In reading Dr. Hua Carroll’s January post here in the Health Policy Forum on the "Cultural Differences in the Treatment of Pain," two statements stood out to me:

1) The Centers for Disease Control and Prevention has declared prescription drug abuse an epidemic, and
2) Fighting prescription pain medication abuse is an uphill battle. (1)

Now—I admit—at times, I am guilty of watching [drug] epidemics go by, as there tends to be so many of them and just about everything has the potential to be abused. Just a few months ago, media reports focused on bath salts followed by hand sanitizer as abused substances—the “flavor of the month,” if you will. We seem to be a nation of drug abuse and drug-related epidemics. At least, that is what I thought until I saw Vanguard’s OxyContin Express that illustrates the “bustling pill pipeline that stretches from the beaches of Ft. Lauderdale to the rolling hills of Appalachia.” (2) This led me on a sort of mini-literature review of my own.
 
Consider the following facts I’ve discovered:

• Non-medical use of prescription drugs is the second category of most drugs abused after marijuana, and controlled prescription drugs (including OxyContin, Ritalin, and Valium) are now fourth in most-abused substances in America after marijuana, alcohol and tobacco.
• 56 percent more Americans abuse prescription drugs than abuse cocaine, heroin, hallucinogens and inhalants combined.
• Women are significantly more likely than men to be prescribed narcotics and anti-anxiety medications.
• 12- to 17-year old girls are more likely than boys of the same age to abuse psychotherapeutic drugs.
• Almost 60 percent of 12th graders who reported misusing or abusing prescription drugs said they obtained them from friends or relatives. (3)

Recently, the National Association of State Alcohol/Drug Abuse Directors published its findings from an inquiry on prescription drug misuse and abuse. In it, 45 participating states indicate that prescription drug abuse was a critical issue within their jurisdictions, and 29 states already have task forces to specifically address prescription drug abuse. (4) The Office of National Drug Control Policy (ONDCP) has even included a policy focus in its 2012 National Drug Control Strategy in an effort to curb prescription drug abuse. (5)

The landscape of the problem—which includes 1) the increasing number of deaths from overdoses, 2) ease of access due to the vast number of people living with chronic pain who live in or head households with those who will misuse/abuse those drugs, and 3) a willingness to misuse/abuse due in part to the misperception of safety in taking these drugs—supports Dr. Carroll’s assertion that, “fighting prescription pain medication abuse is an uphill battle with no easy solution.” More Americans are living with chronic pain today than in times past; as a result, they have more pain management medications at home, which increases the potential for abuse. Once, pain medication was kept in the medicine cabinet in the bathroom; now, whole kitchen cabinets are dedicated to housing pain medications. In short, part of the problem is easy access to drugs; part of the solution is access to recovery.

Dr. Carroll also notes, “It requires a comprehensive approach to address the problem at clinician, patient and manufacturer levels.” I’d like to add that it takes all of us: We’re the ones we’ve been waiting for.

The comprehensive approach is not limited to clinicians, patients, and manufacturers. For example, ONDCP participated in the Food and Drug Administration’s workshop on Naloxone. And, as of last December, state, local, and tribal law enforcements’ participation in the Drug Enforcement Administration’s National Prescription Drug Take Back Day resulted in the collection and destruction of 498 tons of prescription medication. Collaborations across agencies and systems show us what we can accomplish when we work outside of our designated silos.

So, what can you and I do? As professionals and passionates in the ever-changing health care landscape, we can:

• Follow ONDCP’s strategy lead of education—not just for opioid prescribers, but for ourselves, our clients, and our stakeholders.
• Support state and tribal systems in their efforts to craft a recovery-oriented system that ensures continuity, for both clinical treatment and recovery support across agencies and faith-based and community organizations.
• Work to develop innovative ways to lead the behavioral health care cultural revolution needed to make system collaboration a reality.
• Promote and participate in drug take-back days as a team or an individual household.

ONDCP recognized that effectively curbing this epidemic will take the cooperation of “federal agencies, state, and local government, parents, prescribers, and patients.” It really does take a village.

References

1. Bersamira, C., Harwood, R. (2012) State substance abuse agencies and prescription drug abuse: Initial results from a NASADAD membership inquiry. National Association of State Alcohol and Drug Abuse Directors. Retrieved from: http://nasadad.org/wp-content/uploads/2012/04/NASADAD-Prescription-Drug-Abuse-Inquiry-FINAL-04-2012-3.pdf.

2. Executive Office of the President of the United States. (2012). National drug control strategy (2012) Retrieved from: http://www.whitehouse.gov/sites/default/files/ondcp/2012_ndcs.pdf.

3. Manchikanti, L. (2006) Prescription drug abuse: What is being done to address this new drug epidemic? Testimony before the subcommittee on criminal justice, drug policy, and human resources. Pain Physician; 9,287-321.. Retrieved from: http://www.asipp.org/documents/PrescriptiondrugabuseWhatisbeing.pdf.

4. Bersamira, C., Harwood, R. (2012) State substance abuse agencies and prescription drug abuse: Initial results from a NASADAD membership inquiry. National Association of State Alcohol and Drug Abuse Directors. Retrieved from: http://nasadad.org/wp-content/uploads/2012/04/NASADAD-Prescription-Drug-Abuse-Inquiry-FINAL-04-2012-3.pdf.

5. Executive Office of the President of the United States. National drug control strategy (2012) Retrieved from: http://www.whitehouse.gov/sites/default/files/ondcp/2012_ndcs.pdf.