Thursday, October 22, 2015

Obama Says US Will Tackle Prescription Drug Abuse

The New York Times reporting on President Obama’s visit on Wednesday October 21, 2015 to West Virginia is in this article entitled “US Will Tackle PrescriptionDrug Abuse.” In the article, it notes that: “Experts say few prescription drug health care providers are properly trained to safely prescribe painkillers, while access to medication-assisted treatment for addicts is too difficult.”

President Obama's visit to West Virginia comes as politicians are grasping for a policy response, including presidential candidates in both parties. Former Secretary of State Hillary Rodham Clinton has laid out a $10 billion plan that promotes treatment over incarceration. New Jersey Gov. Chris Christie has visited drug rehabilitation centers and talked up his work to create drug courts at home that mandate treatment over jail time for non-violent offenders.

Before leaving the White House, Obama ordered federal agencies that employ health care providers to offer training on prescribing painkillers. They also must review their health insurance plans and address policies that might prevent patients from receiving medication as part of their treatment.

A Centers for Disease Control and Prevention (CDC) report released in July 2015 found the number of people who reported using heroin within the past year had nearly doubled from 2002 to 2013. Heroin use was up among nearly all demographic groups, but showed particular spikes among women and non-Latino whites. Researchers say two factors are driving the trend: the rise in abuse of opioid painkillers — drugs that are often a precursor to heroin — and the increasing availability of cheap heroin.

Researchers found that most users reported using at least one other drug in combination with heroin, which contributes to high overdose rates. Between 2002 and 2013, the rate of heroin-related overdose deaths nearly quadrupled, and more than 8,200 people — by some estimates, one in every 50 addicts — died in 2013, according to the CDC.

Commentary: It is curious that now that the demographic of drug abusers is non-Latino whites, there is more emphasis on treatment than incarceration. Heroin use was never seen as a drug for whites but now that it is - the attention is properly focused on it. Better late than never. Substance abuse it turns out does not respect anyone and it does not discriminate against race or economic status. However, it takes the mainstream to get affected before our policies change. 

Perhaps our nation has learned something from criminalizing drug possession – including the shameful past of mandatory minimums for crack cocaine and other drugs that sent many people of color or of low socioeconomic status to prison for many years for the crime of being an addict. If this is what it takes, then it is still the right thing to do. It reminds me of the times when AIDS was regarding as an issue affecting gay men but when it began to effect others, the country took action. This is a national health issue and highlights the issues with addiction that have been around for years.

Now the insurance companies need to treat addiction as a disease and provide health insurance coverage. One of the issues that arises is that once an addict is detoxed, the health insurance companies claim “no medical necessity” and refuse to provide coverage for residential programs that last over 30 days.

Physicians also need to be trained to spot those who are not simply “dependent” on painkillers but have become addicted. Since once those prescription drugs will not be prescribed, it seems that patients are then going to seek heroin or other drugs from non-medical sources and this is how heroin and prescription drugs get intertwined.

Practice point: Physicians and pharmacists need to take as much continuing education in these areas. Simply refusing to write prescriptions is not the answer. Yet this is now what is being reported. Post-surgery patients are being denied more than a couple of days of painkillers and physicians and pharmacists are running scared. 

Part of the answer is creating new systems, new type of consent forms and patient education which is also in writing, and perhaps having pain patients watch videos which detail that the warning labels are NOT advisory or suggestive but that mixing other drugs, exceeding dosage or mixing alcohol is a life or death issue. If one overdose death can be prevented - it is worth it. Pharmacists need to increase the warnings even for those who have taken the medications before - with the Internet some people think they are their own physicians and know better than the physicians or pharmacists.

All this takes time and of course insurance companies do not pay for "counseling" patients but this can be systemized for the health of patients and so that physicians and pharmacists are not blamed if the patient abuses or misuses the prescribed drugs. If we could put "black box" labels on any medications that could cause death when not taken as prescribed, it should be done. This is part of the FDA's domain and all the regulatory and licensing agencies need to work together in order to address this crisis.

Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law


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