Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

"Drugs for Profit"

Here is a summary of FDA statistics and decisions. “Prescription drug misuse now rivals illicit drug use as a cause of emergency department visits.

Experts noted that just a small fraction of opioid abusers get medicines directly from physicians. According to the 2008 National Survey on Drug Use and Health, only 7% of people who misused oxycodone in the past year said they got it from a doctor. Seventy-six percent of users bought or stole the drugs from a friend or relative, or received the opioids as gifts.

A patient told me of a system used by injured workers in a rural community in which they go to two physicians for pain management. They get almost the identical narcotic prescriptions for each.

In reality, their orthopedic pain is actually quite mild so they use about 1/4 of one prescription to manage their own pain. They abuse another 1/4 of the prescription for recreational purposes They then have 1 1/2 of the two precriptions left over. These they sell and are able to general $6-8 thousand dollars per month from the narcotics.

Emergency department visits related to misuse of prescription or over-the-counter drugs doubled from 500,000 in 2004 to 1 million in 2008 while Illegal drugs such as cocaine and heroin were involved in 1 million emergency room visits, a figure that stayed flat over that same time period.

Opioids were the prescription drugs most likely to land users in the emergency department, accounting for an estimated 305,885 visits in 2008, more than double the 2004 estimate of 144,644. People who misuse opioids are vulnerable to respiratory depression and can become unresponsive quickly, experts said. They eventually may stop breathing and experience cardiac arrest.

As physicians have moved to treat acute cancer and chronic pain more aggressively using opioids, the opportunity for recreational use of the drugs has grown. People seem to be more comfortable using prescription drugs than street drugs because they are prescribed by a doctor and approved by the FDA. But the logic isn’t good, because the safety doesn’t extend to their misuse.

The FDA plan would require manufacturers to step up their efforts to educate physicians and patients about the dangers of the drugs through medication guides, patient education sheets and continuing medical education courses on “appropriate patient selection, dosing and patient monitoring,” as well as “patient counseling on the safe use, storage and disposal of opioids.”

Drugmakers would be required to survey doctors to show that their knowledge of appropriate opioid prescribing practices has improved. However, the plan does not require physicians to receive training or take opioid-related testing before prescribing the drugs, an idea the FDA had considered previously. The plan also rejects a proposal to require that manufacturers develop registries to track patients who take opioids.

America’s top-selling opioid, the extended-release form of oxycodone marketed as OxyContin, recorded $2.9 billion in 2009 sales for Stamford, Conn.-based manufacturer Purdue Pharma, according to the prescription data analysis firm IMS Health.

Pain specialists responded with relief that the FDA proposal does not mandate opioid training for physicians.

In a June 30, 2009, letter sent jointly with 14 other physician organizations, the AMA said mandatory certification for opioid prescribing should be used only as a “last resort.”

Physicians and other health professionals should do more to tell patients, especially parents, about the dangers of letting their opioids get into others’ hands.

There is a role for the public health community….as a parent, may safeguard your gun or your alcohol from your kids in order to protect them, yet you are just leaving your prescription drugs out there for the taking.”

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