States fight prescription drug addiction epidemic with patient contracts, data tracking

With prescription drug abuse worsening throughout the country, officials in several states are working aggressively to raise awareness of the problem and develop solutions. In Nebraska, for example, a state patrol investigator recently called prescription drug abuse an "epidemic" in the state, according to a press release from the University of Nebraska Medical Center (UNMC).

Meanwhile in Vermont, a recent report from the state medical society contends that the state loses about one resident per week to a fatal drug overdose.

In Maine--a state with the highest per-capita rate of opiate addiction in the nation--the number of babies born with opiate withdrawal symptoms has skyrocketed, as have robberies of pharmacies, the Lewiston-Auburn Sun Journal reported.

Part of the problem has to do with the evolution of how physicians treat pain. When opiate narcotics were first introduced for pain management, there was thought to be "little risk of developing the self-destructive behavior characteristic of addiction," according to a 1990 report from the Sacramento-El Dorado Medical Society, UNMC reported.

However, many of the medications on the market today absorb into a person's body very quickly and have a short half-life of staying in one's system, making them extremely compatible with addiction, said Aly Hassan, assistant professor of psychiatry at UNMC's College of Medicine.

The Vermont Medical Society's Cy Jordan, a former primary care physician, agrees. "These medications are much more addicting," he said in a statement. "There's a bigger downside than was thought in the medical community. And there's a higher awareness of that now."

The scrutiny on prescription painkillers has become so intense, in fact, that a recent survey from WebMD found that 15 percent of doctors said they would be willing to undertreat a patient's pain if they feared that person could become addicted to the medication.

Many physicians, indeed, feel cornered between a rock and a hard place when it comes to treating patients' pain, noted Vermont's Cy Jordan. For that reason, the medical society recommends that practitioners adopt a single, comprehensive set of guidelines for treating chronic pain. These standards would include recommendations for shared decision-making in the treatment of chronic pain and recommendations for informing patients of the risks of opioid therapy, among other guidelines.

The Vermont report also suggests that the state's prescription drug-monitoring program, similar to that adopted in other states, can be improved, in particular, by updating its data more frequently.

In Maine, which also recently created a drug-tracking database, the state Board of Licensure in Medicine and the Board of Osteopathic Licensure reviewed and updated its existing prescribing guidelines in 2010. In following part of those recommendations, many Maine doctors today require their pain patients to sign controlled-substances contracts, in which they agree to submit random blood or urine samples to ensure their prescribed medications are in their systems (and therefore not sold to someone else) and that other drugs are not present.

The contract "re-emphasizes the fact that these are serious medications that actually have a strong addiction potential," Michael Kelley, chief medical officer of behavioral health at St. Mary's Regional Medical Center in Maine, told the Lewiston-Auburn Sun Journal. "I actually want my patients to be a little scared of these medications."

To learn more:
- read the statement (.pdf) from the University of Nebraska Medical Center
- check out the story from Vermont Public Radio
- see the white paper from the Vermont Medical Society
- read the article from the Lewiston-Auburn Sun Journal