Calamity at the pharmacy: Quelling swelling rate of opioid addiction

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By state Rep. Jim Moeller

Maybe we’re climbing out of a nightmare. Just maybe we’re leaving the hellacious plague that is the falling into the wrong hands and showing up on the wrong agenda of painkilling drugs. Yes, as Sisyphean an undertaking as the casual observer might mock it out to be, the hard work of combating prescription-painkiller abuse is indeed showing some trace of triumph. So notes a recent Olympian newspaper editorial (Encouraging signs opioid overdose rate is on the decline, 5/29/2012).

Ladies and gentlemen, here please to partake of, if you will, a little back story.

The time, winter 2010. The place, Olympia. The setting, that year’s legislative session. A successful measure I prime-sponsored directed five statewide organizations to adopt new rules on chronic, non-cancer pain management. Established by the Medical Quality Assurance Commission, the Board of Osteopathic Medicine and Surgery, the Podiatric Medical Board, the Dental Quality Assurance Commission and the Nursing Care Quality Assurance Commission, these new rules emphasize the following elements:

* Guidance on dosing criteria, including a dosage amount that cannot be exceeded without consulting a pain-management specialist.

* Guidance both on seeking specialty consultation, and on the ways in which electronic specialty consultations may be sought.

* Guidance on tracking clinical progress by using assessment tools that focus on pain interference, physical function, and overall risk for poor outcomes.

* Guidance on tracking the use of opioids.

Tragedy led to legislation

Several years back, tragedy, as so often it does, called lawmakers to arms.

A prescription-drug overdose in Southwest Washington, a fatal overdose in fact, prompted the 2010 legislation. In the fall of 2009, a pain-management clinic in the Vancouver area closed after this death of one of its patients, a local teenager, from an overdose of prescribed opioids. When the clinic closed, many of its patients faced the prospect of running out of their pain medication. They would have no way to continue with their treatment plans. Their only option of trying to find another physician or clinic to accept them as patients fell through when they were repeatedly turned away by those potential alternatives.

The despairing citizens who contacted my office were understandably frustrated at the fearful prospect of having to find a way to get along somehow without a familiar treatment to control their pain. Many physicians were reluctant to take on chronic pain patients due to the lack of rules for prescribing opioids. I also talked about the opioids conundrum with Dr. Alex Cahana, Chief of the Pain Management Clinic at the University of Washington, and Dr. Gary Franklin, Medical Director at the state Department of Labor and Industries. I met with Drs. Cahana and Franklin several times to discuss pain-management issues and possible legislation for the upcoming (2010) session.

By the end of the previous decade, an increase in opioid addiction here in Washington and all across the country set off a public-health emergency. Opioid-related deaths topped highway deaths as the No 1 killer in the United States. Exasperatingly, though, it’s a killer spawned from the best of intentions. The addiction, you see, often begins with the treatment of pain. In the 1990s, many states changed their laws to prevent the under-prescription of opioids, which led to an increase in the number of opioid deaths. Over the next several years, the over-prescription of opioids led to tolerance and addiction with no improved function.

Toxic mix of opioid and alcohol

Observes the Olympian editorial: “From 1995 to 2008, opioid-related deaths in Washington increased from 23 to 505 per year, a climb of more than 2,000 percent. All of these accidental overdoses occurred when the victims mixed a prescription opioid with alcohol or some other prescription or illicit drug.” The newspaper item also cites terribly alarming information from Together, a substance-abuse and violence-prevention organization in Thurston County: Three in five teenagers cop to having taken prescription painkillers from the family medicine cabinet. Young people these days are entering treatment for opiates 19 times more often than kids just a decade back.

Terms of the 2010 legislation kicked fully in just this past January. Sure enough, there are some early, encouraging signs of a descent in overdose rates.

But no, don’t you go getting yourself too comfortable, Mr. and Ms. United States of America. A HealthDay News story (“Many Americans taking too much acetaminophen,” 6/1/2012) reports rather alarming nonprescription-drug findings in a study just unleashed by Northwestern University researchers.

Five hundred adult patients were selected and interviewed for the study from among folks at outpatient general-medicine clinics in Atlanta and Chicago. More than half of the participants in the study reported using acetaminophen (Tylenol and related medicine) in the past six months. Nineteen percent of them said they took acetaminophen every day or at least a couple of times a week. Clearly, we best all keep our guards up — way up. Because even the over-the-counter stuff is nothing with which to be toyed.

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