The war against drugs. When most people hear this they think of Reagan’s draconian drug control policies or the deadly battle with Central American cartels. While the fight continues south of the border, a growing problem continues to be ignored by lawmakers and citizens, alike; the abuse of prescription medications.
Prescription drug abuse or, the non-medicinal use of controlled opioids, central nervous system depressant and stimulants, has been named “the silent epidemic” by the Drug Enforcement Administration (DEA) and the Center for Disease Control (CDC). This epidemic has hit young Americans particularly hard, with one in five teens using drugs such as Oxycontin and Vicodin to get high. To further contextualize, Americans are only 4% of the world population yet consumes 80% of the global supply of opioids. If this issue continues to go unaddressed, the growing reliance on these prescriptions drugs will pose a great threat to the American economy, people, and healthcare system.
As little media and Congressional attention this issue has received, America’s addiction to pain killers has already cost taxpayers a whopping $190 billion a year.i This enormous estimate is a product of traditional costs, such as emergency room visits for overdoses (up 98.4% over the past five years in Florida alone), and new concerns such as the increased number of “opiate babies” being born from addicted mothers. Drug related crimes have also spiked with an 81% increase in pharmacy robberies between 2006 and 2010.ii Figures may not do justice in painting the loss of human life however, in 2008 alone, pain killer addicts were disproportionately involved in 14,800 deaths or 73.8% of prescription drug overdose deathsiii.
In response to this growing crisis, many states have taken it upon themselves to create drug control policies. That said, while the attempts are admirable, local legislation fails to fight the epidemic on the national scale. One year ago, Florida, was branded the epicenter of pill mills or clinics specializing in prescription pain medication. To combat these clinics, the Florida legislature, along with attorney general Pam Bondi, passed legislation that imposed strict punishments for the possession and excessive prescription of medication, established strike teams, and launched a prescription drug monitoring program (PDMP). Though Florida and other states such as Kentucky have successfully reduced the number of pill mills in their respective states, these policies have done nothing but push abusers and their suppliers out to other regions. Sadly, pill mills are beginning to move north and out west to areas were access to prescription strength pain killers for non-medicinal use were previously limited.
A number of officials, including state attorney generals, members of Congress, and DEA and FDA representatives, have recommended several national policy measures that would restrict access to drugs for abusers. First, programs educating individuals of the addictive properties of these drugs must be available, and required, for doctors and patients. According to various organizations and agencies working on the issue, prescription drug abuse is dangerous due to public perception. There is a widespread assumption that because these drugs are legally obtained from doctors, they are safe for consumption and not addictive. Education and an uniformly well trained medical staff acts as the front line in detecting fraudulent claims from patients who need medication for chronic pain.
Second, law enforcement agencies must work in tandem to track and arrest suppliers and be given the capability to arrest both abusers and doctors who provide prescriptions. Using Florida as a model, law enforcement can find success by facilitating cooperation between federal, state, and local law enforcement officers through “strike forces” that specialize in intercepting these transactions. At risk communities should also be integrated into local efforts, not targeted by enforcement officers. For example, Seattle found measurable success by building a positive relationship between Native American communities and local police force by catering to the needs of the specific communities.
Lastly, these groups must be given proper training and technical assistance in tracking the movement of large quantities of drugs. An national electronic database, or PDMP, can provide real time updates on drug movements while effectively deterring theft or abuse by restricting access points. Tracking drugs by unit, rather than lot, increases notification of stolen, tampered or misplaced goods. Some states currently have implemented similar drug monitoring programs, but little work has been done to incorporate these efforts with neighboring states and enforcement agencies. A nation wide drug database, while helpful, also raises concerns over security issues like many other health IT initiatives. Can this national database enforce measures of public safety without having to sacrifice patient privacy? Without protections in accordance to HIPAA regulations, advocates of drug monitoring programs will find it hard to find consumer and congressional support.
While people are needed to work the front lines, Congress must step up to the plate and close the loop holes that allow the proliferation of these abuse enterprises. These holes, such as the legality of pain clinics and mail order pharmacies, work to exploit the healthcare system. Mail order or online pharmacies may be convenient however, they create a number of opportunities for consumers to purchase drugs without legitimate medical claims. The recently proposed Safe Doses Act may reduce the incentive to commit crimes associated with prescription drug abuse, but it does little to address the physicians who over-prescribe in the first place. Proposed legislation must find a careful balance between restricting over-prescribing physicians and safeguarding drug access for patients with legitimate needs. As a nation, our response to this crisis is not enough or fast enough. Unless we can fight the issue from all fronts to cut off the head, this problem will continue to grow and wreak havoc on communities not yet hit.