Prescription narcotics (or opioids) are inadequately regulated in our nation. Without coordinated action among the health professions and a new framework of federal law, millions of residents of all ages will lose their futures to addiction. Many thousands will lose their lives.
In 2009, 22 million Americans age 12 and older used drugs illicitly. Marijuana was the most frequently used substance (16.7 million users). Prescription drugs, especially narcotics, were used for non-medical purposes by 7 million.
Among teenagers, recreational use of prescription painkillers exceeded that of marijuana. Most teens first obtain their drugs from relatives or friends. Misuse of prescription opioids has steadily risen in rural and economically depressed areas of the South and Midwest. Tennessee ranks almost 50 percent above the national average in narcotics prescriptions per capita.
A generation ago prescription narcotics were under-utilized. Physicians feared the risk of habituation among their patients. They worried about sanctions from state boards if they were seen to prescribe these drugs excessively.
In the 1990s this pattern began to change. Patients with malignancies and other chronically painful conditions were deemed legitimate candidates for long-term opioid therapy. Pain-management grew into a respected medical specialty. Usage progressively increased. Worries of addiction faded.
At the same time that prescribing habits changed, more potent, longer-lasting pain suppressers entered the marketplace. In addition to relieving pain, these drugs create a euphoria or “high.” Maintenance of the high requires steadily larger doses of medication. Some patients found themselves addicted after short-term use of a prescribed opioid.
Many physicians became careless, prescribing powerful pain-relievers inappropriately and with little thought of addictive risks. A few corrupt physicians set up “pill-mills” in states with little regulation of narcotics. Florida became a destination for pill merchants who would load their suitcases with fraudulently obtained pills which they would resell at great profit in their hometowns.
In 2005 an estimated 20,000 deaths resulted from drug overdose. This represented a doubling from 1999. West Virginia witnessed a five-fold increase in drug mortality rates during this interval. Opioids were the most commonly implicated drugs. Low-cost methadone was atop the list.
The cost of drug overdose and addiction is substantial. Related health care costs and lost productivity cost at least $10 billion yearly. The value of destroyed lives and dreams cannot be calculated.
Fixing this epidemic requires federal legislation. If a single state has lax drug laws, users and criminal merchants will simply flock to it. Until the implementation of stricter laws in April, Florida was a narcotics haven.
We need an electronic data base that tracks doctors, pharmacists and users so that excessive use can be identified and criminal activity thwarted. Critics of a legislative solution contend this interferes with the doctor-patient relationship and invades individual privacy. Many states already have such legislation in place. Properly constructed, a data base can protect privacy and not interfere with the appropriate use of these drugs.
The education of physicians and dentists must be addressed. Lax habits of prescribing potentially addictive medications can be countered by required, annual updates in the appropriate use of these drugs. Training programs for health care professionals must emphasize risks as well as benefits of opioids.
Education, beginning in elementary school, is vital. Careless and wrongful use of prescription drugs must be emphasized with the same vigor as campaigns against tobacco use and illegal drugs such as methamphetamine and cocaine.
Before each of us is offered a prescription for pain we should inquire if there is a risk of addiction and if there are safer alternatives such as physical therapy or acupuncture.
We can either address this continuing calamity or we can ignore it and, thereby, write off the lives of millions of our fellow citizens.
Contact Clif Cleaveland at Cleaveland1000@comcast.net.