RX DRUG MISUSE, ABUSE, DIVERSION A SERIOUS HEALTH PROBLEM

The current anthrax scare has, among other things, started a debate about
medicines, their availability and safety. This is on top of the ongoing
debate about prescription drug coverage. And it is time to bring another
aspect of prescription drugs to the table. Misuse, abuse and diversion of
prescription drugs is a serious health care problem of epidemic proportions.

Consider these numbers: According to the National Institute on Drug Abuse,
an estimated 9 million people 12 and older used prescription drugs for
nonmedical reasons in 1999. The same agency reported that a recent national
survey of primary care physicians and patients found that 46.6 percent of
physicians find it difficult to discuss prescription drug abuse with their
patients. The elderly represent 13 percent of the U.S. population but
consume one-third of all prescription drugs. Roughly 3 percent were abusing
the medications.

The U.S. Drug Enforcement Administration estimates that prescription drugs
were sold for about $25 billion in 1993 in the illegal drug market,
compared to an estimated $31 billion spent that year on cocaine, including
crack. According to the DEA, prescription medications account for more than
half of the 20 controlled substances most often involved in overdoses and
drug-related emergencies. About 25 percent of the people taking
prescription drugs were misusing them. The most commonly misused and abused
medications include sedatives, sleeping pills, anti-anxiety medicines and
painkillers.

Every practicing physician encounters, on almost a daily basis, patients
seeking medicines not necessarily for a genuine medical reason. It is
happening at a time when there is increasing pressure on all health care
providers to do a better job of pain management. The recent criminal
indictment of a physician in Florida, after a patient died with OxyContin
overdose, is very unsettling. Such instances only obfuscates an already
muddled situation.

The magnitude of this problem requires a thorough understanding and an
aggressive campaign to combat it. Some effective measures are already being
tried.

State medical boards are providing clear guidelines to physicians about
pain management. Brochures are developed to provide clear instructions to
the patients regarding proper administration of prescribed medicines.
Pharmacies are assisting patients in understanding the side effects and
work well with the physicians in identifying potential harmful events. The
prescription habits of physicians are changing because of heightened
sensitivity and understanding. New prescription forms are being used to
prevent forgery.

Communitywide organizations like Together We Care in Ohio County are
working on the educational campaign as part of an overall strategy to
reduce substance abuse, particularly among young people.

Various states are experimenting with reporting systems. The Kentucky
Cabinet for Health Services has implemented a prescription reporting
program. The system, Kentucky All Schedule Prescription Electronic
Reporting ( KASPER ), for reporting the dispensing of Schedule II-V drugs
by pharmacies, dispensing physicians, dispensing veterinarians, or other
Kentucky licensed dispensers, has been created to collect data. Physicians
and pharmacies are utilizing the KASPER reports to identify potential cases
of drug overutilization, misuse, or overprescribing for referral to
appropriate practitioners, professional licensing boards or other agencies.

Abuse is frequent, and there should not be any hesitation to address the
problem with the patients. Frequently, there are warning signs to indicate
prescription drug abuse, and being alert is the only way to begin the
process of helping the patient.

It is a common clinical experience to see patients take painkillers for
depression. Appropriate counseling and using antidepressants is a simple
concept, but lack of such a support system is a real problem in the rural
health care system.

Diversion of prescription drugs into the illegal market exacerbates the
existing problem of recreational drug abuse. Access to prescription drugs
at home makes it easy for family members to participate in diversion.
Patients need to be instructed to discard unused and unneeded medicines.
Doctor-shopping by people who abuse medicines and also participate in the
diversion for profits is an open secret. The techniques used are amusing
and creative. If they could only use that creativity for common good.

Solving this serious problem requires a collective effort, and we need to
enlist and mobilize every community asset. A well-informed citizenry is an
important tool for local health care providers, pharmacies and the law
enforcement agencies trying hard to reduce and eventually eliminate the
prescription drug misuse, abuse and diversion.