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David Russo - Prescription drug abuse

Shutterstock photo
Shutterstock photo

The United States consumes 83 percent of the world’s oxycodone and 99 percent of its hydrocodone, according to a 2010 International Narcotics Control Board report. These are both generally classified as potent painkillers and sedatives used for a wide variety of medical needs such as pain control, anxiety and depression.

Unfortunately, abuse of these prescription medications has become prevalent in our country — and particularly in Oregon.

In 2006, EcoNorthwest studied the dollars-and-cents effect of such abuse. Its study noted total direct economic costs from substance abuse in Oregon alone totaled approximately$5.9 billion in 2006, or an amount equal to the entire budget for the state of Oregon in 2013. This cost includes the use of both prescribed and illegal drugs; there is so much cross-over between the groups that costs cannot be attributed to one or the other. The $5.9 billion fell into the following three categories:

n $4.2 billion in the loss of earnings as a result of lost productivity by drug and alcohol abusers who die prematurely, are sick, fail to come to work or are incarcerated as a result of substance abuse, and by victims of crimes committed by abusers.

n $813 million in health care costs related to substance abuse programs.

n $967 million in other costs, such as violent, property and consumption-related crimes; expenditures on alcohol and drug enforcement laws, criminal justice and social welfare programs; and property damage attributed to motor vehicle crashes and fires.

Oregon health providers and leaders, as well as policymakers, should be paying attention. A July 2014 study by the Centers for Disease Control and Prevention documented how Oregon is fourth in the U.S. for long-lasting opioid prescriptions, 16th for high-dose opioid prescriptions and in the top half for overall opioid prescribing.

In running a pain management medical practice in Hood River, I see how difficult it is for patients to deal with chronic, life-altering pain issues. Sometimes, the outcome is abuse of or addiction to the very pain-relieving medications designed to help.

A study of prescription opioid abusers in a drug rehabilitation program found that 80 percent tampered with opioid tablets to accelerate drug release by chewing or administering the drug intranasally or intravenously.

But recently, CNN reported the Federal Drug Administration has approved a new “smart pill.” The smart pill uses emerging technology to render certain pain medications completely inactive when their form is altered. Medical research and development companies designed the smart pill to prevent abuse of “those medications that are highly addictive and often abused, such as opioids and benzodiazepines.”

If altered or abused, smart pills can also be developed to produce unpleasant side effects, to alter the timed release and to only be ingestible when taken orally. Such formulations could go far toward preventing continued abuse and addiction as well as overdoses.

For years, prescribing protocols have allowed or even required switching or substituting prescriptions of new, abuse-deterrent medications with the lower cost. But addictive opiate and benzodiazepine prescription medications. Consequently, low-income people have been at higher risk of addiction and overdose from prescription pain killers. One Washington state study found that 45 percent of people who died from prescription painkiller overdoses were Medicaid enrollees.

Insurance providers compound the problem by requiring higher co-pays for the new, more-expensive prescription meds, thus encouraging consumers to ask for the lower-cost drugs.

The good news is that health providers and advocates in Oregon are working together in an attempt to end these practices. In August, the American Academy of Physical Medicine and Rehabilitation, which represents pain management specialists and physiatrists, developed guidelines on responsible opioid prescribing practices for chronic pain patients.

Such standards are not only timely for Oregon, they reinforce what many, many health providers and I do every day: balance risks and benefits; screen and triage for substance use disorders, psychological disorders and addiction; monitor patients closely, including their clinical toxicology outcomes; prioritize patients’ function and quality of life; and provide a personalized plan of care.

It’s going to take a team to resolve Oregon’s abuse problems.

We know, besides the correct prescribing methods, that the best way to decrease abuse opportunities is to increase the use of smart pills. This can be done at the pharmacy counter and by prescribers noting “dispense as written” when issuing a prescription or electronic prescription order.

We are asking health leaders, prescribing providers and state policymakers to follow the CDC’s report by examining prescribing practices to better control the possibility of abuse and overprescribing, so we all can enjoy the benefits of modern medicines as well as caution in our care.

Local reaction
The Yamhill Community Care Organization, or YCCO, is addressing the prescription medication abuse issue head-on in our community.
YCCO recently invited all local prescribers to a meeting raising awareness of the issue and recommending they adopt the recently developed opiate prescribing guidelines.

David Russo, D.O., is a physician and pain management specialist in Hood River. He helped develop the national guidelines to help physicians and patients better manage their opioid prescriptions.

When prescription medications are diverted by drug abusers, they are usually altered to accelerate drug release and effects. New technology would help prevent such misuse. Shutterstock.com

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