Pubdate: Tue, 13 Nov 2001
Source: Messenger-Inquirer (KY)
Copyright: 2001 Messenger-Inquirer
Contact:  http://www.messenger-inquirer.com
Details: http://www.mapinc.org/media/1285
Author: Dr Janna Pathi
Note: Dr. Janna Pathi lives in Beaver Dam and is a general surgeon at Ohio 
County Hospital.

RX DRUG MISUSE, ABUSE, DIVERSION A SERIOUS HEALTH PROBLEM

The current anthrax scare has, among other things, started a debate about 
medicines, their availability and safety. This is on top of the ongoing 
debate about prescription drug coverage. And it is time to bring another 
aspect of prescription drugs to the table. Misuse, abuse and diversion of 
prescription drugs is a serious health care problem of epidemic proportions.

Consider these numbers: According to the National Institute on Drug Abuse, 
an estimated 9 million people 12 and older used prescription drugs for 
nonmedical reasons in 1999. The same agency reported that a recent national 
survey of primary care physicians and patients found that 46.6 percent of 
physicians find it difficult to discuss prescription drug abuse with their 
patients. The elderly represent 13 percent of the U.S. population but 
consume one-third of all prescription drugs. Roughly 3 percent were abusing 
the medications.

The U.S. Drug Enforcement Administration estimates that prescription drugs 
were sold for about $25 billion in 1993 in the illegal drug market, 
compared to an estimated $31 billion spent that year on cocaine, including 
crack. According to the DEA, prescription medications account for more than 
half of the 20 controlled substances most often involved in overdoses and 
drug-related emergencies. About 25 percent of the people taking 
prescription drugs were misusing them. The most commonly misused and abused 
medications include sedatives, sleeping pills, anti-anxiety medicines and 
painkillers.

Every practicing physician encounters, on almost a daily basis, patients 
seeking medicines not necessarily for a genuine medical reason. It is 
happening at a time when there is increasing pressure on all health care 
providers to do a better job of pain management. The recent criminal 
indictment of a physician in Florida, after a patient died with OxyContin 
overdose, is very unsettling. Such instances only obfuscates an already 
muddled situation.

The magnitude of this problem requires a thorough understanding and an 
aggressive campaign to combat it. Some effective measures are already being 
tried.

State medical boards are providing clear guidelines to physicians about 
pain management. Brochures are developed to provide clear instructions to 
the patients regarding proper administration of prescribed medicines. 
Pharmacies are assisting patients in understanding the side effects and 
work well with the physicians in identifying potential harmful events. The 
prescription habits of physicians are changing because of heightened 
sensitivity and understanding. New prescription forms are being used to 
prevent forgery.

Communitywide organizations like Together We Care in Ohio County are 
working on the educational campaign as part of an overall strategy to 
reduce substance abuse, particularly among young people.

Various states are experimenting with reporting systems. The Kentucky 
Cabinet for Health Services has implemented a prescription reporting 
program. The system, Kentucky All Schedule Prescription Electronic 
Reporting ( KASPER ), for reporting the dispensing of Schedule II-V drugs 
by pharmacies, dispensing physicians, dispensing veterinarians, or other 
Kentucky licensed dispensers, has been created to collect data. Physicians 
and pharmacies are utilizing the KASPER reports to identify potential cases 
of drug overutilization, misuse, or overprescribing for referral to 
appropriate practitioners, professional licensing boards or other agencies.

Abuse is frequent, and there should not be any hesitation to address the 
problem with the patients. Frequently, there are warning signs to indicate 
prescription drug abuse, and being alert is the only way to begin the 
process of helping the patient.

It is a common clinical experience to see patients take painkillers for 
depression. Appropriate counseling and using antidepressants is a simple 
concept, but lack of such a support system is a real problem in the rural 
health care system.

Diversion of prescription drugs into the illegal market exacerbates the 
existing problem of recreational drug abuse. Access to prescription drugs 
at home makes it easy for family members to participate in diversion. 
Patients need to be instructed to discard unused and unneeded medicines. 
Doctor-shopping by people who abuse medicines and also participate in the 
diversion for profits is an open secret. The techniques used are amusing 
and creative. If they could only use that creativity for common good.

Solving this serious problem requires a collective effort, and we need to 
enlist and mobilize every community asset. A well-informed citizenry is an 
important tool for local health care providers, pharmacies and the law 
enforcement agencies trying hard to reduce and eventually eliminate the 
prescription drug misuse, abuse and diversion.
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MAP posted-by: Rebel