Healthcare / Medicaid / Politics

Lock In Drug Abuse

“I looked at that menu, and I just couldn’t control myself!” How many times have you walked into a restaurant planning to order a salad but instead got a whopping 2,000 calorie steak meal? We’ve all faced shortages of self-control, trading in short-term gain for long-term strain. Choosing the inferior food option is only one bad choice out of many: staying up late, procrastinating on work and not exercising. How could people be so impulsive?

Researchers and pharmaceutical companies have proposed a solution for those who need to focus better on their goals. For individuals who have a tough time concentrating and being motivated, Adderall has been prescribed. Adderall makes living with an inclination towards impulsivity, Attention Deficit Hyperactivity Disorder (ADHD), easier for those who use it as prescribed.

The problem arises when lack of oversight makes it easy for people, especially teens and college students, to take it illegally. Young adults can go doctor shopping which allows them to find a doctor who will prescribe them what they want. Because the drug releases dopamine in the brain, a strong risk exists to developing an addiction.

Individual colleges report abuse rates as high as 43 percent! This gives college students an edge over their peers and an ability to cram a lot in a short period of time.  Students who fake symptoms to get a prescription or those who buy illegally are putting their lives at risk, however, and more attempts need to be made to curb access to these drugs.

Kevin Brady recently introduced a bill, the Protecting Integrity in Medicare Act of 2014, designed to help Medicare drug plans reduce fraud. The bill introduced by Brady would restrict the abuse of prescription drugs, allowing the drug plans to “lock in” suspected abusers to a single doctor and pharmacy for pain medications.

In the past, beneficiaries who abused drugs would have generally filled their prescriptions at multiple pharmacies with hopes that the doctor or pharmacy would not question them. Drug plans can detect this sort of activity, but Medicare drug plans have lacked the authority to prevent this abuse. It is bills such as these that can prevent fraud that leads to the waste of resources and loss of lives.

Richard, a college student awarded a full academic scholarship to Greensboro College in North Carolina, obtained a prescription even though according to his parents, Richard had no psychiatric history or even suspicion of problems through college.

Richard’s friends shared about his drug abuse behaviors, “He would just procrastinate, wait ’til the last minute and then take a pill to study for tests,” said Ryan Sykes, a friend. “It got to the point where he’d say he couldn’t get anything done if he didn’t have the Adderall.” With time, doctors gave Richard more positive diagnoses and prescriptions for Adderall. Richard’s behavior became more erratic. He lost jobs, and tensions with his parents remained high. He developed paranoid lines of thought. When he took 60 mg of Adderall, he committed suicide and left no note.

We are individuals free to make choices, so shouldn’t we be in control of ourselves at all times? Couldn’t Richard have made the decision to do his homework on time and not have to take an addicting stimulant like Adderall? Well the answer to that is “no,” we can’t always have the willpower to act, and our health care law needs to detect and prevent abuse of drugs.

Bills, such as the one that Brady introduced, will set the stage for how we should prevent medication fraud and tragic deaths. Restricting drug prescriptions for those who have clear abuse problems is an important first step. For Richard and other college students who have clear problems, policy changes that affect the availability of cocaine-like stimulants-are imperative.

Currently, 46 state Medicaid agencies operate these programs, and 49 states have enacted prescription drug monitoring legislation. The United States Department of Health and Human Services, the Center for Disease Control, the Centers for Medicare & Medicaid Services, the Government Accountability Office and the Office of National Drug Control Policy have all called for a “Lock-In” program, in Medicare, in one form or another.  For those who have not mastered this personal journey of self-control, policy can play a role. Policy can create the environment in which an individual can flourish.