Prescription drug abuse on the rise
According to the Hillsborough County Medical Examiner’s Office, prescription drug abuse has become more fatal than abuse of illegal street drugs.
What we’ve noticed in probably in the last 10 years across all parts of the United States, and in particular Florida, are unprecedented numbers of prescription drug overdoses in patients coming through the medical examiner’s office.
Dr. Julia Pearson is the chief forensic toxicologist at Hillsborough County’s Medical Examiner's Office in Tampa.
In this county right now, our top two drugs in terms of overdoses, are actually two prescription drugs. One is oxycodone, which can be formulated as Percocet or oxycontin. And the second drug is methadone, which used to be used to treat heroin addiction, and now is being used to treat chronic pain. So those two drugs are the number one and number two causes of drug overdoses in this county, which is quite a substantial number of cases. At this point, we’re looking at almost 300 drug overdoses per year in Hillsborough County, which is almost one case per day.
Pearson said the increase in oxycodone deaths began in the late '90s with the release of the prescription drug Oxycontin.
They would actually start crushing the pills, and snorting the pills, and injecting the pills and die of overdoses. Starting around 2006 or so, we started seeing people use methadone to treat chronic pain. And ever since 2006, we’ve seen another increase in prescription overdoses, primarily due to the combination of both.
Florida, like many other states, has a prescription drug monitoring program, or PDMP, aimed to curb doctor shopping — that is, filling prescriptions at multiple pharmacies. Florida’s prescription drug monitoring bill was signed into law last year, but was not provided any funding by the legislature.
There is a provision in the bill that requires the state’s Office of Drug Control to support the effort to raise the million dollars needed to launch the program.
The Florida PDMP Foundation has so far raised about $150,000 toward the effort. So you can see that we’re making substantial progress, and we expect to meet the goal by the end of the year.
Bruce Grant, director of the Office of Drug Control, says the bill is just the start of a solution.
The Prescription Drug Monitoring Program is a good first step. It is not a silver bullet, it is not one answer to the problem of prescription drug diversion in the state of Florida. We’re also looking at enhancing the PDMP bill this year to allow provisions that would allow some sort of flagging doctors who overprescribe—possibly to see what doctors have not been prescribing according to accepted medical practices.
There is controversy in the medical community surrounding the possible overuse and of prescriptions like oxycodone. Dave Craig is a clinical pharmacist specialist at [Moffitt Cancer Center]
Are they appropriate for all patients? No. Are they appropriate for certain patients? Absolutely.
Craig is also a member of American Pain Society, an international professional organization that seeks to end pain and suffering in patients, and he currently serves on its board of directors.
Certainly, there is some very good data looking at acute pain and cancer pain, but patients who have non-cancer pain — for example, headache, neck pain, back pain, those kinds of things — is where it becomes more controversial, because the data is not so supportive there. The increased deaths over the past number of years is thought to be attributed from primarily non-cancer-related use of opiate-type of medications, specifically combined with other CNS (central nervous system) depressants like benzodiazepines or other narcotics.
Craig spoke about doctors who work with patients who have chronic, non-cancer pain using a few common precautions so the patients understand the risks involved. Craig said these strategies include informed consent and a doctor-patient agreement.
An agreement between the physician and the patient that the patient, for example, needs to do certain things to continue to get these heavy medications. Then typically, also the agreement would include language regarding random urine drug screens to look for compliance or look for patients who might be doing other things, other substances, for example. Another strategy would be just to have patients frequently follow up with them, for example, on a weekly basis, and only get weekly prescriptions.
For more information on prescription drug abuse, contact the Hillsborough County Anti-Drug Alliance online at hcada.com.comments powered by Disqus