New form of OxyContin seems to have led to a decrease in abuse and a corresponding increase in heroin use.

According to Forbes, the Journal of Pain and other publications, the introduction of a new tamper-resistant form of OxyContin in 2010 seems to be responsible for a decrease in abuse of the drug. Drug addicts previously crushed OxyContin pills to circumvent the drugs time-release mechanism and experience the full impact of the drug in one rush. Instead of allowing drug abusers to crush the pill for snorting or injection, the new OxyContin turns into a gummy mush when tampered with.

Unfortunately, the reformulation of OxyContin does not appear to be leading to an overall drop in drug abuse. In the past decade, OxyContin became so popular as a drug of abuse in rural communities that it was nicknamed “hillbilly heroin.” This nickname has unfortunately proved to be somewhat prophetic since many former OxyContin users are now turning to heroin to achieve a similar high. According to Dr. Gregory Davis, a professor of pathology and coroner in Birmingham, Alabama, the city has recently seen a rise in heroin overdoses from one or two per year to one or two per week.

A study recently published in the New England Journal of Medicine shows the shift away from OxyContin abuse. In 2009, about 36 percent of patients at drug treatment centers reported that their primary drug of abuse was OxyContin. In 2012, following introduction of the new form of OxyContin, about 13 percent said it was their primary drug. More than 30 percent of the patients said their drug of abuse was another opioid such as fentanyl or hydromorphone. The study involved more than 2,500 patients at 150 treatment centers in 39 states. Especially troubling is that fact that 20 percent of patients reported using heroin in the past 30 days.

One of the patients involved in the study said that heroin is becoming more popular because it is cheaper, more readily available and easier to use than prescription opioids. According to Theodore Cicero, professor of psychiatry at Washington University and co-author of the study, the upsurge in heroin use could be even more dangerous than prescription drug abuse. Addicts don’t know for sure the strength of a heroin dose and they must use it much more frequently to avoid withdrawal. Heroin also carries a risk of disease transmission through needle sharing. In addition, heroin addicts often engage in illegal activities to obtain money to buy the drug.

Cicero says it is also possible that some people are switching to other prescription drugs like Vicodin to get high. Because they would have to take higher doses of these other drugs to get the same high that OxyContin once delivered, they are at increased risk of overdose. According to Cicero, deterring the use of one drug will not necessarily get people to stop using drugs altogether. So although OxyContin’s reign as king may have ended, the drug abuse problem in American lives on.

NYC Mayor Michael Bloomberg

In response to a citywide and national epidemic of prescription drug abuse, Mayor Michael Bloomberg has instituted a policy in New York City that will restrict the use of prescription painkillers in the city’s public hospitals. The policy, which will affect the distribution of prescription drugs from hospital emergency rooms, could set a model for hospitals across the nation.

Under Bloomberg’s new policy, emergency room patients will only be given three days worth of narcotic drugs like Percocet and Vicodin. Oxycontin, which has been shown to be one of the most addictive painkillers, will not be distributed at all from 11 public emergency rooms. This is also true of methadone and Fentanyl patches. Emergency rooms also will not fill painkiller prescriptions that are reported to have been stolen, lost or destroyed.

One of the goals of the new policy is to reduce the amount of drugs that end up in medicine cabinets and diverted for sale on the street. When he announced the new policy, Mayor Bloomberg said that a quarter million teenage and adult New Yorkers are abusing prescription painkillers. Two million prescriptions for highly addictive opioid painkillers are written in New York City each year. According to New York health commissioner Dr. Thomas Farley, an estimated 40,000 city residents are in need of treatment for painkiller dependency. The situation has led to an increase in drug overdoses and deaths, robberies of neighborhood pharmacies and a rise in prescription fraud.

The new policy is not without its critics. Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians, stated that he would prefer to leave decisions about prescriptions in the hands of physicians. However, emergency room physicians had not developed their own policy to limit the abuse of prescription painkillers. Other critics have pointed out that emergency rooms are often the primary source of medical care for the poor and uninsured. The policy could deprive these people of access to medication for legitimate pain.

NYC health officials say that the new policy will not apply to patients who are being treated for cancer, nor will it limit drugs being dispensed to patients who have been admitted to the hospital. Similar policies have been enacted in Utah and Washington State. The new policy does not restrict painkiller prescriptions in about 50 private emergency rooms in New York City, but many of these hospitals say they will voluntarily adopt the new regulations.

About 20% of American seniors take pain medication several times per week

There are currently 38 million adults over age 65 represent in the U.S, representing 13% of the total population. One third of all prescriptions are written for this group. According to the Substance Abuse and Mental Health Administration (SAMHSA), 2.8 million seniors abuse prescription drugs. By 2020, seniors will represent 20% of the population and SAMHSA estimates that 4.4 million will abuse drugs.

Many experts believe that aging Baby Boomers are more likely than their parents to turn to drugs for pain relief. Members of the World War II generation showed a tendency to be stoic about pain and to be careful about their use of drugs. Baby Boomers, who were exposed to drugs like marijuana and LSD in their youth, are more inclined to turn to prescription painkillers as seniors.

Senior Warning Signs

Older patients pose unique challenges when it comes to detecting prescription drug abuse. Many of the signs and symptoms of abuse may be mistaken for natural results of the aging process. The AAAP warns healthcare providers about these warning signs of senior prescription drug abuse:

• Multiple medical problems.
• A high incidence of chronic pain.
• Asking for a painkiller prescription during the first office visit.
• Doctor shopping for multiple prescriptions.
• Requesting early pain prescription refills.
• Reporting that a pain prescription has been lost or stolen.
• A disheveled appearance.
• Mood disorders.

According to Dr. Louis Trevisan of the Yale University School of Medicine, physicians should be just as careful about prescribing opioid-based drugs like OxyContin and Vicodin to elderly patients as they are with younger patients. Physicians also need to be aware that patients who take opioids for noncancer pain for an extended period could experience withdrawal symptoms when they stop.

Surgical approaches to drug and alcohol addiction are controversial among members of the medical community.

Doctors in China are experimenting with an extreme treatment for addiction. The experimental procedure consists of destroying portions of the brain’s pleasure center in an attempt to stop cravings for opiate drugs like heroin. Possible side effects including permanently disabling an addict’s ability to experience the entire range of human emotions, including the capacity to feel joy.

Attempts to Ban Controversial Procedure

The controversial procedure was banned by the Chinese Ministry of Health in 2004, due in part to pressure from Western media related to ethical concerns. There are also suspicions that researchers have not been truthful about results of the procedure and have exaggerated the benefits in order to be published in leading medical journals. The Ministry of Health’s decision was also reported to be based on the lack of long term data about effects of the procedure.

The ban on the procedure was not complete, however. Some physicians have been allowed to continue their research on the use of brain surgery to treat addiction. In 2007, the Wall Street Journal reported on one Chinese doctor who claimed to have performed the surgery on more than 1000 patients. The same doctor admitted to using the procedure on another 1000 patients to treat depression, epilepsy and schizophrenia.

Lasting Side Effects

A study of the procedure, which is referred to in the medical community as ablation of the nucleus accumbens, was recently published in World Neurosurgery, a Western medical journal. Publication of the study has sparked a debate about whether this type of research should be included in a reputable scientific journal. One of the authors of the study, Guodon Gao, describes the surgery as a feasible solution for psychological dependence on opiate drugs.

The study describes lasting side effects experienced by more than 50% of the patients who had the procedure, including a loss of motivation and memory problems. The study also found that more than half the patients had relapsed within five years and were once again addicted to opiates. If these results are true, the success rate is only slightly better than the 30 to 40% success rate that can be achieved with conventional substance abuse and addiction treatment.

The area of the brain that the surgery affects controls the desire for opiate drugs as well as for more fundamental pleasures like food, sex and love. Many Western scientists are concerned that a procedure that results in life-changing alterations to the brain is being performed in a country where citizens have limited human rights.

Doctors need to monitor patients who are taking addictive medications.

The National Institute on Drug Abuse estimates that roughly 116 million Americans suffer from chronic pain. Healthcare providers have long struggled with the challenges involved with the long-term treatment of pain, including the need for escalating doses as patients become tolerant to medication and the risk of addiction.

Doctors and Hospitals Worry about Negative Patient Feedback

According to Sherry Green, CEO of the National Alliance for Model State Drug Laws (NAMSDL), education for prescribers needs to focus less on patient satisfaction and more on improvements in patient functioning. Green also points out that with physician ratings available online, some doctors feel pressured to give patients the drugs they ask for rather than risk a negative rating. Hospitals are also contributing to the pressure to satisfy patients due to their own fear of negative patient feedback.

Green’s comments were made at a recent NAMSDL meeting that was convened to address the problem of “pill mills” and prescription drug abuse. Meeting attendees included law enforcement officials, addiction experts, doctors and medical board members.

Individualized Patient Care is the Key to Safe Use of Medication

The group identified the practices of so-called pill mills as a major contributor to the current prescription drug abuse epidemic. These practices include a focus on prescribing drugs without taking medical histories and a lack of physical examinations and follow up on patient outcomes. Patient care is not individualized – the same medications are provided to all patients regardless of their condition. In contrast, Green defines legitimate pain management as a holistic process that involves a variety of different approaches in addition to prescription drugs.

To minimize the risk of addiction, physicians should become familiar with each patient’s risk factors, including a family history of drug abuse or mental illness. It is also crucial to monitor patients for signs of abuse while they are taking prescription drugs. Frequent requests for refills and claims that a prescription has been lost are two of the warning signs of drug abuse.

A preliminary set of proposals that will help policymakers enact practical solutions for prescription drug abuse were drafted at the NAMSDL meeting and will be distributed to stakeholders for review. Many states are currently focusing on implementing prescription drug monitoring databases to fight the proliferation of pill mills. Getting doctors and other drug prescribers to consult a state database before writing a prescription for a patient who may be doctor shopping is one of the many challenges that these states will face.

Prescription overdoses kill more people than heroin and cocaine combined

The proposed legislation is a response to  an LA Times investigation into coroner reports. The investigation revealed that numerous deaths caused by the overuse of prescription pain medication can be linked to a handful of physicians. The Times examined 3,733 prescription drug related deaths that took place between 2006 and 2011 in the counties of Orange, San Diego, Los Angeles and Ventura. It was revealed that 1,762 cases resulted from overdosing on medications that had been prescribed by doctors. A total of 71 doctors were found to have prescribed drugs to at least 3 patients who died from overdose and addiction. Five doctors had prescribed medications to 10 or more patients who overdosed.

Sen. Price promptly responded to the Times report, stating that it’s an immediate red flag to see one doctor connected to multiple prescription medication overdoses. The Medical Board believes that coroners who don’t report prescription drug deaths have made it difficult to hold doctors accountable for their prescribing methods. On November 1, Sen. Price and California’s Medical Board wrote new legislation attempting to close the misinformation gap. By requiring coroners to report all prescription drug overdoses, the Medical Board can conduct detailed investigations into physicians who prescribed medication to deceased patients and to determine if the reason for prescribing was legitimate.

This new proposed legislation has received favorable comments from coroners and physicians throughout the state. Dr. David Hadden, Fresno County Coroner, told the Times that he sees a small number of prescription drug deaths each year and has no problem with additional reporting requirements. Orthopedic surgeon Dr. Sergio IIic, President of the Fresno Madera Medical Society, also believes the legislation will be beneficial. New reporting requirements will assist in identifying the large number of physicians who over-prescribe narcotics to patients who don’t need them.

If the new legislation takes effect, doctors will be placed on notice when prescribing medication and may become more cautious. At the same time, Hadden and IIic agree that not all deaths caused by prescription drug overdose are the result of a doctor’s negligence. Patients who ignore drug warnings about mixing drugs and alcohol often contribute to their own deaths. Only time will reveal if this new legislation makes it easier to hold doctors accountable for their prescribing methods.

The U.S. prescribes pain killers at a rate that would provide every American one pill for every four hours all day for three weeks. Pain pill prescriptions grew an astounding 600 percent from 1997- 2007 according to the government.
Although that may be good news for the U.S. pharmaceutical industry, in may not be such good news for consumers (or their families and loved ones). Accidental overdose is now the number one cause of accidental deaths in this country, exceeding even the number of deaths in traffic accidents.   Heath Ledger’s tragic and well publicized death is but one of many celebrity accidental overdoses that has garnered significant attention, but the truth is that it is happening to your family, friends and neighbors as well.

A Tragic Loss, but Only One of Thousands...

A Dangerous Road of Tolerance and Addiction

Our seemingly endless reliance on pain killing medication certainly provides relief. But over time these drugs lose their effectiveness due to the body’s building up tolerance resulting in consumers wanting more and reliance on an increasing amount of painkillers can lead to abuse. Thus one may consume more pills than initially prescribed and unknowingly significantly increase the risk of death. Add alcohol to the mix of a large  dose of prescription painkillers and a tragic end becomes even more likely.
Of course, the vast majority of pain-killing prescription drugs are indeed prescribed by a medical doctor. It seems that physicians are quick to prescribe a drug to address the immediate issue of pain, rather than explore the fundamental underlying problem. Though not intentionally, these prescriptions may lead to over-prescription and subsequent addiction to the drug by the patient.

Southern California Taking Steps

In Southern California, State Senator Curren Price of  Los Angeles wants to help address this  cause of accidental death by requiring coroners to report any prescription drugs that may be associated with the death of an individual to the California Medical Board.

This may help identify doctors who (unwittingly in most cases) are over-prescribing pain killers that end up contributing factors in otherwise preventable deaths. This move was precipitated by an LA Times report which concluded that almost half of all deaths involving prescribed drugs in four local counties involved victims who had a prescription to the medicine that was a contributor to their death.

Although not universally endorsed by doctors, many who would worry about the malpractice ramifications or license issues that would inevitably emerge from such reports to the Medical Board, such legislation may help stem an increasing and bad trend in the use, and abuse of prescription medicines.

Maine – Surprisingly Vulnerable to Opiate Addiction

Random drug testing is the latest weapon being used to fight Maine’s high rate of prescription drug abuse. The per-capita rate of addiction to opiate drugs in Maine is the highest in the nation. More residents of the state seek treatment for painkiller abuse than for alcoholism. Additional effects of Maine’s prescription drug problem include an increase in the number of pharmacy robberies and in the number of babies being treated for opiate withdrawal. Prescription drugs are also being blamed for a rise in crime across the state, especially burglaries. Public Safety Commissioner John Morris blames many of the burglaries on prescription drug addicts who break into homes in search of drugs. The targets of home robberies are often infirm or elderly people.

Maine

Like many other states, Maine has instituted a Prescription Monitoring Program. The program consists of an electronic database for tracking prescriptions for controlled substances. Pharmacists upload the names of patients who receive controlled drugs so doctors can check on patient activity before writing prescriptions. The state has also set up a task force to address the problem of prescription drug abuse.
Many drug experts in Maine believe that the high rate of prescription drug abuse in the state has been fueled by a greater availability of diverted drugs compared to other states. Maine was the first state where OxyContin was marketed by Purdue Pharma. Between 2006 and 2010, the number of prescriptions for oxycodone written by Maine doctors rose by 50 percent. The state’s Prescription Monitoring Program seems to be having an effect since doctors wrote about 300,000 fewer prescriptions for narcotic drugs in 2011.