Category Archives: Prescription drugs
Later this week a final rule goes into effect from the U.S. Drug Enforcement Agency (DEA) aimed at reducing the misuse of controlled substances. The new rule will allow pharmacies and other approved outlets to accept unused controlled substances from people who want them out of their home so they can’t be abused by people with no medical need for the medications.
Previously, the drugs could only be disposed of at home, brought to a law enforcement agency or brought to one of two annual community “take back” days that the DEA started in 2011. Unused drugs are often found in homes because physicians typically prescribe thirty days’ worth of painkillers after surgery or illness, which can lead to addiction or to the drugs being left in home medicine cabinets where they are ripe for misuse.
Under the rule, certain outlets (including manufacturers, distributors, narcotic treatment programs, retail pharmacies and hospitals/clinics with an on-site pharmacy) can apply to the DEA to become authorized collectors. The public can find authorized collectors in their communities by calling the DEA Office of Diversion Control’s Registration Call Center at 1-800-882-9539.
Experts say the rule is a good start toward getting millions of controlled substances out of the hands of abusers and potential abusers. Data clearly demonstrates the need:
- According to the 2012 National Survey on Drug Use and Health, almost twice as many Americans (6.8 million) currently abuse pharmaceutical controlled substances than those using cocaine, hallucinogens, heroin and inhalants combined.
- Nearly 110 Americans die every day from drug-related overdoses, and about half of those overdoses are related to opioids, a class of drug that includes prescription painkillers and heroin.
- More than two-thirds of people who misuse prescription painkillers for the first time report obtaining the drugs from friends or relatives, including from a home medicine cabinet.
Writing for the Network for Public Health Law blog, lawyer Corey Davis said that while the new rule doesn’t address some key issues—such as who will pay for the returned drugs to be destroyed and whether pharmacies will face any liability if returned drugs are stolen—“it’s an important step forward in drug abuse and overdose prevention.”
Recommended Reading: Some Drugs—Especially Oncology Medicines—Have Been in Short Supply for Too Many Years
Health Affairs and the Robert Wood Johnson Foundation recently released an issue brief on the continuing shortages of certain drugs, most frequently injectable drugs for cancer treatment. According to the issue brief, there have been fewer reports of newly unavailable drugs in the last few years, but problems remain, forcing many patients to skip some treatments or sometimes opt for a less-effective drug. U.S. Food and Drug Administration (FDA) updates on drug shortages in just the first two weeks of September found sixteen injectable drugs in short supply, two of them new to the list.
Recent Government Accountability Office reports have found several reasons for the shortages, including:
- Difficulty acquiring raw materials
- Manufacturing problems
- A loss of drug products when factories are updated and modernized
- Low reimbursement by Medicare and other government payment programs
- FDA regulations that may slow down new drug approvals
The authors of the issue brief say that it is unlikely that Congress will act, and that the industry has and will make changes likely to help bolster some supplies. Also, thorough reviews such as the current issue brief help remind policymakers that some drug shortages remain.
Read the full issue brief.
Michigan, Minnesota, North Carolina and Wisconsin have been tapped to join the second round of the National Governors Association’s (NGA) Prescription Drug Abuse Project, tasked with developing comprehensive, evidence-based statewide action plans to help combat the growing public health problem. Nevada Gov. Brian Sandoval and Vermont Gov. Peter Shumlin will lead the project, with their states also taking part.
Over the next year, the states participating in the project will accomplish the following:
- Attend two, two-day meetings with other policy academy states;
- Host an in-state workshop coordinated by NGA Center for Best Practices staff;
- Develop a strategic plan for reducing prescription drug abuse;
- Participate in regular conference calls and other meeting activities; and
- Receive state-specific technical assistance from NGA staff and national experts.
“We are united by a common goal to reduce prescription drug abuse,” said Sandoval, in a release. “Bringing states together will help each of us learn ways to combat this growing problem. It is an honor to serve as co-lead on this timely and important issue.”
“Communities across the country continue to be affected by the abuse of prescription drugs,” added Shumlin. “That is why this initiative remains so important for governors. As the leaders of our states, our primary concern is for the health and safety of our citizens.”
According to the U.S. Centers for Disease Control and Prevention (CDC), prescription drug overdose is now the leading cause of death from injury, with approximately 113 U.S. deaths each day and 6,748 people treated daily for misuse or abuse in the nation’s emergency departments (EDs).
Additional data on prescription drug abuse from the CDC includes:
- In 2011, among people ages 25 to 64, drug overdose caused more deaths than motor vehicle traffic crashes;
- Drug overdose death rates have been rising steadily since 1992, with a 118 percent increase from 1999 to 2011 alone;
- In 2011, 33,071 (80 percent) of the 41,340 drug overdose deaths in the United States were unintentional, 5,298 (12.8 percent) were of suicidal intent, 80 (0.2 percent) were homicides, and 2,891 (7 percent) were of undetermined intent;
- In 2011, drug misuse and abuse caused approximately 2.5 million ED visits, with more than 1.4 million of these related to pharmaceuticals;
- Between 2004 and 2005, an estimated 71,000 children were seen in EDs annually because of medication overdose (excluding self-harm, abuse and recreational drug use); and
- Among children under age 6, pharmaceuticals account for roughly 40 percent of all exposures reported to poison centers.
>>Bonus Links: Read more of NewPublicHealth’s coverage of prescription drugs and prescription drug abuse. Below is a selection of our most recent coverage of the public health crisis:
- CDC: Physicians are Fueling Prescription Painkiller Overdoses
- Study: Today’s Drugged Drivers More Likely to Mix Alcohol and Drugs, Have Taken Multiple Prescription Medicines
- New NIH Pain Research Database Could Be a Key Tool in the Fight Against Prescription Drug Abuse
- Saturday is National Prescription Drug Take-Back Day
- Recommended Reading: FDA Approves Handheld Treatment for Prescription Drug Overdose
Inappropriate and dangerous prescription practices for painkillers are driving high addiction and overdose rates—46 people die of a prescription painkiller overdose every day—according to a new Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC).
The CDC has also found wide variation in prescription practices across the country:
- Southern states had the most prescriptions per person for painkillers, especially Alabama and Tennessee.
- The Northeast, especially Maine and New Hampshire, had the most prescriptions per person for long-acting and high-dose painkillers.
- Nearly 22 times as many prescriptions were written for oxymorphone (a specific type of painkiller) in Tennessee than were written in Minnesota.
In total, doctors wrote 259 million prescriptions for painkillers in 2012—or enough for a bottle of prescription pain pills for every American adult in the country.
“Prescription drug overdose is epidemic in the United States. All too often, and in far too many communities, the treatment is becoming the problem,” said CDC Director Tom Frieden, MD, MPH. “Overdose rates are higher where these drugs are prescribed more frequently. States and [medical] practices where prescribing rates are highest need to take a particularly hard look at ways to reduce the inappropriate prescription of these dangerous drugs.”
According to the CDC, deaths from drug overdoses have been rising steadily over the past two decades and have become the leading cause of injury death in the United States—linked strongly to the overuse of prescription painkillers. In 2011, of the 41,340 drug overdose deaths in the United States, 55 percent were related to pharmaceuticals, and almost three quarters of those were from prescription painkillers.
Study: Today’s Drugged Drivers More Likely to Mix Alcohol and Drugs, Have Taken Multiple Prescription Medicines
The profile of a drugged driver has changed substantially since 1993, according to a new study released today in the journal Public Health Reports, which shows that more drivers are now testing positive for prescription drugs, marijuana and multiple drugs.
“While we’ve seen a decrease over the years in motor vehicle fatalities involving people under the influence, the nature of those crashes is changing,” said study author Fernando Wilson, PhD, an associate professor at the University of Nebraska Medical Center.
The study examines trends in the characteristics of U.S. drivers who were involved in fatal crashes between 1993 and 2010 and tested positive for drugs. The study, funded by the Public Health Law Research program of the Robert Wood Johnson Foundation, was set up to investigate the relationship between state laws and the consumption of alcohol and other drugs in fatal car crashes. It found that the percentage of drugged drivers with three or more drugs in their system nearly doubled from 1993 to 2010, increasing from 11.5 percent to 21.5 percent.
“In 1993, about one in eight drivers were using multiple drugs concurrently. By 2010, it was closer to one in five. That’s a large increase in drug use,” Wilson said. “Beyond that, we’re also seeing more and more people using drugs and alcohol together. About 70 percent of drivers who tested positive for cocaine had also been consuming alcohol, and almost 55 percent of drivers who tested positive for cannabis also had alcohol in their systems.”
- Almost 60 percent of cannabis-only users were younger than 30 years.
- Thirty-nine percent of prescription drug users were 50 years old or older, which seems to be in line with an overall increase in the use of prescription drugs by Americans, and the older population in general.
“These trends are likely to continue into the future given the aging U.S. population, an increasing reliance on prescription medications by medical providers and increasing initiatives to legalize marijuana,” said Wilson. “However, it is unclear whether current state policies are completely up to the challenge of addressing the growing issue of drugged driving.”
NewPublicHealth recently spoke with Wilson about the study. He said he embarked on the research because of the tens of thousands of motor vehicle crashes each year and the need to figure out the most effective policies to curb distracted driving. According to Wilson, eighteen states have zero-tolerance laws for drugged drivers, but recent studies suggest that these laws may not be effective enough in decreasing traffic deaths.
A new database on pain research established by the National Institutes of Health (NIH) and several other federal agencies might help practitioners choose more effective and safer options for their patients dealing with pain. It could also potentially reduce reliance on opioid drugs, which often turns patients into addicts and creates an easy source of the drugs for potential abusers.
The database, launched last week, is called the Interagency Pain Research Portfolio (IPRP) and offers information on federal pain research projects. According to the NIH, pain is a symptom of many disorders and can be a disease itself; the economic cost of pain is estimated to be hundreds of billions of dollars annually in lost wages and productivity.
“This database [allows] the public and the research community...to learn more about the breadth and details of pain research supported across the federal government. They can search for individual research projects or sets of projects grouped by themes uniquely relevant to pain,” said Linda Porter, PhD, Policy Advisor for Pain at the National Institute of Neurological Disorders and Stroke (NINDS), part of the NIH.
Both in public speeches and private briefings with reporters, U.S. Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, has called on physicians to find alternatives to narcotics for pain patients when medically advisable, such as guided imagery and other forms of relaxation. He’s also called for starting with less potent medications than narcotics, in order to reduce the chance of addiction and to introduce far fewer amounts of prescription drugs into the community where they are often taken from medicine cabinets by people—especially young adults—for whom they’re not prescribed. According to the Substance Abuse and Mental Health Administration, approximately 22 million people nationwide have taken narcotic pain relievers for non-medical reasons.
U.S. Food and Drug Administration head Margaret Hamburg, MD, also spoke on the subject during a town hall meeting last week on prescription drug abuse, hosted by the Johns Hopkins School of Public Health and the Clinton Foundation. Hamburg said that “we need to recognize that opiates are... probably most often not the treatment strategy of first choice...but it may be the option a provider knows best. We need to actively engage with the scientific research community and industry to try to develop new non-opiate, non-addictive pain strategies...”
This Saturday, April 26, is The National Prescription Drug Take-Back Day, an effort led by the U.S. Drug Enforcement Administration (DEA) for the eighth time in three years to safely dispose of potentially dangerous expired, unused and unwanted prescription drugs.
Last October, Americans turned in more than 647,000 pounds of prescription drugs at more than 4,100 sites operated by the DEA in partnership with state and local law enforcement offices. More than 3.4 million pounds of pills have been collected since the initiative began. The goal is to help reduce the huge cache of prescription pills that pose a risk of poisoning and death for young children, as well as the potential for abuse, overdose and death by the millions of people who take prescription drugs not prescribed for them in an effort to get high.
Every state has put resources into reducing prescription drug abuse in the last few years and recent surveys indicate abuse rates are dropping—though the problem is still significant. The 2013 National Survey on Drug Use and Health produced by the Substance Abuse and Mental Health Services Administration found that that 5.3 percent of young adults used prescription drugs for nonmedical purposes in the past month, similar to rates in several previous years, but lower than 2009, when 6.4 percent of young adults used prescription drugs for nonmedical purposes.
DEA studies show that a majority of abused prescription drugs are obtained from family and friends, often from home medicine cabinets. Contributing to the pileup is the fact that people are advised not to put many drugs in the trash or down the toilet so as to avoid contaminating water supplies and harming animals.
New laws are being proposed in many states to help families and facilities more easily get rid of unused drugs. Health departments in many communities, including the State of Colorado, can refer people to sites that will accept some unused prescription pills—though often not narcotics—at various times of the year for disposal.
In an effort to combat the growing epidemic of prescription drug abuse and overdose, the U.S. Food and Drug Administration (FDA) has approved a small, easy-to-use injector—similar to an EpiPen—that can be used to revive people who have stopped breathing or lost consciousness from an opioid drug overdose. The device, called Evzio, provides a single dose of naloxone, which is the standard treatment for opioid overdoses but up until now was mostly only available in hospitals and other medical settings.
The device, expected to be available starting this summer, will enable early intervention that increases the chances of survival. According to the National Center for Injury Prevention and Control , nationally, sales of prescription painkillers per capita have quadrupled since 1999—and the number of fatal poisonings due to prescription painkillers has also quadrupled.
The FDA’s approval comes at a critical time. In October of last year, Trust for America’s Health released a report that found that a very small number of states are implementing more than just a few promising strategies that have been identified to help combat the widespread drug abuse that continues to increase across the United States. The report, Prescription Drug Abuse: Strategies to Stop the Epidemic, which was funded by a grant from the Robert Wood Johnson Foundation, showed that only two states—New Mexico and Vermont—have implemented all ten strategies. TFAH also released an interactive tool with state-by-state prescription drug overdose death rates and state scores on the 10 key steps to curb abuse.
Carl R. Sullivan III, MD, director of the addictions program at West Virginia University, said the FDA’s approval of Evzio “is a big deal, and I hope [it] gets wide attention,” according to The New York Times. “It’s pretty simple: Having these things in the hands of people around drug addicts just makes sense because you’re going to prevent unnecessary mortality.”
Read the full story from The New York Times.
HHS Will Allow Some to Skip Insurance for 2014 without Penalty
The U.S Department of Health and Human Services (HHS) made some key rule changes to the Affordable Care Act (ACA) late last week. People whose insurance plans were cancelled for 2014 because the plans did not meet the requirements for plans under the ACA — such as covering essential benefits including some preventive care with no copays — will be permitted to buy a “catastrophic” plan which has only minimal coverage or opt for no insurance for the coming year, but pay no penalty. HHS has set up a hotline, 1-866-837-0677, for people whose policies were canceled so they can get advice on coverage for 2014. Read more on the Affordable Care Act.
NIH Study: Drop in Prescription Drug Abuse, Rise in Marijuana Use Among High School Seniors
The percentage of high-schoolers who think using marijuana regularly poses a major risk to health has fallen dramatically in the past 10 years, according to this year’s Monitoring the Future survey, which measures drug use and attitudes among the nation’s eighth-, 10th-, and 12th-graders. Actual rates of marijuana use have also increased among high school seniors, with 6.5 saying they smoke marijuana daily, up from 6 percent in 2003 and 2.4 percent in 1993.
“This is not just an issue of increased daily use,” said NIDA Director Nora D. Volkow, MD. “It is important to remember that over the past two decades, levels of THC — the main psychoactive ingredient in marijuana — have gone up a great deal, from 3.75 percent in 1995 to an average of 15 percent in today’s marijuana cigarettes. Daily use today can have stronger effects on a developing teen brain than it did 10 or 20 years ago.”
Other findings of the survey include:
- For the first time, the percentage of students in all three grades combined who say they smoked cigarettes in the past month is below 10 percent (9.6 percent) compared to 16.7 percent 10 years ago and 24.7 percent in 1993.
- Continued abuse of Adderall, commonly used to treat attention deficit hyperactivity disorder, with 7.4 percent of seniors reporting taking it for non-medical reasons in the past year.
- Five percent of seniors report abuse of cough products containing dextromethorphan, down from 6.9 percent in 2006, the first year it was measured by the survey.
- For cocaine and heroin, while there was no significant change from the 2012 rates, there continues to be a gradual decline in use, with both drugs at historic lows in all three grades.
- Use of alcohol by teens continues a steady decline. For 12th-graders, alcohol use peaked in 1997, with more than half (52.7 percent) reporting drinking alcohol in the past month. Only 39.2 percent of seniors reported past month use this year.
Read more on Substance Abuse.
Earlier Cataract Surgery for Seniors Could Reduce Car Accidents
Researchers at the University of Alabama at Birmingham have found that earlier surgery cataract surgery may reduce car accidents among older drivers by about 16 percent.
Currently, most U.S. insurers cover the surgery based on both findings of an eye exam and vision complaints by patients. However, the researchers say that cognitive deficits, age, insurance coverage, income, or simple procrastination, may keep older people from telling their doctor about their vision problems.
The researchers developed a model to simulate a common vehicle collision for people 60 to 89 and implemented control conditions of earlier and later cataract surgery and found that the change to earlier surgeries would increase cataract surgery expenditure for people ages 65 and older by eight percent and for people ages 60-64 by about 47 percent. However, those expenses would be offset by reductions in medical and emergency services costs following car accidents. The study was published in Accident Analysis and Prevention. Read more on aging.
In 2008, the U.S. Department of Veterans Affairs (VA) sent Army paratrooper Jeffrey Waggoner to an Oregon hospital to recover from an addiction to painkillers. However, once there they instead gave him a steady stream of medications, eventually releasing him for a weekend with 19 prescription drugs in hand. He was found dead of an overdose three hours later.
“As a parent, you’d want to know how this happened to your child,” said his father, Greg Waggoner, according to a new report from The Center for Investigative Reporting (CIR). “You send your child to a hospital to get well, not to die.”
In its investigation, CIR found that, post 9/11, the VA has increasingly been treating addictions with a variety of drugs, “feeding addictions and contributing to a fatal overdose rate among VA patients that is nearly double the national average.” Over the past dozen years, prescriptions for the four opiates hydrocodone, oxycodone, methadone and morphine have increased by 270 percent.
Waggoner’s weekend leave medications included 12 oxycodone pills.
As part of its investigation, CIR has created a comprehensive interactive tool that shows the VA systems with the highest prescription rates and allows users to search for information by region and system. The data is culled from CIR’s own research, as well as information from the VA and the U.S. Census Bureau.
Trust for America’s Health also recently released an interactive tool on the growing public health issue of prescription drug abuse—about 6.1 million Americans use or abuse prescription drugs. The tool allows users to search state-by-state prescription drug overdose death rates and find out how each scores on 10 key steps to curb abuse.
>>Read The Center for Investigative Reporting’s “VA’s opiate overload feeds veterans’ addictions, overdose deaths”
>>Read NewPublicHealth’s story, “New Report: Most States Not Implementing Enough Proven Strategies to Prevent Prescription Drug Abuse”