Policy Analysis | May 2011

A Prescription Drug Epidemic

Jeremy Williams

A study by the Substance Abuse and Mental Health Services Administration found that treatment admission for prescription pain pill abuse has quadrupled nationally in the past decade, and that this increase spans every age, gender, race, ethnicity, education, employment level and region of the country. The National Institute on Drug Abuse reports that about 20 percent of people in the United States, or 48 million, have used prescription drugs for nonmedical reasons. Even more alarming, according to a report by the Centers for Disease Control and Prevention, overdoses from prescription drugs in the United States doubled from 1999 to 2007, and each year more than 20,000 people die from overdoses, far more people than are killed by controlled substances like cocaine and heroin. In addition, the South has one of the highest rates of overdose related to prescription drug abuse and misuse.

National Drug Control Policy Director Gil Kerlikowske has called prescription drug abuse the nation's "fastest-growing drug problem," and last month he revealed a new strategy by the White House to reduce misuse of such drugs by 15 percent in five years through a nationwide education campaign; training for clinical practitioners; and establishing prescription drug monitoring programs in all 50 states (currently, only 35 states are operating such programs). In addition, the U.S. Food and Drug Administration is asking makers of pain medications to assist in supplying materials that physicians can use while counseling patients on the risks and benefits of using prescription pain medications.

When taken properly, opioids, which are synthetic versions of opium and include drugs such as morphine, codeine, oxycodone and others, can help people deal with chronic pain. However, they can become addictive or be used for nonmedical means. Abusers typically crush and inhale the pills, or inject them, in order to produce a euphoric high. Oftentimes, these drugs are obtained from friends and family members, but the growing number of pain clinics that supply drug dealers and addicts with illicit prescription painkillers has contributed to the epidemic.

Many states across the nation have begun addressing the proliferation of these "pill mills." For instance, in 2007, Utah initiated a statewide media effort, the "Use Only As Directed" campaign, to educate people on the dangers of prescription drug abuse. The state also created guidelines for clinical practitioners who prescribe opioids. The effort resulted in a nearly 13 percent decrease in prescription drug overdose deaths in just one year. Other states, such as Ohio, have created task forces to assess the problem and determine proportional responses.

Florida has become a hub for prescription drug activity. According to a report by the Florida Department of Law Enforcement and the state Medical Examiners Commission, during the first six months of 2010, there were 1,268 deaths in the state caused by misuse of prescription drugs. More than 850 pain clinics currently are registered in Florida, where doctors prescribe about 85 percent of all opioids purchased in the United States. The state passed legislation (SB2272) last year to begin strengthening regulation on pain management clinics. Some of the provisions in the legislation included: limiting anyone paying cash for a prescription to a 72-hour supply; requiring specific training for doctors who practice pain management; and establishing a database for monitoring prescription drugs. The state is going further this year with regulation. A bill (HB7095) in the House of Representatives would ban most doctors from dispensing certain controlled substances and limit pharmacies to dispensing no more than 5,000 doses of those drugs during any given month. It passed the House on April 21 with only one dissenting vote. The slightly different Senate bill (SB818) would mandate that the state's prescription drug database conform to federal requirements. Also, the Senate bill does not include the 5,000 dose a month limit on pharmacies, on the grounds that many facilities, such as cancer centers and nursing homes, often dispense large amounts of needed painkillers. Neither piece of legislation would repeal existing law requiring a database (Governor Rick Scott pushed for such a repeal early in the session, on the grounds that it would infringe on patient privacy.)

Although other states have not seen the level of prescription drug distribution as Florida, they have been severely affected by trafficking. Among them is West Virginia. According to the state Health Statistics Center, in 2008, the latest year for which data is available, 390 people in the state died from accidental overdoses of prescription drugs. That number has quadrupled since 2001, when only 91 deaths in West Virginia were attributed to prescription drug overdoses. Overdose associated with prescription drugs is now the leading cause of accidental death in the state, accounting for more fatalities than even car accidents. The state has run a prescription drug monitoring program since 1995, but is examining ways to expand treatment and prevention programs.

Kentucky is considered a major destination state for the Florida "pill mill pipeline," an underground prescription drug network weaving north through the Appalachian states. According to Governor Steve Beshear, 82 people die each month due to prescription drug overdoses, making it the leading cause of accidental death in the commonwealth. Kentucky has been operating a variety of prescription drug treatment and assistance programs, as well as a prescription drug electronic monitoring system, for more than a decade, and has become a model for other states, including Florida. The governor's office has pointed out that patients' information has remained secure, and that there has never been a breach in the system.

Georgia, whose rural communities also have been severely affected by the influx of prescription drugs from the "pill mill pipeline," became the most recent Southern state to enact a prescription drug monitoring program. The General Assembly passed Senate bill 36 this year, which establishes a database for tracking prescription drugs and flagging patients who attempt to get multiple prescriptions filled, or "doctor shop," as well as doctors and pharmacies that repeatedly fill such requests.