

7. Florida implements prescription drug database. In October, Florida's prescription drug database went live. The database, although not mandatory, aims to cut down on "doctor shopping," where patients visit multiple physicians to obtain prescriptions for painkillers. A new law signed earlier this year by Florida Governor requires physicians and pharmacists to enter prescriptions into a database within seven days.

The Florida Independent reported that 21.8 million prescription records had been uploaded into the database as of Nov. 28. The paper also reported a 10-fold increase in records between late October and Nov. 15 when the number of records sat at 19.5 million. The number of practitioner queries grew from more than 10,000 patient advisory reports requested as of Oct. 25 to more than 160,000 as of Nov. 28.

Related Articles on Prescription Painkillers:
Opioid Abuse Linked to Mood and Anxiety Disorders
Medical Marijuana Used With Opiates Could Help Patients Reduce Pain
Dr. Michael Lowenstein: Increase in Opioid Use for Abdominal Pain Part of Larger Problem

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