Fighting the American Prescription Drug Problem - Matt Sandlin

As a child, I distinctly remember the days we would have a guest speaker that would come and educate us about the dangers of illegal drugs. The police officer described many different substances, and scenarios, and warned us against the consequences of succumbing to “peer pressure”, and using illegal drugs. My idea of a “dangerous drug” was anything that wasn’t given to someone by their doctor, or parents. The drug problem in America has taken on a new face, as drugs that were considered problematic in my youth (crack, cocaine, etc) have taken the back-seat with the rise in prevalence of the abuse of opioid pain medicines. I believe that with the employment of specific techniques, and installment of proper laws and regulations, we as a nation can dramatically decrease the misuse of these medications.

An “opioid” analgesic (hydrocodone, morphine, codeine, oxycodone, etc) is a class of medicine that binds to opiate receptors throughout the body, and sends signals to the brain that causes pain to be blocked, breathing to be slowed, and the increased release of the neurotransmitter dopamine (How do opioids work in the brain?, 2002). This class of medicine has many legitimate uses including post-surgical pain, palliative care, treatment of acute injuries, but has become widely abused because of the euphoria experienced with the rapid release of dopamine. What makes this type of drug even more dangerous is the addictive nature of the substance, and the misery of withdrawal.

I believe the first step in reducing the problem is to enact proper legislation that requires all states to place in effect a prescription drug monitoring system (PDMS). Multiple studies have shown a decrease of prescription drug overdoses on a per-state basis when PDMS’s are enacted (EPIDEMIC:RESPONDING TO AMERICA’S PRESCRIPTION DRUG ABUSE PROBLEM, 2011). This is a very useful tool we use on a regular basis in the Emergency Room when we suspect drug seeking behavior from a patient. PDMS’s enable physicians to see in real-time a list of scheduled drugs that the patient has filled recently, the dates filled, prescribing physician, and pharmacy. If every state had a way to monitor the prescriptions, and this was a known fact among the general public, it would dramatically decrease instances of “doctor shopping” both prophylactically and in practice. As of 2011, 35 states have enacted a prescription monitoring system, which is funded jointly by the federal and state governments (EPIDEMIC:RESPONDING TO AMERICA’S PRESCRIPTION DRUG ABUSE PROBLEM, 2011).

If you’ve traveled the interstates of Tennessee, Georgia, or Florida in recent years, odds are you’ve seen billboards for pain clinics or pain management centers. Pain clinics exist to treat chronic pain conditions, but are becoming part of the problem as they are not properly regulated. I believe that pain clinics should be physician owned for the simple reason of keeping it legitimate. Several cash-only pain clinics are opened by non-physicians with the sole intention of making quick money, and by the sheer amount that are up and running, business seems to be booming. The state of Florida has been considered by many to be one of the easiest places to obtain narcotic pain medicines, and has attracted patients from many neighboring states because of this. In 2009 Florida practitioners are reported to have ordered 41.2 million oxycodone pills, a staggering amount when compared to the 4.8 million total pills purchased from practitioners from the other 48 states (Leinwand, 2011). Many pain clinics dispense medicines on-site, which in my opinion should be made illegal, because doing this gives pain clinic physicians incentive to prescribe more, thus make more money. If pain clinics could no longer dispense medicines on site, it could no longer be used as an extra venue for the clinic to use to make more money.

I believe that if we wish to decrease the prescription abuse problem, we must go to the root of the problem, and punish any physician or pharmacist found to be operating in negligence. Under the circumstance that a physician or pharmacist is found to be guilty of non-compliance with regulations, I believe they should be subject to fines, jail time, and possibly the permanent revocation of their license. I’ve read several news articles recently pertaining to the “crack down” on pain clinics in Florida, and see that many physicians and pain clinic owners that have been found operating in negligent ways are being brought to justice, and I find this encouraging.

The prescription abuse problem in America is definitely a multifaceted dilemma, and must be dealt with on many levels. I understand that opioid pain medicines are an essential part of medicine, and thousands of patients with legitimate pain issues benefit from pain management programs. Keeping this in mind, I believe by taking calculated steps as a nation, we can combat “pill mills”, and the prescription abuse problem, all the while reserving this powerful medication for those that truly need it.

Works Cited

How do opioids work in the brain? (2002). Retrieved January 29, 2012, from The National Alliance of Advocates: http://www.naabt.org/faq_answers.cfm?ID=6

EPIDEMIC:RESPONDING TO AMERICA’S PRESCRIPTION DRUG ABUSE PROBLEM. (2011). Retrieved January 29, 2012, from Whitehouse.gov: http://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/rx_abuse_plan.pdf

Leinwand, D. (2011, Febuary 24). Florida raids target sellers of pain pills. Retrieved January 29, 2012, from USA Today: http://www.usatoday.com/news/nation/2011-02-23-pill-mill_N.htm