One state’s stand against prescription drug abuse:
On January 1, 2001, the Joint Commission – an organization that monitors the quality of hospitals and other healthcare facilities – launched a pain management campaign that mandated healthcare providers evaluate and assess all complaints of pain. With this regulatory emphasis, pain was treated aggressively and the prescribing practices of physicians were drastically changed. Into this new world, stepped pharmaceutical companies with newer, more potent narcotic analgesics to assist physicians meet the pain relief needs of patients (oxycontin anyone?). At about the same time, there was literature showing that addiction to narcotics prescribed for acute pain was very rare; and this mindset has made its way into the lay websites and publications. Unfortunately there is a difference between addiction and abuse and while users may not be addicted, the desire to get high is a powerful one. These factors and others created a perfect storm; the abuse of prescription medications is now an ‘epidemic’ according to the CDC.
This epidemic is driven by prescribing practices in response to the perception of the Joint Commission mandate that all pain must be treated aggressively and effectively. Prescriptions written for narcotic pain medications have increased 4-fold since 1999. This increased supply has led to 15,000 deaths in 2008, more than those caused by heroin and cocaine combined. Multiple organizations including the CDC, state and local health departments and organized medicine groups are working on policies and guidelines to restore balance on the assessment and treatment of pain, but limit the availability of narcotics through the prescribing process.
One state that is well ahead of the other 50 in terms of physician prescribing guidelines is the state of Washington. In the CDC vital signs snapshot on prescription drug abuse, it was highlighted that Washington has one of the highest rates of narcotic prescribed and a high death rate due to prescription pain medication abuse.
Prescription pain killers by state population:
Prescription painkiller overdose deaths:
A guideline collaboratively created by multiple organizations expressly for the emergency department use of narcotics in pain management in response to new laws and these statistics. This guideline has 17 bullet points and seeks to educate physicians on a new law that limits narcotic prescription writing and that all pain must be assessed, but the treatment of pain –especially chronic pain — is a multidisciplinary responsibility and it is appropriate to coordinate care with other providers and to limit the amount of narcotics prescribed. To create such a guideline and still meet the needs in the treatment of their pain was not doubt a time-consuming endeavor and I applaud their efforts to curb this epidemic in their state while still meeting the needs of assessment and treatment for patients in pain.
So what about Illinois?
Here in Illinois, for the past few years, prescribing providers have had access to the Illinois Prescription Monitoring Program. A similar program was just launched this year in Washington. This database allows qualified medical professionals to see what prescriptions for painkillers have been filled, the dates filled and which healthcare provider wrote the prescription. When I am in the emergency department, I look up almost every patient with the need for possible narcotics for pain relief. Most often I will find that no prescriptions have been written in the past year or more, but occasionally, I will see several dozen narcotic prescriptions written by multiple physicians over a 1-2 year period for a single patient. I am hesitant to write for narcotics for someone who just filled a prescription for 90 tablets 2 weeks ago. I think most other physicians who use the database are too. What is the net effect of a prescription monitoring program like this?
I think this quote from the CDC says it all:
“Some states have a bigger problem with prescription painkillers than others.
- Prescription painkiller sales per person were more than 3 times higher in Florida, which has the highest rate, than in Illinois, which has the lowest.”
Best wishes for a healthy and safe 2012. Till next Tuesday,