COMBATING THE GROWING ABUSE OF PRESCRIPTION DRUGS
This national calamity has hit rural states particularly hard. The federal Drug Enforcement Administration reports that the diversion of prescription painkillers – Oxycontin in particular – is an emerging threat in many rural states.
No state, however, has been hit harder than Maine. The number of accidental deaths in Maine from drugs increased six-fold from 1997 to 2002, jumping from 19 to 126. Prescription drugs were present in 60 percent of those deaths last year. According to the 2002 Maine Youth Drug and Alcohol Survey, an alarmingly high 25 percent of the state's high school juniors and seniors abuse prescription drugs.
In my capacity as Chairman of the Senate Government Affairs Committee, I recently held a special hearing in Bangor to investigate this problem further, and I was joined by Senator John Sununu of New Hampshire. We heard from witnesses ranging from law enforcement officials and medical experts to drug addiction counselors and community activists, and their testimony will help us begin to address this growing threat to our communities.
The category of prescription drugs most prevalent in this epidemic consists of opiate painkillers classified as Schedule II drugs, the federal designation given to legal drugs with the greatest potential for abuse and addiction. Many accidental drug deaths involve a mixture of substances – alcohol and other types of pills – but Schedule II drugs like Oxycontin have increased significantly as a primary or contributing cause of death. The abuse of Oxycontin in rural regions occurred swiftly, and now another Schedule II drug – methadone – is showing up with growing frequency in autopsy reports. In Maine, methadone was the cause or contributing factor in four deaths in 1997; last year, it was present in 46. The federal Drug Abuse Warning Network reported that in 2001, nearly 11,000 people turned up in emergency rooms after abusing methadone, almost double the number of such visits only two years before. Methadone, a synthetic opiate, functions both as a painkiller and as heroin substitute for those attempting to overcome addiction. In recent years, its use as a painkiller experienced a resurgence as physicians became increasingly wary of prescribing other better-known painkillers. Used properly, methadone is a beneficial drug, but as the overdose numbers prove, it is a killer when used improperly.
There are no national data comparing the amount of misused methadone that originates from pain prescriptions versus methadone coming from addiction-treatment clinics. State-by-state anecdotal evidence suggests that treatment clinics account for one-third to one-half of the diverted medicine. Although the majority of methadone overdoses may well come from pain prescriptions, the impact of treatment centers as a source is significant and troubling.
The dramatic increase in methadone abuse and deadly overdose coincides not only with a crush of new prescription opiate addicts needing treatment and with methadone's resurgence as a pain medication, but also with the changes in the federal regulation of addiction treatment clinics in 2001. Two significant developments occurred: the number of doses a clinic client could take home to avoid daily clinic visits was increased greatly; and second, a therapy of mega-doses, doses many times greater than what had been standard, gained acceptance.
But it is not just methadone and other Schedule II prescription opiates like Oxycontin doing the damage. In state after state, medical, treatment, and law-enforcement authorities are reporting an ever-expanding array of prescription drugs being diverted from their intended purposes to illegal purposes. These drugs are less notorious and subject to less scrutiny, and increasingly are being abused in combinations that result in addictions, dependency, and overdoses that are extremely difficult to treat. As we heard in our hearing, the means by which these drugs are diverted range from petty theft to "doctor-shopping" and organized criminal activity.
It is tragically ironic that, while our streets are awash in diverted prescription medications, the under-treatment of pain in legitimate patients remains a national problem. The American Medical Association reports that each year some 13 million Americans suffer from pain that could and should be relieved. A primary reason for this, according to the AMA, is that honest and caring physicians are increasingly reluctant to prescribe adequate pain relief, lest the drugs be diverted and lead to addiction and overdose, and for fear that their prescription practices will be investigated.
It will not be easy to remedy this problem, but there are steps we can take that may help. Increased funding for drug enforcement and for substance abuse treatment programs, as well as an electronic prescription monitoring system that would alert doctors and pharmacists to customers attempting to obtain prescription drugs through multiple doctors, could make an important difference. It may be helpful to provide seed money for such a tracking system through federal legislation, an approach my colleagues and I will consider. And, most of all, we need to educate the public to the dangers of abusing prescription drugs. The experts told my committee that many individuals who would never think of trying heroin or cocaine mistakenly believe that they can abuse prescription drugs with impunity.
The diversion of prescription drugs must be brought under control, but at the same time, we must be mindful not to interfere with access to pain-relieving drugs by legitimate patients. As I investigate this problem further, I will work to reduce the abuse of prescription drugs that is harming so many communities, while protecting those patients who rely on these drugs for their intended purpose.
