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Finding the Balance in the Fight against Prescription Drug Abuse

Thomas MacLellan, Director, Homeland Security & Public Safety Division, National Governors Association Center for Best Practice

By all accounts, the negative effects of prescription drug abuse on society are far reaching and growing. Consider the following: seven million Americans currently abuse prescription drugs. Between 2004 and 2010, emergency room visits involving prescription opioids increased 156 percent and admissions increased six times. The estimated total cost to the United States for nonmedical use of prescription opioids in 2011 was $53.4 billion. Although those figures are forcing many policymakers and law enforcement officials into action, successfully reducing prescription drug abuse will require a measured response that balances patients’ access to prescription drugs with legitimate restrictions, the use of critical information with privacy rights, and the concerns of law enforcement with those of the medical and health communities.

Striking that balance will require gubernatorial leadership and partnerships among law enforcement and the medical and health communities. The National Governors Association, under the leadership of Alabama Gov. Robert Bentley and Colorado Gov. John Hickenlooper, recently launched a prescription drug abuse reduction project to help states develop and implement coordinated and balanced approaches to reducing prescription drug abuse. The year-long initiative will work with cross-disciplinary teams to include such officials as attorneys general, state public health officials, state chief information officers, and legislators from seven states beginning in September. It will ultimately provide other states valuable lessons for moving forward with comprehensive reduction efforts.

A primary challenge to reducing prescription drug abuse is balancing the therapeutic needs of individuals while at the same time ensuring that adequate controls are in place to limit illicit use. Complicating the problem is that, according to the Centers for Disease Control and Prevention (CDC), more than 70 percent of individuals who abuse prescription drugs get them from friends and family. Leftover drugs in medicine cabinets are an easy source for abuse. Consider prescription opioids, which many people need for pain management but do not often use their entire prescription. Those same drugs are the most abused and are behind the majority of emergency room visits and overdoses.

Two strategies can help reduce the amount of “leftover” prescription drugs. First, modifying the prescribing behaviors of doctors, dentists, and others could have a significant impact. For example, reducing the number of pain pills initially prescribed while allowing for refills as appropriate could help reduce the number of leftover medicines. That might present hardships for patients without easy access to a pharmacy, but it will not affect the majority of individuals. Second, most patients have not been educated as to when and how to properly dispose of leftover prescription drugs. Although disposal presents some complications, basic education on proper disposal of leftover pills could help reduce the number of drugs sitting exposed in medicine cabinets.

Another challenge is balancing the use of critical information with privacy rights. Take for example prescription drug monitoring programs (PDMPs) that are in operation in 41 states. The analytic tools provided by those programs are not being fully used to identify anomalous trends or to help doctors and pharmacies make the appropriate therapeutic decision in real-time when prescribing and dispensing medicines. Although tremendous amounts of information and data are gathered, law enforcement’s access to that information is limited. That complicates both day-to-day enforcement and law enforcement’s ability to gain a broader view of the scope of the issue.

Successfully reducing prescription drug abuse will require an enterprise-wide and regional understanding of the problem. Better use of PDMPs by law enforcement and the medical community—coupled with strong privacy protections—will help create a better situational awareness of the threats that states and regions face. It also will help doctors and pharmacists identify patients struggling with addictions.

Reducing prescription drug abuse has often been described as squeezing a balloon: squeeze one end, the air simply goes into the other. A balanced and coordinated approach, however, changes that dynamic and offers the best chance for success.

More information on the NGA prescription drug abuse project can be found here: http://www.nga.org/cms/home/news-room/news-releases/page_2012/col2-content/governors-bentley-and-hickenloop.html

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THOMAS MACLELLAN