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