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How to combat prescription-drug abuse

Long-acting prescription opioids (e.g., Oxycodone, Hydrocodone) are powerful clinical tools in some cases but a curse in others. As prescriptions for these medications have increased more than tenfold in the past 12 years, many people in pain have gotten relief, sometimes for the first time since their illness struck. But the abuse of such medications has also increased, to the point that overdosing on prescription opioids will probably be the most common cause of accidental death in the U.S. this year (surpassing gunshot wounds and car accidents).

My home state of West Virginia has been particularly hard hit, and now leads the nation in overdose death rates. At the invitation of Senator Daniel Foster, MD, (a Stanford alum) and Delegate Don Perdue (a pharmacist), I returned home last week to testify in both houses and brief Governor Earl Ray Tomblin on how the state could respond. These were my key points:

  • More than once a week, a West Virginian dies of a drug overdose while holding prescriptions from five or more providers. This implies that West Virginia must strengthen its prescription monitoring system to better identify doctor shopping as well as to catch the extremely small number of providers who are engaging in criminal conduct.
  • Putting pain-pill addicted people who commit petty crimes (e.g., doctor shopping, disorderly conduct, petty theft) into prison is a mistake. A new generation of community supervision programs has shown that many drug-involved offenders can be placed in programs that help them stop drug use while keeping the community safe, at far lower cost than prison.
  • Naloxone, an opiate antagonist that temporarily reverses the effects of opioids, should be made available to every public health and public safety professional who is likely to encounter people in overdose (e.g., highway patrol officers, fire fighters, homeless shelter staff).
  • Expanding addiction treatment is both the right thing to do and a cost-effective investment. Washington State found that its Medicaid program actually saved money when it expanded treatment because people with untreated addictions otherwise are frequent users of emergency rooms.
  • Prescription drug “take back events” can be valuable. At a small town in Arkansas I visited last year, a sheriff held a 5-hour event in a mall parking lot, during which 50,000 pills were turned in by local residents. That was twice as many pills as the town had people. These events are also an opportunity to create a broader public perception that unused medications are not safe enough to simply leave lying around or to give away to friends and relatives.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington.

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