Hooked on pills [Editorial]

Our view: Preventing prescription drug abuse requires a multi-pronged approach to the problem of addiction

September 14, 2014

State officials are hoping a new public health initiative to track the distribution and sale of highly addictive prescription drugs in Maryland can help reduce the number of people who abuse such medications. The initiative, inspired by a program originally developed in Kentucky 15 years ago, has led to a drastic drop in prescription drug abuse there, and it has the potential to become an important element in Maryland's overall effort to reduce overdose deaths from both legal and illegal drugs.

Health officials say the prescription drug monitoring program has several goals. It establishes a statewide database of prescriptions for opioid painkillers such as OxyContin and Percocet that will alert physicians and pharmacies to suspicious purchases that suggest fraud or abuse. It's also intended to make the health professionals who use it more aware of the dangers of overprescribing such medications and to steer suspected abusers into treatment and recovery programs.

Whether the initiative will play a significant role in reducing the number of drug overdose deaths in Maryland is less clear. Such deaths have been rising in recent years as prescription pain medications have become more expensive and harder to obtain as a result of the state's efforts to crack down on abuse. In the worst-case scenario, people addicted to prescription drugs who suddenly find themselves unable to purchase opiates legally may turn to black market products or even to illegal narcotics like heroin, which is cheap and easily purchased on the street but poses even greater public health and safety risks than prescription drugs.

It's in the nature of addiction that people will go to almost any lengths to satisfy their cravings and avoid the sickening symptoms of withdrawal. It's easy to imagine that an addict turned away from a physician or pharmacy because of previous suspicious purchases uncovered through a prescription drug database might well turn to the dealer on the corner rather than accept a referral to a community drug treatment center. Physicians and pharmacists can encourage people they suspect of abusing pain pills to get help for their addiction, but they can't compel them to do so.

That's why tracking prescription drug sales and offering treatment alternatives can be effective in reducing overall drug overdose deaths only if they are part of a comprehensive drug prevention strategy aimed at reducing addiction to both illegal narcotics and prescription drugs. The plan developed by the state health department over the last two years represents a multi-pronged approach to the problem with a goal of reducing overall drug overdose deaths by 20 percent by the end of 2015.

In addition to monitoring prescription drug sales and improving access to drug treatment programs, the Maryland Opioid Overdose Prevention Plan calls for better tracking and information sharing among agencies regarding overdose deaths, enhanced clinical education and training for health care providers and outreach programs targeting specific communities at high risk for overdose deaths. The effort also includes distributing the anti-overdose drug naloxone to family members of addicts so they can act quickly to save the lives of overdose victims, and protects them from criminal prosecution under Maryland's so-called "Good Samaritan Law," which provides immunity for anyone who assists a victim of overdose or reports it to police.

Maryland is one of the last states to introduce a prescription drug monitoring program, but unlike those of many states, its initiative is seated in the health department rather than in the criminal justice system or the pharmacy board, and it increasingly treats addiction as public health issue rather than as a matter for courts and police. The monitoring program is just one of the initiatives aimed at reducing overdose deaths in the state, albeit a vital one, and it can be successful as part of an overall overdose prevention strategy tailored to the needs of the individuals and communities most at risk of becoming hooked on pills.

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