Author: Justin Mckibben
When discussing the very real devastation of the opioid crisis some people are still skeptical as to how big of a part prescription opioids play in the problem. While all patients should have access to comprehensive care for conditions relating to severe pain, ignoring the fact that prescription drug abuse is a crucial element of the epidemic is far too careless.
Many states had to face the issue of pill mill clinics and doctor shopping. Now one state, in particular, is now taking massive action in hopes of ending a very serious problem that has only grown over the years. Authorities in North Carolina took a close look at how prescription drugs wind up on the streets.
One of the key factors to narcotic medications hitting the illicit market was doctor shopping.
Doctor Shopping Stats
First, let us explain what doctor shopping is for those unfamiliar with the concept. Innovations in Clinical Neuroscience described the practice of doctor shopping, saying it:
“- entails the scheduling by patients of office visits with multiple clinicians for the same agenda, either for a continuing illness or to procure prescription drugs illicitly. As expected, the explicit definitions in the literature vary considerably, with a significant proportion focusing on a given illness episode.”
Essentially, doctor shopping is when patients visit multiple doctors with the intention of having a prescription given and then filled from each physician, giving them an abundance of medications.
Now in the case of North Carolina, this tactic grew a great deal of momentum as the opioid epidemic spiraled out of control in the past few years. According to WRAL, a Raleigh-based news outlet:
- In 2010, the State Bureau of Investigation says there were 88 doctor shopping cases.
- In 2016, that number rose to 184
- That is a 110% increase in doctor shopping incidents!
According to NBC Charlotte:
- Approximately three people North Carolina die every day in due to drug overdoses.
- Around half of those deaths are due to opioid painkillers.
So now, what moves is North Carolina making to try and fight back?
The Strengthen Opioid Misuse Prevent Act
After realizing just how big of an issue prescription drugs were playing into their current drug problem, officials in North Carolina have decided to put measures in place to try and prevent doctor shopping.
Starting January 1st with the new year, North Carolina enacted a new law, referred to as the Strengthen Opioid Misuse Prevent Act. So what does this new measure do?
- It allows doctors to only give a five day supply of opioids for pain from certain injuries, like broken bones.
- After a surgery, it allows doctors to prescribe a seven day supply.
- Refills can be given as needed, but the first refill will be limited.
North Carolina also gave some thought to protecting those in severe need of pain management resources. The new law does not apply to those with:
Local Authorities Unsure of the Future
The executive director of the North Carolina Board of Pharmacy, Jay Campbell, told reporters that while the action is being taken, it will probably never be completely eliminated. Campbell states,
“We’re certainly hoping that we can radically reduce the scope of drug diversion from pharmacies or any place else. But it is a problem that is never going to go away.”
However, Campbell believes there are certain indications of doctor shopping that pharmacists can keep an eye on as well, such as:
- The patient is visiting a pharmacy far outside their normal location.
- The patient brings in prescriptions from doctors the pharmacy is not familiar with.
Officials trying to stop doctor shopping in the area are asking pharmacists to be alert and ask questions when appropriate. Meanwhile, they are also working to develop other means of drug monitoring, including a system in which North Carolina doctors can register when they prescribe opioids to monitor records and catch patterns of doctor shopping.
There may now be some light at the end of the tunnel. Overdose death rates due to many legal prescription opioids are still rising, but they are rising far more slowly than that of fentanyl and other synthetic opioids according to a CDC report. While it is terrible that the death rates are still increasing, the fact that the rate of progression has slowed noticeably could suggest that many of the recent efforts aimed at curbing widespread over-prescribing practices could be starting to have a positive impact on the extent of the opioid crisis.
Medical Detox for Opioids
An important thing to remember is that for those suffering from substance use disorder or a physical dependency to opioids should always seek safe medical treatment in order to get off these powerful drugs. Opioid abuse presents an inherent risk to the body and the brain. Because of the often difficult and uncomfortable withdrawals, detoxing from opioids is best done in a safe medical environment.
Palm Healthcare Company’s detox facilities will offer a more comprehensive model for recovery from opioid addiction. Medical detox consists of both psychological treatment from professionals for both addiction and co-occurring mental health issues, as well as pharmacological treatment from medical specialists who can decide if there are optional medications to help ease the detox process.
What a medical detox for opioids should always do is provide a trained staff to monitor important vital signs like:
- Respiration levels
- Blood pressure
- Body temperature
- Heart rate
Abruptly discontinuing opioids can be painful or even damaging to the body. Make sure to seek the appropriate help. If you or someone you love is struggling, do not wait. Please call toll-free now. You are not alone.
CALL NOW 1-800-951-6135
Author: Justin Mckibben
Despite the fact that over 91 people die every day from an overdose due to prescription drugs, some people still struggle to realize that prescription drug abuse is the driving force behind the current opioid epidemic. According to the American Society of Addiction Medicine (ASAM):
- 4 out of 5 heroin users started out abusing prescription pain medication
- 94% of people in treatment for opioid addiction surveyed in 2014 switched to heroin from prescription opioids.
One of the biggest issues is that powerful opioid painkillers are being overprescribed. Whether due to aggressive marketing tactics used by Big Pharma companies or the corrupt ‘pill mills’ where doctors were dishing out excessive prescriptions of potent drugs to be sold on the street, prescription opioids flooded the neighborhoods across the nation, helping create one of the worst addiction outbreaks in American history.
But it wasn’t just the fact that drugs were making it onto the streets. In general, even legitimate opioid prescriptions were astonishingly high. While too many people still think the only problem is heroin or street drugs, the facts show us that opioid painkillers were still largely overprescribed in recent years, which contributed to the current crisis.
Too ‘Legit’ to Quit
According to the National Survey on Drug Use and Health, nearly 92 million U.S. adults in 2015 were taking a legitimately prescribed opioid. That translates to 38% of the adult American population.
There were an estimated 240 million opioid prescriptions in 2015, nearly one for every adult in the general population. Even the Deputy Director of the U.S. National Institute on Drug Abuse, Dr. Wilson Compton, said,
“The proportion of adults who receive these medications in any year seemed startling to me”..”It’s an awful lot of people who take these, mostly for medical purposes, but within that, a significant percentage end up misusing them,”
So while a lot of these prescriptions were going to treating serious conditions, how many ended up on the street or being abused at home because they were overprescribed?
The same NSDUH survey found that 11.5 million people misused prescription opioids they obtained through illicit means. Overall, Dr. Compton states that these results indicate medical professionals are doing a poor job of appropriately prescribing these medications.
The trend didn’t end there. According to a new report, nearly 3 million people who had surgery in 2016 became persistent opioid users, taking the drugs 3-6 months after a procedure. The report also states that due to overprescribing, 3.3 billion pills were left unused by patients, which left them open for diversion or misuse.
Some pain management advocates insist that pain may end up being undertreated due to the rising scrutiny of opioid prescriptions. Many of these advocates say it is extremely difficult to truly know if opioids are overprescribed because pain is too hard to objectively quantify. Therefore, some patients may actually need more relief resources than others.
Yet, prescribing rates are still, at the very least, questionably high. Especially considering by most estimates that over 50% of opioid pills legitimately prescribed are unused by patients, which suggests significant overprescribing certainly exists.
4 Doctors, 6 Million Pills, 1 Year
One recent case in particular that stands out concerning overprescribing of medications is the story of a small northwestern county in Arizona where 4 doctors prescribed nearly 6 million opioid pills in a 12 month period. The data provided by the Controlled Substances Prescription Monitoring Program did not list the doctors by name, but did give detailed information about the prescriptions.
Out of all 4, the top prescribing doctor is responsible for:
- More than 20,000 opioid prescriptions
- Equaling out to over 1.9 million pills
- That comes to 7,350 pills a day
The second-place prescriber is responsible for:
- More than 15,000 prescriptions
- Equaling out to nearly 1.6 million pills
The other two doctors totally a combined 2.4 million pills prescribed.
The four doctors in question are located in Mohave County, which as of 2016 is home to approximately only 205,249 people. That comes out to about a 30 opioid supply for every single person in that county.
Now while pain may be hard to objectively quantify, these numbers are obviously unsettling. Even the executive director of the Arizona Board of Pharmacy, Kam Gandhi, could not explain why or how these four physicians were able to issue so many opioid pills.
A spokesperson for Attorney General Mark Brnovich declined to specify exactly what actions are being taken by his office concerning this development. However, according to AZ Central Doug Skvarla, who directs the Controlled Substances Prescription Monitoring Program, said that information has been passed on to Brnovich’s office for “an open investigation.”
Illicit Use of Prescriptions
There are plenty other issues with opioid prescriptions being taken advantage of all over the United States. Pain management advocates often argue that the problem isn’t about opioid prescriptions; it’s the people that misuse and divert the medications. In other words, that the people abusing opioids frequently don’t have a legitimate prescription. A lot of opioid pills being abused are obtained illicitly.
Many people won’t use their whole prescription. Many will actually give pills to a loved one who doesn’t have their own pain treatment. Or they will sell their remaining pills. Pill mills and ‘doctor shopping’ allowed for the even worse spread of excessive opioid prescriptions. Like in Illinois, where one individual received 73 prescriptions for opioid drugs from 11 different prescribers and filed them at 20 different pharmacies. In some cases, the individual filled prescriptions at multiple pharmacies in one day.
There is absolutely a high demand on the illegal drug market for prescription opioid painkillers. As a former addict who spent over 7 years using, buying and selling opioid medications on the street, I can say there is plenty of ways to get these drugs without a prescription.
However, if we back-track a little bit, how did so many potent medications get onto the streets if there is no overprescribing?
Feeling the Pain
Pain management is absolutely necessary. There must be resources and effective medications available for those suffering from serious medical conditions or recovering from life-altering procedures. There is no denying that we have to provide effective pain relief options for patients who desperately need it. So, of course, this is a difficult conversation to have, because many people can take these medications are directed and be fine when they are gone. Some people require long-term pain treatment, but it does not result in a severe addiction.
Still, the fact is that if these medications weren’t being prescribed more than medically necessary, they would have never flooded the underground drug marketplace as rapidly and as abundantly as they did. Between doctors overprescribing (sometimes for kickbacks), patients working the system and manipulating physicians, and the aggressive marketing tactics of Big Pharma going unchecked, there are plenty of elements at play.
Undoubtedly when we examine the opioid epidemic we cannot ignore any contribution. We have to make efforts to combat the spread of heroin addiction. There has to be an intensive effort to deal with the incredibly deadly synthetic opioids like fentanyl and carfentanil, and people also have to acknowledge their own choices and do their part to move forward. It might be a difficult and painful process, but it is necessary.
Still, overprescribing of opioid medications cannot be ignored. We should explore all options concerning prescription monitoring programs, enforce current regulations of drug distribution, and develop innovations in pain management therapy.
According to one report, even just a 10% reduction in surgery-related opioid prescribing would reduce:
- The number of excess post-surgical pills available for diversion or misuse by 332 million
- The annual number of patients who go on to persistent opioid use after surgery by 300,000
- Annual drug costs by $830 million
Not only can we do better to treat those suffering from chronic and severe pain, but we can do better to make sure these potent and habit-forming medications don’t end up in the wrong place. For those who abuse prescription opioids, or who have found themselves using heroin, we need to provide safe and effective treatment options. Palm Partners Recovery Center has been treating people struggling with drug dependence and substance use disorder for decades, focusing on holistic and comprehensive care. If you or someone you love is struggling, please call toll-free now.
CALL NOW 1-800-951-6135
(This content is being used for illustrative purposes only; any person depicted in the content is a model)
Author: Shernide Delva
Doctors are supposed to have our best interest at heart. Unfortunately, when money is involved, that might not always be the case. In fact, a new report found a direct relationship between payments doctors receive and the medications they recommend to patients. Physicians who receive payments from medical drug and device makers tend to prescribe more brand-name drugs than generic medications.
ProPublica, the Pulitzer Prize-winning independent newsroom, published the report titled “Dollars for Docs” after analyzing physicians who wrote at least 1,000 prescriptions in Medicare Part D, the government prescription drug program that covers more than 39 million Americans.
The report looked at payment data from pharmaceutical and medical device companies in 2014 and compared that data with medications prescribed by physicians using Medicare Part D during the same period. “Payments” include anything from meals, royalties, promotional speaking, consulting, business travel and gifts. Sure enough, their analysis discovered the more money doctors receive from the medical industry; the more likely they are to push brand-name medications over generic versions.
To be fair, this study was not intended to encourage disdain for the medical industry and greedy doctors. Rather, this study was to analyze the data and research the facts to either confirm or deny suspicions that the public has raised. The medical industry gets scrutinized on a daily basis for being influenced through financial means. This study is the first to confirm one aspect of that suspicion..
Dr. Aaron Kesselheim, an associate professor of medicine at Harvard Medical School, further elaborates by stating the report is less about proving that industry patients sway doctors to prescribe certain drugs, but that it “again confirms the prevailing wisdom … that there is a relationship between payments and brand-name prescribing.”
Is there a difference?
The study also confirms that there is no real difference between brand-name and generic drugs. Generics go through the same FDA standards and often work just as well as name brands for a cheaper priced. Generics are simply not as heavily advertised, so consumers are unfamiliar with the names.
There are some exceptions, however. Dr. David W. Parke II, chief executive of the American Academy of Ophthalmology, explained in the report, that for conditions like HIV/AIDS, generics are typically not available or not nearly as effective. Some complicated conditions leave little room for non-generic options.
“In some cases, there are very appropriate and clinically valid reasons” for doctors who are outliers in their prescribing, he said.
Despite these anomalies, the results prove that as payments increase, brand-name prescribing rates increase steadily as well. For example, the brand-name prescribing rate of internal medicine doctors who received no payment was 19.8% compared to 30.1% for physicians who received over $5000 from medical drug or device makers.
The pattern is much high in states like Nevada where over 90% of doctors received, at least, one payment from a company in 2014. On the other hand, in other states like Vermont, less than 20% of physicians have received payment from a company. Regardless, this pattern is seen widely across the United States.
“You can debate if these payments are good or bad, or neither, but what isn’t debatable is that they permeate the profession,” said Dr. Walid Gellad, associate professor of medicine at the University of Pittsburgh.
ProPublica also listed the top 50 companies that dispense payments and the highest earning doctors as part of its report. You can use their search engine to determine if your doctor has received a drug company payment.
Keep an open mind when it comes to treatment options. Often, generic options are just as effective as more expensive name-brand options. Speak up to your doctor and let them know you want to explore other medication alternatives. If you do not ask, you will never know. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135.