Pubdate: Fri, 22 Aug 2014
Source: New York Times (NY)
Page: A12
Copyright: 2014 The New York Times Company
Contact: http://www.nytimes.com/ref/membercenter/help/lettertoeditor.html
Website: http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Sabrina Tavernise

IN MOVE TO CURB DRUG ABUSE, D.E.A. TIGHTENS RULE ON WIDELY PRESCRIBED
PAINKILLER

WASHINGTON - The federal government tightened the prescribing for the
most common form of painkiller in the country on Thursday, the final
step in a policy shift that has been years in the making.

The stricter rule for hydrocodone, which is the most widely prescribed
painkiller in the United States and which is an ingredient in drugs
like Vicodin, is one of the most far-reaching efforts to stop the
growing epidemic of prescription drug abuse. More than 20,000
Americans die every year because of prescription drug abuse, according
to federal data.

The rule places hydrocodone in a tougher, more restrictive category,
and the changes it requires are sweeping. Doctors will no longer be
able to call in prescriptions by telephone, and patients will not be
allowed to get refills on the same prescription, but will have to
return to a health care professional to get a new one. The drug will
have to be kept in special vaults in pharmacies. The Drug Enforcement
Administration published the rule on Thursday; it will take effect in
45 days.

"This is substantial," said Dr. Nathaniel Katz, assistant professor of
anesthesia at Tufts University School of Medicine in Boston. "It's a
sign of a shift toward more cautious opioid prescribing."

He added: "This will be an inconvenience to some, but policy is a
machete, not a scalpel, and you have to figure out where to use it. I
think people will be more helped than harmed."

Abuse of painkillers now claims the lives of more Americans than
heroin and cocaine combined, according to federal data, and the number
of Americans who die from prescription drug overdoses has more than
tripled since the late 1990s. Prescription drugs account for the
majority of all drug overdose deaths in the United States. In all,
drug-induced deaths have outstripped those from traffic accidents.

Senator Joe Manchin III, Democrat of West Virginia, whose state is
among those hardest hit by the epidemic of painkiller abuse, applauded
the change. He called the shift "a tremendous step forward in fighting
the prescription drug abuse epidemic," one that he said would
"undoubtedly help prevent these drugs from getting into the wrong
hands and devastating families and communities."

Still, the change is sure to draw strong criticism from some pain
management experts, who argue that the rule creates unfair obstacles
for patients in chronic pain, making it harder, for example, on those
who cannot easily make a trip to the doctor.

Other experts point out that the change will not necessarily lead to
less abuse. For example, oxycodone, another highly abused painkiller
and the main ingredient in OxyContin, has been in the more restrictive
category since it first came on the market. Oxycodone and methadone
account for far more overdose deaths than hydrocodone.

Dr. John Mendelson, a professor of medicine at the University of
California, San Francisco, and an addiction specialist, said he
expected the change would lead to an increase in prescriptions of
other drugs such as oxycodone, and a rise in the use of heroin, which
has been increasing as towns and cities crack down on prescription
drug abuse. He said he believed the small decrease in addiction to
prescription drugs that the changes could bring would probably be
offset by an increase in heroin use.  
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