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. - --- MAP posted-by: Rebel