Prescription abuse on the rise
Opioid prescribing for acute and chronic pain has been rising dramatically in the United States since the 1990s. In the years from 1997 to 2006, retail sales for morphine, hydrocodone and oxycodone rose 196%, 244%, and 732%, respectively.
Meet Mr. Hawkins
Mr. Hawkins is a 46 year-old who comes to clinic for his first visit since losing his job a year ago. His major complaint is back pain that he describes as “8 out of 10” on his worst days.
Opioid abuse rising too
During a similar time frame, prescription opioid misuse has also been on the rise in the United States. The Substance Abuse and Mental Health Services Administration (SAMHSA) Drug Abuse Warning Network (DAWN) reported that the estimated number of ED visits for non-medical use of opioid analgesics increased 111% from 2004 to 2008 (from 144,600 to 305,900 visits) and increased an additional 29% from 2007 to 2008. The highest numbers of ED visits were recorded for oxycodone, hydrocodone, and methadone, each of which showed statistically significant increases during the 5-year period.
Client Case: Mr. Hawkins
Mr. Hawkins has had this pain since a car accident during which he was hit from behind (he was a restrained driver) 2 years ago. He was seen in the Emergency Department after the crash but was released, being told that his x-rays were unremarkable.
With death rates tripling
According to the Centers for Disease Control and Prevention, during the most recent decade, the number of drug poisoning deaths involving opioid analgesics more than tripled from about 4,000 in 1999 to 14,800 in 2008. Opioid analgesics were involved in more than 40% of all drug-poisoning deaths in 2008, up from about 25% in 1999.
Client Case: Mr. Hawkins
Mr. Hawkins’ pain is described as a “dull ache” in the central lumbar area and is worsened by any type of bending or lifting more than 10 or 15 pounds. He also notes that if he stands or walks more than about 20 or 30 minutes, he has to stop due to the pain. He occasionally has a sharp pain that radiates from his back to his buttocks but this doesn’t happen very often. He takes ibuprofen with only minimal relief but has not tried other medications.
Indiana State Legislature Takes Action…
To directly address the problem of controlled analgesic overprescribing, the Indiana State Legislature passed a new resolution that took effect on December 15, 2013, known as the Title 844 Medical Licensing Board of Indiana Emergency Rule. This action allows the Attorney General’s office to move more quickly in taking enforcement action against practitioners who overprescribe and obtain records for investigation. As a result, new guidelines for the ongoing care and documentation of this care, have been mandated. A summary of the requirements are included in First Do No Harm.
First Do No Harm should REQUIRED READING for anyone who writes pain medications for any reason.
Also, see Bitterpill.in.gov for more information on prescription drug abuse.