Misuse of Scarce Health Dollars

March 17, 1992

There is no conclusive evidence that abuse of narcotic prescription drugs is out of control in Maryland. There is, however, evidence that many Americans are undermedicated for pain. A federal study recently urged doctors to pay more attention to adequate pain relief for patients after surgery. The problem is also acute among cancer patients. Why, then, is the state health department planning to spend $500,000 to create a new bureaucracy to monitor prescriptions of drugs that have sound medical uses but a high potential for abuse?

Officials at the federal Drug Enforcement Administration insist prescription drug abuse is troubling, but their evidence is largely anecdotal. The closest thing to real data -- emergency room admissions for drug overdoses -- suggests the problem may actually be declining in Maryland. Moreover, no one could argue that prescription drug abuse even remotely rivals the difficulty Maryland faces from illicit street drugs like cocaine or heroin. Given the lack of firm data on prescription drug abuse and the proposal's lack of attention to the problem of pharmacy theft (in all likelihood a much greater source of abuse), the department's plan for a statewide prescription monitoring system may be a classic example of bureaucrats rushing to fix something -- anything -- before they can prove how or where it's broken.

This is the kind of foolishness that exacerbates budget crises, but in this case cost issues may well be overshadowed by humanitarian concerns. Efforts to monitor prescription drugs in other states have made many doctors less willing to prescribe narcotics, regardless of the justification.

Is it such a terrible thing that Maryland has one of the nation's highest per capita consumptions of Dilaudid -- a potent narcotic that is effective on cancer pain? After all, Maryland also has the country's highest cancer death rate, with 9,900 cancer deaths expected this year, and the state is home to three major cancer treatment centers -- Johns Hopkins, the University of Maryland and the National Institutes of Health.

A prescription monitoring program is not a major budget item. nTC But given the crippling cuts being imposed in other areas -- such as drug treatment programs -- the diversion of money to create a new bureaucracy to tackle a situation that represents only a tiny fraction of the drug abuse problem is a misuse of scarce resources.

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