Prescription Drug Abuse: Stemming the Tide of a New Epidemic
According to Robert Stutman, former special agent in the U.S. Drug Enforcement Agency (DEA) and one of the nation’s top experts on drug abuse, we are in the midst of the worst drug epidemic seen in the U.S. in the past fifty years. Sadly, the drugs involved are not illegal drugs such as cocaine or heroin, but legal drugs often obtained from family members, who have been prescribed them by physicians. Many times those at the core of this abuse problem are not just the celebrities and local members of the community seen on television, but younger victims – children and teenagers. “The situation today is much worse than with crack or heroin - but there are no dope peddlers.” “The peddlers are parents who get their drugs, usually extended-release opioids, from physicians and they end up in kids’ hands.” In fact, in people 12 and over using prescription drugs non-medically, less than 5% of them obtain their drugs from a drug dealer.1
Use and Abuse of Prescribed Opioids – the Devastating Impact
How has this epidemic come about? The scale of the problem is linked to the high quantity of opioids prescribed in the United States. As Mr. Stutman explains, “The most prescribed drug in the U.S. is hydrocodone/acetaminophen2 and the U.S. is the highest consumer of opioids worldwide on a per capita basis3. In total there are over 240 million opioid prescriptions written in the U.S. each year2, with 15-20% of doctors’ visits resulting in the prescription of an opioid.4”
The widespread use of opioids has translated to a steep rise in drug-related hospital admissions and deaths. The number of hospital emergency room visits per month due to prescription drug overdose has more than doubled over 5 years to over 25,000/month5. In 20 states the number of unintentional drug poisoning deaths exceeds the number of deaths due to motor vehicle crashes or suicides6.“I think in any medical professional’s opinion that makes it an epidemic.” observes Mr. Stutman.
The seriousness of the problem has been recognized by the Obama administration. According to Gil Kerlikowske, Director of National Drug Control Policy,"Prescription drug abuse is our Nation's fastest-growing drug problem, with shocking consequences measured by overdose deaths, emergency room visits, treatment admissions, and increases in youth drug use. The Obama Administration is mounting an unprecedented effort to address this public health epidemic... Parents should act today to protect young people by talking to their kids about the consequences of drug use7."
The Root Cause – Drugs Obtained in the Home by High School and College Students
The involvement of both parents and medical professionals in addressing this issue is an approach that Robert Stutman has long advocated. A starting point is to recognize how children are typically obtaining these drugs: a patient receives a supply of drugs for post-operative pain but only uses a small proportion of that supply. The remaining pills sit unsupervised in the medicine chest, available for anyone in the household to obtain and share with their friends. “What most parents don’t understand is that all kids do is go to the medicine chest and look for any pill that has a warning label on it - and those are the pills they take.”
In high schools over 9% of 12th graders have used a prescription narcotic in the last year8, while abuse among college students of controlled opioids has more than tripled in recent years9. With college-aged students likelier to abuse controlled prescription drugs than any other group, they are disproportionately suffering overdoses and drug-related deaths.
Reducing the Risk of Abuse – the Role of Parents and Medical Professionals
“One of things I tell parents” says Mr. Stutman, “is the simplest way to save kids lives is to have every doctor tell every patient to buy a hand-gun locker. Take all your pills with a warning label and keep them locked in that locker. You will save hundreds of kids’ lives a year simply by doing that.”
Recognizing the need for physicians to ensure the prescriptions they write are used appropriately Mr. Stutman has a list of steps doctors can take to demonstrate a good faith effort to achieve compliance. This starts with establishing an opioid contract with chronic pain patients and includes random urine testing, use of the state drug database, if available, and a serious discussion about the dangers of drug abuse.
He believes there needs to be a paradigm shift in the way the medical community deals with this issue: “The DEA does not expect medical professionals to be perfect but they do expect them to try their best.” A more rigorous approach to opioid prescribing will come about with the expected implementation of Risk Evaluation Mitigation Strategies (REMS) for pain medication. These may mandate training and certification for any physician prescribing opioids and will likely require prescriber and patient education.10
Mr. Stutman stresses that nobody is trying to stop physicians from prescribing pain relievers as appropriate.“All we’re saying is: ‘Please understand there needs to be a paradigm shift – so, if you prescribe them just take the extra steps. And we’ll save kids’ lives.’ ”
- 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings; Office of National Drug Control Policy http://oas.samhsa.gov/NSDUH/2k9NSDUH/2k9ResultsP.pdf
- The Use of Medicines in the United States: Review of 2010; IMS Institute for Healthcare Informatics; April 2010
- Narcotic Drugs Estimated World Requirements for 2011 Statistics for 2009; International Narcotics Control Board; United Nations, New York, 2011
Opioids for Chronic Pain; Deborah Grady, MD, MPH; Seth Berkowitz, MD; Mitchell H. Katz, MD; Arch Intern Med. Published online June 13, 2011.
Emergency Department Visits Involving Nonmedical Use of Selected Prescription Drugs - United States, 2004—2008; Morbidity and Mortality Weekly Report; Centers for Disease Control and Prevention; June 18, 2010 / 59(23);705-709 www.cdc.gov/mmwr/preview/mmwrhtml/mm5923a1.htm
Narcotic Pain Relief Drug Overdose Deaths a National Epidemic; ScienceDaily (Apr. 26, 2011); www.sciencedaily.com/releases/2011/04/110425173904.htm
White House Drug Policy Director Highlights Growing Public Health Toll of the "Prescription Drug Abuse Epidemic; Office of National Drug Control Policy; Thursday, January 6, 2011; http://www.whitehousedrugpolicy.gov/news/press11/010611.html
Monitoring the Future; National Survey Results on Drug Use, 1975–2006; Lloyd D. Johnston, Ph.D., Patrick M. O'Malley, Ph.D., Jerald G. Bachman, Ph.D., John E. Schulenberg, Ph.D; U.S. Department Of Health And Human Services 2006; National Institutes of Health; monitoringthefuture.org/pubs/monographs/vol1_2006.pdf
Wasting the Best and the Brightest: Substance Abuse at America’s Colleges and Universities; The National Center on Addiction and Substance Abuse at Columbia University; March 2007; www.casacolumbia.org/templates/publications_reports.aspx
REMS: The FDA and Pain Medications; American Pain Foundation;