Pubdate: Sun, 18 Jan 2015
Source: Boston Globe (MA)
Copyright: 2015 Globe Newspaper Company
Contact: http://services.bostonglobe.com/news/opeds/letter.aspx?id=6340
Website: http://bostonglobe.com/
Details: http://www.mapinc.org/media/52

DETAILS OF HEROIN STORY HOLD RAMIFICATIONS FOR ADDICTION POLICY

Opiate addiction is a public health crisis, and Governor Charlie Baker
is right to target it as a priority for his administration. But coming
up with the right prescriptive for combating it means getting the
facts straight from the start.

The new governor quickly acknowledged he misstated one part of a
tragic story that he relayed during his inaugural address about
19-year-old Evan Greene, who died last January after a fatal overdose
of heroin. In his speech, Baker said the young man was prescribed
opiates for pain after a routine medical procedure. "Slowly and
unknowingly, he became addicted to them," Baker said. "When the
prescription ended, he turned to heroin."

His death, said Baker, "was an agonizing, yet all too familiar story."
Unless the state took action, "many more individuals and families like
the Greene's will have the same terrible experience."

However, as first reported by the Brockton Enterprise, what Baker
described is not what happened. According to Greene's parents, a
friend introduced their son to prescription painkillers after he
started smoking marijuana and that eventually led to his heroin
addiction. Baker apologized for the error, and the Greene family was
not upset by it. John Greene, Evan's father, said Baker's willingness
to raise awareness of the drug addiction problem is more important
than the specific chain of events relating to his son.

However, the precise chain of events goes beyond one family's pain. It
matters from a policy perspective. What's the best way to stop the
flood of prescription drugs, and who is most responsible for the harm
it is causing? Massachusetts is grappling with those questions.

Baker presented a popular narrative: A young person is prescribed
painkillers and ends up a heroin addict. But as demonstrated by Evan
Greene's story, that is not always the case.

According to the Centers for Disease Control, almost all prescription
drugs involved in overdoses originate from prescriptions, not pharmacy
theft. However, once prescribed and dispensed, the drugs are
frequently diverted to other users. According to the CDC, more than
three out of four people who misuse prescription painkillers are using
drugs that were prescribed for someone else.

Still, a July 2014 CDC report concluded that "an increase in
painkiller prescribing is a key driver of the increase in prescription
overdoses."

Meanwhile, physician-advocacy groups like the Massachusetts Medical
Society argue that patients with chronic pain, cancer, or terminal
pain should be able to get needed medication. The MMS also rebuts the
premise that physician over-prescribing is the root cause of the
current addiction crisis; pharmacy theft and diversion from family and
friends should also be factored in.

The truth is important, and Massachusetts should try to get at
it.

The state has the foundation to do so. A prescription drug monitoring
program - considered one of the best tools available to track
prescription use - was established here in 1992. At that time, it only
covered Schedule II drugs (which are narcotics, such as morphine,
OxyContin, and stimulants). In 2010, the program was expanded to
include all federally controlled substances (any drug that has
potential for abuse).

Now, the state should do more with the data it collects: For example,
the data should be cross-referenced to see if people who are dying
from drug overdoses have prescription histories, as recorded by the
monitoring program. That could establish the connection between
overdoses and prescribers who inappropriately write many prescriptions
or write prescriptions for high dosages.

Such analysis would not paint the full picture of the problem,
however, since it is well-known that some people who start off with a
prescription from one doctor hop to others. But it would be a start in
getting beyond tragic anecdotes.
- ---
MAP posted-by: Matt