Fight prescription-drug abuse

Wednesday, July 15, 2009

The recent tragic death of Michael Jackson has once again brought drug addiction

back in focus. Although toxicology results will not be available for several weeks,

the reports from his family and friends suggest that he was continually battling drug

addiction.

If so, his demise (and that of Heath Ledger last year) will serve as yet another

reminder of the burden of this problem on our country. In the last 10 years, the

number of Americans (including teens) abusing controlled prescription drugs has

more than doubled to 15 million.

Joseph A. Califano Jr., Chairman and Founder of the National Center on Addiction

and Substance Abuse, recently stated that between 1992 and 2003, while the U.S.

population increased 14 percent, the number of people abusing controlled

prescription drugs jumped 81 percent — twice the increase in the number abusing

marijuana, five times the number abusing cocaine and 60 times the increase in the

number abusing heroin.

If it is revealed that Jackson received controlled substances from multiple

physicians, then naturally these physicians will come under scrutiny. But, it is

important to realize that the majority of drug abusers have obtained their

medications legally through a prescription, and one of the most common methods of

doing this is through “doctor shopping” — a practice in which patients receive

prescriptions, such as pain killers (but also drugs like Valium and Ritalin) from

multiple doctors to treat the same illness.

As doctor shopping has increased, some physicians have stopped believing their

patients, particularly when it comes to prescribing controlled substances. Other

physicians believe the patient, but wait several weeks (or months) to prescribe these

medications, to give them time to request and review old records. The end result is

that law-abiding patients suffer.

Congress took a big step in 2005 to address doctor shopping. The National All

Schedules Prescription Electronic Reporting (NASPER) Act is a law that provides

for the establishment of a controlled substance monitoring program in each state,

with communication among all state programs. The concept for the NASPER was

provided by the American Society of Interventional Pain Physicians, and had three

important goals: physicians’ and pharmacists’ access to monitoring programs,

monitoring of Schedule II to IV drugs, and the sharing of this information across

state lines.

Having a coordinated, privacy-protected prescription-monitoring program that spans

all 50 states could save hundreds of millions of dollars in prescriptions in the

Medicaid and Medicare programs alone, not to mention assisting in the early

identification of patients at risk of addiction or diversion. That would lead to the

initiation of appropriate medical interventions and help avert the tragic personal,

family, and community consequences of untreated addiction.

Most states already have monitoring programs in place, but the fundamental flaw

with them is that they are reactive — created to help law enforcement identify and

prevent prescription drug diversion after the fact. To be more effective, these

programs need to become proactive by allowing access to this information by

physicians and pharmacies.

It is now up to the individual states (including ours) to adopt the NASPER

guidelines.

If the states get on board, physicians would feel less threatened by doctor shopping,

and less time would be spent worrying about a prescription falling into the wrong

hands.

TODD P. JOYE, M.D.

Pain Associates of Charleston

Old Georgetown Road

Mount Pleasant

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