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Commentary: Defining The Epidemic of Prescription Painkiller Abuse

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The Centers for Disease Control and Prevention has described the country’s sharp rise in overdoses over the last decade from prescription painkillers, or opioids, as an epidemic. But it can be easy to lose sight of what “epidemic” truly means.

In this case, it means that, in the past decade, more than 100,000 people from across the United States died from overdoses involving prescription painkillers. That’s enough people to fill Yankee Stadium to capacity —twice.

It means that for every 1 person who died from a prescription painkiller overdose in 1999, nearly 4 died in 2009.

It means that if the painkiller overdose death rate had remained level since 1999, rather than rising so sharply, more than 60,000 people would still be alive today.

The epidemic can trace its roots to a dramatic increase in the 1990s in the prescribing of prescription painkillers in an attempt to better treat pain. Unfortunately, this increase in prescribing has paralleled an increase in drug overdoses and overdose deaths. In fact, enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for a month.

We have an unprecedented public health problem on our hands, and it does not need to be this way. Our public health response must be consistent with the scale of the problem.

As a doctor, I know the vast majority of health care providers want only to help their patients. We must educate and equip providers with the appropriate skills and tools to accomplish this.

We need to have safeguards in place to alert providers to signs of prescription drug abuse and to help patients who are abusing them. We must also have mechanisms that will spur communities to take action when health care providers are irresponsible or engage in illegal activities like running pill mills.

State prescription drug monitoring programs are electronic databases that can help providers see their patients’ prescription history and identify problematic behaviors. These critical public health tools have great potential to reverse this epidemic, and must be accurate and timely, and convenient to use by busy providers.

The costs of prescription drug abuse should be made clear to insurance carriers so they are motivated to monitor the prescribing and use of addictive prescription drugs and to impose appropriate limits. For example, private insurers and Medicaid programs find that coordinating care by limiting at-risk clients to one doctor and one pharmacy for controlled prescription drugs can reduce inappropriate use and decrease costs.

We also need to help patients who are abusing prescription drugs to get into treatment. Some emergency departments and primary care providers have found success by identifying patients who are abusing prescription drugs and connecting them to community resources and treatment centers to help manage their addiction.

These are just a few of the promising interventions that can make a big difference. Other interventions such as clinical guidelines, public and provider education, safe medication storage and disposal, and improving access to substance abuse treatment are also important to addressing this critical public health issue.

This epidemic of drug overdose is not a necessary consequence of adequate pain management. Sensible interventions to prevent prescription painkiller abuse and diversion will not condemn more people to untreated pain. Instead, they will allow us to reduce the number of people who misuse, abuse or overdose from these powerful drugs while ensuring patients have access to safe, effective pain treatment.

Thomas R. Frieden, MD, MPH
Director, Centers for Disease Control and Prevention
Administrator, Agency for Toxic Substances and Disease Registry

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