The Obama administration announced on Tuesday a new initiative to reduce prescription painkiller misuse and overdose, a problem that has become the leading cause of death in 17 states, surpassing car accidents — and killing more than 28,000 people annually. The new plan includes increased funding for state prescription drug monitoring programs (PDMPs) as well as an FDA-led program to educate doctors about risks related to opioid painkillers…..
…..do drug monitoring programs work? If they are effective at reducing misuse and deaths, do they also reduce appropriate pain care? Not mentioned in the announcement of the White House plan was a relevant new study led by researchers at the Centers for Disease Control and Prevention (CDC), which compared rates of overdose deaths and prescribing in states with and without PDMPs between 1999 and 2005.
PDMPs collect information about patients' prescriptions in a database and make the data accessible to doctors, pharmacists and sometimes law enforcement. The new study, published recently in the journal Pain Medicine, found that such prescription monitoring had no effect on either overdose deaths or rates of prescribing…..
Advocates for pain patients worry, however, when they see large reductions in prescribing associated with monitoring programs. "The states where there are PDMPs indicate that fewer Schedule 2s are prescribed," says Siobhan Reynolds, a long time activist for pain treatment. "That means that the people with the most severe pain are bearing the burden of all these supposed safety measures."…..
Another difference between New York and Pennsylvania may involve the availability of naloxone, the overdose antidote that can be used to revive victims. Most people who overdose are not legitimate pain patients who mistakenly take the wrong amount, but people who misuse opioids with other drugs, in most cases mixing them with alcohol or other depressants like Xanax. Fully 70% of those who report misusing painkillers do not have their own prescription for them, but obtain the drugs from a relative or friend.
In the mid 2000s, New York State began a major initiative to provide naloxone to addicts at programs like needle exchanges, and to train them on how to save overdose victims. By contrast, Pennsylvania has only a few naloxone programs.
In Illinois, the Chicago Recovery Alliance has distributed more than 11,000 naloxone kits since 2001 — and more than 1,000 overdose reversals have been reported since then, along with a reduction in heroin overdoses…..
Naloxone has not been reported to cause harm if it is used unnecessarily. Its worst side effects tend to be withdrawal symptoms caused by reversing the overdose and therefore blocking the opioid's action on the brain.
But although Food and Drug Administration commissioner Margaret Hamburg acknowledged at a press conference Tuesday that naloxone might be part of the solution to reduce overdose deaths, use of the treatment does not appear in the strategy released by the administration.
The Drug Policy Alliance's reaction to the plan and its ignoring of the genuinely life-saving naxolone:
overdose prevention advocates were dismayed by significant omissions in the plan. Glaringly absent is any mention of a proven, evidence-based intervention called naloxone, an inexpensive generic medication approved by the FDA that rapidly reverses opiate overdose.
The action plan comes with a hefty price tag. ONDCP is requesting a $222 million increase in funding from Congress to implement it. "It's discouraging that the new plan ignores cost effective, proven solutions like naloxone and Good Samaritan 911 policies, while simultaneously calling for hundreds of millions of taxpayer dollars for unhelpful programs like prescription drug monitoring databases. It's described as 'comprehensive,' but in fact it's insufficient," said Meghan Ralston, harm reduction coordinator for the Drug Policy Alliance.
States such as New Mexico and Washington have already implemented Good Samaritan 911 policies, a no-cost solution encouraging people to quickly report an overdose to emergency medical professionals without fearing arrest for minor drug possession. Hundreds of college campuses across the country also have similar policies in place.
Reason on prescription drug monitoring here and here. Me on Arnold Schwarzenegger's idiotic veto of a good samaritan drug overdose plan in California. Jacob Sullum's 1997 classic on the monstrous effects of government obsession with people using "too many" painkillers.