Emerging public health issue: Prescription Overdose
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Injury is the leading cause of death among children and adults up to age 44 and is the leading cause of potential life lost before age 65 (Healthy States, 2007, p. 3). In 200, more than 120,000 Americans of all ages died from injuries from motor vehicle crashes, suicide, falls, poisoning, drug overdoses, drowning, fires and other causes (Centers for Disease Control and Prevention [CDC], 2006) while more than 20,000 persons in the United States die from drug overdose. Because of its impact on the health of all Americans--young and old--preventing injury is a serious public health challenge. As recent tragedies shine the spotlight on accidental drug overdoses, it’s becoming increasingly clear that prescription drugs are playing an increasing role in accidental deaths (Kelley, 2009, p. 24).
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Emerging public health issue: Prescription Overdose
- 1. By Tosin Ola July 6, 2009
- 2. Prescription Drug Overdose Injury is the leading cause of death across all ages Accidental injuries produce the 5th highest mortality in Americans Prescription drug overdose (PDO) occurs when people take excessive amounts of prescribed drugs or mix prescriptions with other drugs PDO deaths have increased past all other illegal drugs combined.
- 3. Unintentional Drug Overdose Are accidental Are not suicides or homicides Involve recreational drug use Mixing prescribed drugs with illegal drugs Using drugs from that are prescribed for someone else Obtaining narcotics fraudulently Doctor shopping
- 4. Current Legislation: PDMPs State Prescription Drug Monitoring Programs (PDMP) Interstate Exchange of PDMP data Model Interstate Compact
- 5. Current Legislation: Doctor Shopping State Doctor Shopping and Prescription Drug Statutes provide guidelines on Doctor’s prescribing Pharmacies dispensing Emergency dispensation Misuse, forgery, fraud and misrepresentation
- 6. Current Grants and Funding These grants help fund state PDMP programs National All Schedules Prescription Electronic Reporting Act of 2005 (NASPER) Harold Rogers Prescription Drug Monitoring Program
- 7. Drug Monitoring Agencies National Alliance for Model State Drug Laws Office of Diversion Control, Drug Enforcement Agency U. S. Department of Justice, Integrated Justice Information Systems (IJIS) Association of State and Territorial Health Officials (ASTHO) Centers for Disease Control and Prevention National Center for Injury Prevention and Control (NCIPC)
- 8. Needed Legislation: Federal Drug enforcement on the internet Cooperation with HIPAA and privacy laws
- 9. Needed Legislation [cont.] Community awareness/education Increased funding for drug abuse/detox programs Cooperation with agencies across the border i.e. Mexico/Canada
- 10. Needed Legislation: State Oregon needs implementation of PDMP system Prescribing physicians need more training and oversight Stricter laws around dispensation
- 11. Although local, state and national agencies have taken steps to reduce prescription drug overdose, additional key policies and legislature must be enacted. Public health education should be initiated to decrease the number of deaths associated with accidental drug overdose.
- 12. Bernstein, M. (2009, March 31). Prescription drugs top Oregon overdose stats. The Oregonian, p. 1.3. Centers for Disease Control and Prevention. (2006). National Vital Statistics System - Mortality data [Data file]. Available from CDC Web site: http://www.cdc.gov/nchs/deaths.htm Getty Images. (2009). Keyword search: yellow pill bottles. Retrieved July 6, 2009 from http://gettyimages.com Healthy States (2007). Public health issues: prescription drug overdose. Retrieved July 2, 2009, from http://www.healthystates.csg.org/ Kelley, A. (2009). Accidental overdoses from legal drugs. Council of State News Magazine, 4(11), 24-28. U.S. Department of Justice, Drug Enforcement Agency (2008). Questions and answers on State prescription drug monitoring programs. Retrieved July 4, 2009, from http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm#3
Editor's Notes
- Injury is the leading cause of death among children and adults up to age 44 and is the leading cause of potential life lost before age 65 (Healthy States, 2007, p. 3). In 200, more than 120,000 Americans of all ages died from injuries from motor vehicle crashes, suicide, falls, poisoning, drug overdoses, drowning, fires and other causes (Centers for Disease Control and Prevention [CDC], 2006) while more than 20,000 persons in the United States die from drug overdose.Because of its impact on the health of all Americans--young and old--preventing injury is a serious public health challenge. As recent tragedies shine the spotlight on accidental drug overdoses, it’s becoming increasingly clear that prescription drugs are playing an increasing role in accidental deaths (Kelley, 2009, p. 24).
- Deaths from prescription drug overdoses have increased to the point where they exceed deaths from heroin, cocaine and other illicit drugs combined, and most are accidental (Kelley, 2009, p. 25). In Oregon, prescription drug overdoses accounted for the most drug-related deaths last year, with methadone the leading cause (Bernstein, 2009, p. 1). Unintentional deaths are not suicides or homicides and usually occur when individuals take excessive amounts of prescribed drugs or mix prescriptions with illegal drugs. Unintentional overdoses can also occur when people use narcotic pain medications in their family medicine cabinet recreationally, unaware of the dangers involved or trusting that FDA-approved prescription drugs are safe for anyone to use (J. Shaw, personal communication, June 30, 2009). But the consequences can be tragic. Still many times, unintentional overdose deaths involve individuals who obtain the drugs through fraudulent means (Kelley, 2009, p. 28). An example is doctor shopping, where addicts and drug dealers buy pills from multiple doctors, usually by faking ailments or medical records (J. Shaw).
- The following policies are in place to curb PDOs.State Prescription Drug Monitoring Programs (PDMP): The ultimate purpose of PDMPs as implemented at the state level is to reduce the abuse of controlled pharmaceutical substances, either directly or indirectly by regulating prescribing and dispensing behavior (J. Shaw, personal communication, June 30, 2009).Interstate Exchange of PDMP data: Since addicts might cross state lines to get access to prescription drugs, this legislation allows disclosures and reporting of dispensed drugs in border states to be available to law enforcement, courts, public health departments, health oversight organizations, and treatment facilities for review provided certain conditions are met (US Department of Justice, Drug Enforcement Agency [DEA], 2008).Model Interstate Compact: The National Alliance for Model State Drug Laws has drafted a Model Interstate Compact to assist states in their efforts to share prescription information across state lines (Healthy States, 2007, ¶ 13).
- Even with the advances in prescription tracking programs, only a few states are working to develop a system to share information among states. Information sharing could be important, especially when it comes to doctor shoppers— those patients who shop for prescriptions from multiple doctors, often in bordering states where no prescription program exists, according to the U.S. Drug Enforcement Administration (Kelley, 2009, p. 25).State Doctor Shopping and Prescription Drug Statutes provide guidelines to doctors on prescribing narcotics and to pharmacies on dispensing the drugs. Prosecution for fraudulent misuse, forgery, misrepresentation and emergency dispensation rules are covered under these statutes (Healthy States, 2007, ¶ 5).
- National All Schedules Prescription Electronic Reporting Act of 2005 (NASPER): The act creates a grant program for states to create prescription drug monitoring databases and enhance existing ones (US Department of Justice, Drug Enforcement Agency [DEA], 2008, ¶ 14).The Harold Rogers Prescription Drug Monitoring grant program provides financial assistance to state authorities who want to create or enhance a prescription drug monitoring program (DEA, 2008, p. 2).
- Several organizations and agencies are monitoring and protecting the laws and statutes against illegal prescription drug use and prescription drug overdose. These include but are not limited to,;National Alliance for Model State Drug Laws: NAMSDL assists states with efforts to address to diversion of, abuse of, misuse of, and addiction to prescription drugs (Healthy States, 2007). Office of Diversion Control, Drug Enforcement Agency U. S. Department of Justice, Integrated Justice Information Systems (IJIS): IJIS is developing a system for the interstate exchange of prescription drug monitoring program data (DEA, 2008, p. 2).Association of State and Territorial Health Officials (ASTHO): ASTHO assesses the knowledge, response, and planning regarding prescription drug misuse and overdose.Centers for Disease Control and Prevention National Center for Injury Prevention and Control (NCIPC): CDC’s Injury Center functions as the focal point for the public health approach to preventing and treating injuries, a paradigm that enriches the entire injury field (CDC, 2006).
- Although the federal government and oversight agencies have instituted programs to help curb this growing health problem, several key areas still need to be addressed. Drug enforcement on the internet: As the state laws get tighter around dispensation, many people will resort to buying drugs online on the internet (Bernstein, 2009). This is very hazardous, not only because the quality of the medications cannot be ascertained, but also because there is no way to control the dispensation of these narcotics (J. Shaw). Tighter laws and enforcement need to address online drug vendors. Cooperation with HIPAA and privacy laws: Proponents of the Health Insurance Portability Act and privacy laws argue that allowing states and agencies to track drug prescription and dispensation violate the privacy of patients (J. Shaw). Having an organization that acts as a liaison between HIPAA and PDMPs will enhance the ability to track violators of the drug system while at the same time protecting and privacy of all patients in the system.
- Community awareness/education: Public health departments need to increase the education surrounding prescription drugs (J. Shaw). Many people have narcotics sitting in the medicine cabinet and this has shown to be dangerous. Teens and young adults have died after using their parents’ or friends’ prescriptions (Bernstein, 2009). Encouraging proper disposal of unused narcotics and public education could stymie this issue. Increased funding for drug abuse/detox programsCooperation with agencies across the border i.e. Mexico/Canada: The laws in US border countries are lax concerning narcotics, especially in Mexico. US citizens can visit a physician in Mexico and get a script for narcotics which they can purchase abroad and bring to the US (J. Shaw). In addition, many of the drugs sold online come in from Canada or Mexico. Increasing the cooperation and oversight on the drug trade in border countries can help the US find and eliminate drug traffickers (DEA, 2008).
- Oregon needs implementation of PDMP system: Although Oregon received the Harold Rogers Grant in 2006 to initiate a state PDMP system; as of the end of last year, there has been no implementation (Bernstein, 2009, ¶ 15). Meanwhile, in 2008, over 200 people have died from prescription drug overdose in Oregon alone (Bernstein, ¶ 11). Further intensity should be applied to get the state PDMP system up and running. Prescribing physicians need more training and oversight: Most prescription drug overdoses are legally prescribed by doctors. To health advocates, this shows that doctors practicing as pain-management specialists need more training and more oversight from the state medical board (J. Shaw).
- The consequences of uncontrolled prescription drug use can be extensive and wide ranging. As shown by the recent death of Michael Jackson, no one is immune from the negative effects of prescription drug use. With over 20,000 deaths last year alone from unintentional drug overdose, this problem is quickly becoming a health epidemic (Healthy States, 2007). Unchecked, the ramifications of prescription drug use has physical, emotional, and financial consequences that can impact the lives of individuals, their families, and society. Further legislation, funding, policies and oversight needs to be provided by federal, state and local agencies and public health departments to curb the rampant misuse of prescribed drugs.