With the FDA recently reporting about the rescheduling of hydrocodone combination products to CII, it brings attention to a topic that is an increasing problem: prescription drug abuse. In 2011 alone, the Centers for Disease Control and Prevention (CDC) reported that “about 1.4 million emergency department visits involved the nonmedical use of pharmaceuticals,” with many of the medications reported as anti-anxiety, insomnia, and benzodiazepines.1 The CDC also reports that prescription opioid abuse costs the US around $55.7 billion annually in lost productivity, healthcare costs, and criminal justice costs.1 In Missouri, health care providers are writing 95 pain killer prescriptions per 100 people, which in relation to the rest of the US, is average.1 Even more disturbing, in 2010, one in every 20 people over the age of 12 reported using prescription painkillers without a medical need.
Prescription drug abuse affects people of all ages, and is something that is difficult to predict. A survey conducted in 2010 by the Substance Abuse and Mental Health Services Administration (SAMHSA) concluded that people ages 12-25 years report the highest incidence of nonmedical prescription drug use.2 The same survey showed that “2.7% of 8th graders, 7.7% of 10th graders, and 8.0% of 12th graders had abused Vicodin.”2 While this might contribute to the argument that the rescheduling of hydrocodone products will eliminate this problem, the SAMHSA survey also has some statistics about OxyContin, which currently has the same CII scheduling that hydrocodone containing products will occupy; in fact “2.1% of 8th graders, 4.6% of 10th graders, and 5.1% of 12th graders” had experimented with OxyContin according to the 2010 survey.2 This may indicate that the scheduling of these medications does not limit access as it should.
A review of five states (California, Illinois, New York, North Carolina, and Texas) conducted by the Government Accountability Office in 2006 and 2007 “found 65,000 instances of Medicaid beneficiaries improperly obtaining potentially addictive drugs at a cost of about $63 million.”2 The same survey also found thousands of instances in which prescriptions were written for patients that were dead or were called in by people posing as prescribers.2 One area where rescheduling hydrocodone products may help is prescription fraud. As a CII, prescribers and nurses may no longer call in prescriptions for hydrocodone products, and handwritten prescriptions must be brought into the pharmacy in order to be filled. Patients may also be “locked-in” with pharmacies in order to be sure patients do not fill prescriptions at multiple locations however, “doctor-shopping” may still occur; and without a prescription drug monitoring program, the full extent of abuse may not be recognized.
Prescription Drug Monitoring Program
49 out of 50 states in the United States have implemented an operational Prescription Drug Monitoring Program (PDMP); Missouri is the last state withholding from the national movement of creating a program that would make illicit use and abuse of controlled substances much more difficult. The aim of a PDMP is to help with the legitimate prescribing of controlled substances, to prevent diversion and/or abuse, and to identify public trends in use and abuse of controlled prescriptions.3 Having a state-wide system that logs dispensed controlled substances allows for prescribers and pharmacists alike to have knowledge of their patients’ filling habits, and would also allow for suspicious activity to be checked by health professionals. The fact that Missouri is alone in having no operational PDMP makes us susceptible to illegal activity within our own borders; it also creates access for patients crossing state-lines to take advantage of the lack of oversight. Although many of the opponents of a PDMP fear the invasion of privacy that a logging system imposes, the implications of increased drug abuse and misuse and the need to continue the legitimate prescribing of medications used in chronic pain should impede those fears.
Without a PDMP in place, physicians and pharmacists lack information that would help the fight against prescription drug abuse, and patients who use those same medications for a legitimate purpose are scrutinized because of controlled substance use. Missouri needs to take a step in the right direction, and join the rest of the nation by putting a PDMP in place to put a damper on prescription drug abuse.
Jennifer Richter, PharmD Candidate 2015
University of Missouri – Kansas City, MU site
MPA Rotation Student, August 2014
- Centers for Disease Control and Prevention. Prescription drug overdose. http://www.cdc.gov/homeandrecreationalsafety/overdose/index.html. July 3, 2014. Accessed August 27, 2014.
- Kirschner N, Ginsburg J, Sulmasy LS. Prescription drug abuse: executive summary of a policy position paper from the American college of physicians. Annals of Int Med. 2014; 160(3) 198-213.
- Drug Enforcement Agency. Prescription drug monitoring program: questions and answers. http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm. October 2011. Accessed August 28, 2014.