U.S. Aims to Reduce Overdose Deaths, But Will the New Plan Work?
U.S. Aims to Reduce Overdose Deaths, But Will the New Plan Work?
Wednesday, April 20, 2011
The Obama administration announced on Tuesday a new initiative to reduce prescription painkiller misuse and overdose, a problem that has become the leading cause of death in 17 states, surpassing car accidents — and killing more than 28,000 people annually. The new plan includes increased funding for state prescription drug monitoring programs (PDMPs) as well as an FDA-led program to educate doctors about risks related to opioid painkillers.
The state of Florida, whose population includes many elderly patients requiring pain treatment, has long resisted using a PDMP. But Florida agreed to do so last week despite privacy objections from its governor. The country's drug czar, along with several other states, have long blamed Florida for being the source of many diverted and misused medications used in the South, noting that 98 of the nation's 100 top prescribers of oxycodone (the generic form of Oxycontin) are located in Florida. Forty-three states currently use PDMPs.
The question is, do drug monitoring programs work? If they are effective at reducing misuse and deaths, do they also reduce appropriate pain care? Not mentioned in the announcement of the White House plan was a relevant new study led by researchers at the Centers for Disease Control and Prevention (CDC), which compared rates of overdose deaths and prescribing in states with and without PDMPs between 1999 and 2005.
PDMPs collect information about patients' prescriptions in a database and make the data accessible to doctors, pharmacists and sometimes law enforcement. The new study, published recently in the journal Pain Medicine, found that such prescription monitoring had no effect on either overdose deaths or rates of prescribing. "In a national study, we compared states that had PDMPs and those that didn't, and found that states with PDMPs overall did not have lower rates of drug overdose or opioid-related deaths and did not have overall less consumption of opioid analgesics," says lead author Leonard Paulozzi, a medical epidemiologist at the CDC.
"I think what it underscores is that utilization of a PDMP is probably not enough," says Dr. Lynn Webster, a board member of the American Academy of Pain Medicine and medical director of Lifetree Clinical Research in Utah.
Paulozzi agrees that the study, whose data only goes up to 2005, doesn't necessarily mean that PDMPs don't work. It may have more to do with how the PDMP works. Another study in which Paulozzi compared New York State's prescription-monitoring program to that of Pennsylvania did find an effect. From 1999 to 2004, overdose deaths in Pennsylvania increased, while the rate in New York did not; during that period, the risk of overdose in Pennsylvania was 1.6 times higher than in New York. And the opioid prescribing rate in New York dropped to two-thirds lower per capita than that of Pennsylvania.
So what did the two states do differently? New York required doctors to use special tamper-proof prescription forms and provided much better funding for its program than Pennsylvania did, according to the study. New York also tracked all opioid prescriptions, while Pennsylvania tracked only those involving the highest risk category of drugs, Schedule 2.
Advocates for pain patients worry, however, when they see large reductions in prescribing associated with monitoring programs. "The states where there are PDMPs indicate that fewer Schedule 2s are prescribed," says Siobhan Reynolds, a long time activist for pain treatment. "That means that the people with the most severe pain are bearing the burden of all these supposed safety measures."
She adds, "Without pain control, people in severe pain develop all kinds of other, expensive medical conditions that taxpayers and those who carry medical insurance ultimately shoulder. So the real cost of these programs is hidden from public view."
Paulozzi says the key is to figure out exactly which individual components of PDMPs are contributing to success in certain states: "Is it proactive use by doctors? Is it proactive reporting of 'doctor shopping' to law enforcement, as opposed to reporting it to doctors? Is it the extent to which staff [at doctor's offices and pharmacies] can make use of data?" He notes that we still don't know which elements matter most and which might unfairly affect pain patients.
Another difference between New York and Pennsylvania may involve the availability of naloxone, the overdose antidote that can be used to revive victims. Most people who overdose are not legitimate pain patients who mistakenly take the wrong amount, but people who misuse opioids with other drugs, in most cases mixing them with alcohol or other depressants like Xanax. Fully 70% of those who report misusing painkillers do not have their own prescription for them, but obtain the drugs from a relative or friend.
In the mid 2000s, New York State began a major initiative to provide naloxone to addicts at programs like needle exchanges, and to train them on how to save overdose victims. By contrast, Pennsylvania has only a few naloxone programs.
In Illinois, the Chicago Recovery Alliance has distributed more than 11,000 naloxone kits since 2001 — and more than 1,000 overdose reversals have been reported since then, along with a reduction in heroin overdoses. (More on TIME.com: Distributing An Overdose Antidote )
But naloxone distribution to addicts doesn't reach first-time users who are at high risk of overdose; nor does it include pain patients who may mistakenly overdose or have their medications stolen by relatives. That's why Wilkes County in North Carolina, which has been hard hit by prescription drug misuse and overdose, runs a pilot program called Project Lazarus that provides naloxone to all high-risk patients when they receive a prescription for strong painkillers, just in case. (More on TIME.com: Should Overdose Antidote Be Made More Accessible?)
"We don't yet know how many overdoses have been reversed but it's going well," says Rev. Fred Brason, the project director for Project Lazarus. At least nine studies have been published evaluating naloxone programs — all of which had positive findings — and they are now available in at least 17 states.
Naloxone has not been reported to cause harm if it is used unnecessarily. Its worst side effects tend to be withdrawal symptoms caused by reversing the overdose and therefore blocking the opioid's action on the brain.
But although Food and Drug Administration commissioner Margaret Hamburg acknowledged at a press conference Tuesday that naloxone might be part of the solution to reduce overdose deaths, use of the treatment does not appear in the strategy released by the administration.
Other elements outlined in the new plan [PDF] include increased Drug Enforcement Agency (DEA) attention to opioid prescribers, take-back plans to reduce problems associated with leftover pills, and a proposal to introduce new legislation requiring doctors and dentists to be educated about opioids before they can receive a DEA registration number to prescribe them.
Will these measures prove effective? Research has not linked law enforcement crackdowns with reductions in overdose death, and physician education requirements and take-back programs have not been extensively studied.
November 16, 2012
Physicians take lead role in confronting opioid misuse, but still face hurdles: This is the second in a series exploring the intersections between effectively caring for people living with chronic pain and the rise in unintentional poisoning deaths due to prescription painkillers. (The first post is here.) The series will explore the science and policy of balancing the need for treatment as well as the need to prevent abuse and diversion. This week’s story looks at clinical efforts to reduce the risk of opioid abuse and overdose while still caring for patients; the next story will explore the role of public health officials in curbing opioid abuse. Read More
November 14, 2012
AMA webinar spells out 8 ways physicians can curb opioid misuse: The Association holds the first in a series of webinars to teach doctors more about appropriate pain management. Read More
September 17, 2012
FDA Warns of Serious Skin Burns from Topical Pain Relievers: FDA Warns of Serious Skin Burns from Topical Pain Relievers Read More
April 3, 2012
Switching Opioids Increases Risk of Overdose Death, Study Says : Switching Opioids Increases Risk of Overdose Death, Study Says Read More
April 1, 2012
Doctors kill thousands due to 'death tables,' Utah expert says in new study : Reference tool responsible in death toll from prescription painkillers Read More
March 8, 2012
What Whitney Houston Teaches Us: Whitney Houston has died from an as-yet unknown cause, but prescription medications are rumored. Her struggles with substance abuse are well documented, because she honestly shared them with the public in hopes of finding her road back. Celebrity deaths bring to our attention the national public health crisis with prescription drugs, and the list is growing: Health Ledger, Anna Nicole Smith, Corey Haim, Mike Starr. These people are not apart from or above us but hold a mirror up to our own lives. Most healthcare practitioners and counselors know a client, a friend or even a family member who has met the same tragic fate. Read More
March 2, 2012
LifeSource Co-Founder Lynn R. Webster, M.D. Receives Inaugural AAPM Presidential Excellence Award for Education: The American Academy of Pain Medicine initiates award to honor Dr. Webster’s work on the AAPM Safe Opioid Prescribing Initiative. Read More
November 2, 2011
Study shows Utah a leading state in painkiller deaths : A new study shows that painkiller abuse has not only reached epidemic levels in the United States, but overdose deaths continue a disturbing rise. Read More
September 14, 2011
Family: Player died from methadone overdose: Family members say a North Carolina high school quarterback died after a big victory last month after accidentally overdosing on some of his grandmother’s pain medication. Read More
August 26, 2011
Dr. Webster Pain Med Safety Interview: Host: Dr. Brian Grieves Radio station # (715) 524-2194 About: Dr. Brian Grieves is a radio show host at WTCH-AM, an affiliation WOTE-AM, both radio stations at Wisconsin. Every Saturday he gives his professional advice on "Health Talk" to his avid listeners in Shawano. Prior to working as a chiropractor, Grieves earned his Bachelors degree from the University of Wisconsin, a doctorate degree from Northwestern College, and his Masters Degree in Public Health from the University of Massachusetts. Read More
June 30, 2011
Dramatic increase of prescription-drug abusers seeking treatment: Dr. Webster joins KCPP to discuss trends in prescription drug abuse. Read More
June 15, 2011
LIFESOURCE ANNOUNCES NEW STUDY FINDINGS AVAILABLE ON DEATHS RELATED TO PRESCRIPTION OPIOD THERAPY: Nonprofit organization strives to address one of the nation’s biggest healthcare problems Read More
April 20, 2011
U.S. Aims to Reduce Overdose Deaths, But Will the New Plan Work?: U.S. Aims to Reduce Overdose Deaths, But Will the New Plan Work? By MAIA SZALAVITZ Wednesday, April 20, 2011 The Obama administration announced on Tuesday a new initiative to reduce prescription painkiller Read More
April 19, 2011
Striving Toward Quality Pain Management: The epidemic of untreated chronic or recurrent pain has lasted for decades, yet millions of people are still not adequately treated. One significant barrier to effective pain management is that clinicians and patients are often reluctant to talk about pain... Read More
April 11, 2011
National Prescription Drug Abuse Expert From Utah To Present At Public Town Hall Meeting In Reading: Medical experts and law enforcement provide insights on adolescent prescription drug addiction Read More
March 22, 2011
National Prescription Drug Abuse Experts To Meet With White House Policy Makers: Experts will address prescription pain medication misuse and accidental overdose deaths with the White House Office of National Drug Control Policy Read More
March 10, 2011
National Prescription Drug Abuse and Overdose Deaths Expert Addresses Healthcare Professionals In Houston: Lynn R Webster, M.D. Read More
February 12, 2011
For Some Troops, Powerful Drug Cocktails Have Deadly Results: February 12, 2011 This article was reported by James Dao, Benedict Carey and Dan Frosch and written by Mr. Dao. In his last months alive, Senior Airman Anthony Mena rarely left home without a backpac Read More
February 5, 2011
There are ways to help, prevent prescription drug abuse: CHARLESTON, W.Va. -- Recently The Charleston Gazette ran a series on the emerging epidemic of prescription drug abuse. In a state with the highest rate of drug-related deaths, highlighting prescription drug abuse is an important public Read More
January 24, 2011
Morphine/Oxycodone Combination Superior to Separate Components: Montreal Read More
January 20, 2011
I Am An Addict: Millions of older Americans are making this confession. Families are being torn apart. The good news: There's help Clean and sober for more than five years, Ron Dash has rebuilt his marriage and his life. “When I saw what Read More
January 10, 2011
Patients suffer when doctors are too scared to prescribe pain pills : Patients suffer when doctors are too scared to prescribe pain pills Monday, January 10, 2011; 8:36 PM Every American should be concerned about the kind of message sent by the Jan. 2 front-page article "Doctors who pre Read More
December 9, 2010
Should an Overdose Antidote Be Made More Accessible?: I've been writing about naloxone — the antidote to overdose of heroin, oxycodone or similar drugs — for more than 10 years, most recently for TIME here. The dru Read More
November 9, 2010
Addiction to painkillers hobbles more patients : ST. LOUIS — Nichole Marie Case unwittingly became dependent on opioid painkiller drugs. She's not alone. The National Institute on Drug Abuse estimated in 2008 that 1.85 million people in the United Stat Read More
October 25, 2010
Opioid safety is focus of $1 million-a-year educational initiative : Opioid safety is focus of $1 million-a-year educational initiative Industry-supported PainSAFE targets how physicians and patients can avoid abuses and misuses of pain treatments. A group that represents patients living with pai Read More
February 11, 2010
Select Medical-Legal Reviews of Unintentional Overdose Deaths
February 11, 2010
Comparison Of The Theoretical Cost Of Morphine And Prialt
November 18, 2009
To Help Healing, Doctors Pay More Attention to Pain. Morning Edition. National Public Radio.: The old notion that pain is somehow "good" for you should be put to rest for good, say health officials. They are increasingly recognizing that control of pain leads to more rapid recovery for hospitalized patients, and can even cut costs. Read More
November 28, 2006
National Expert from Utah Spearheads Educational Campaign: FDA Issues Methadone Warning: Providing Safe Access to Pain Medications. SALT LAKE CITY, Utah – November 28, 2006 – The Food and Drug Administration issued a warning yesterday to healthcare profe Read More
October 24, 2006
Prescription Medication Deaths Are On The Rise: Six Steps You Should Know: National Expert Calls for "Zero Unintentional Deaths" with Brigham City Physicians SALT LAKE CITY, Utah – National pain medicine expert Dr. Lynn R. Webster will present his education campaign entitled Read More
October 18, 2006
Local Pain Medicine Specialist Calls for Zero Unintentional Deaths: National Education Campaign Comes to Brigham City Community Physicians. SALT LAKE CITY, Utah – October 18, 2006 – Dr. Lynn R. Webster, President of the Utah Academy of Pain Medicine and Medical Directo Read More
October 18, 2006
National Expert Calls for Zero Unintentional Deaths: National Expert Calls for "Zero Unintentional Deaths" with Hawaiian Physicians SALT LAKE CITY, Utah – National pain medicine expert Dr. Lynn R. Webster will present his education campaign entitled “Zero Unintentional Overdose D Read More
September 27, 2006
Methadone Related Deaths On The Rise : Six Steps You Should Know SALT LAKE CITY, Utah – Dr. Lynn R. Webster, President of the Utah Academy of Pain Medicine and Medical Director of Lifetree Clinical Research® & Pain Clinic in Salt Lake City, announces six steps to avoid acci Read More
September 20, 2006
Local Pain Medicine Specialist Calls for Zero Unintentional Deaths: Statewide Education Campaign Goes National SALT LAKE CITY, Utah – Dr. Lynn R. Webster, President of the Utah Academy of Pain Medicine and Medical Director of Lifetree Clinical Research® & Pain Clinic in Salt Lake City, announced that h Read More
September 18, 2006
Local Pain Medicine Specialist Calls For Zero Unitentional Deaths: National Education Campaign Comes to St. George Community SALT LAKE CITY, Utah – Dr. Lynn R. Webster, President of the Utah Academy of Pain Medicine and Medical Director of Lifetree Clinical Research® & Pain Clinic in Salt Lake City, a Read More
June 8, 2006
Dr. Lynn R Webster Kicks Off Statewide Education Campaign: LOCAL PAIN MEDICINE SPECIALIST CALLS FOR ZERO UNINTENTIONAL DEATHS SALT LAKE CITY, Utah – Dr. Lynn R. Webster, President of the Utah Academy of Pain Medicine and Medical Director of Lifetree Clinical Research® &a Read More