The prescription drug abuse challenge

October 10, 2011

By Cori Ast

Most Americans would be surprised to learn that more people die from drug-related causes than from motor vehicle accidents. In 2009, at least 37,485 people in the United States died from causes related to drug use - which is higher than the number of motor vehicle fatalities reported that same year. The numbers indicate that the abuse of prescription drugs is playing a larger role in these deaths. Nearly 300 medical professionals, social workers and law enforcement members gathered recently for the Rx Drug Summit at the University of Kansas Medical Center campus in Kansas City, Kan. to discuss what is being called by many a nationwide epidemic.

Prescription drugs are now the second most abused category of drugs, after marijuana, but few prescription drugs are acquired on the street. Instead, 70 percent of abusers obtain their drugs from family or friends. "The problem is now in our medicine cabinet," said U.S. Attorney Barry Grissom.

Abuse in the Midwest

Although the Kansas City metropolitan area is not a center of the epidemic, the Midwest region is far from immune. In 2007, 294 Kansans died from drug-related causes; in Missouri, the total was 730. And several high profile prescription drug-abuse incidents have been reported in the metro over the past several years:

•·  In 2010, Olathe osteopathic physician Wayne Williamson was convicted of illegally distributing prescription drugs. Williamson visited low-income apartment complexes around the metropolitan area, where he wrote prescriptions, often for narcotics, without conducting physical examinations.

•·   Steven Schneider, a former Haysville, Kan., physician, received 30 years in federal prison for his practice of prescribing pain killers that have been linked to 68 overdose deaths.

•·   Kevin Martin Cummings, of Kansas City, Mo., was convicted for conspiracy to distribute more than $1 million worth of oxycodone, much of which was obtained by defrauding Medicare and other insurers.

However, prescription drug abuse is definitely not a problem exclusive to large urban areas. Overland Park police reported five oxycodone deaths in 2010. Michael Joslyn, a patrolman and evidence custodian for the Basehor police department, said his department has seen an increase in the prescription drug problem and officers have begun to discover prescription drug issues during routine traffic stops.

Health care providers play detective

William Pankey, MD, chief medical officer for Swope Health Services, attended the Rx Drug Summit because health care professionals in his clinics see patients with chronic pain. Sometimes his workers have trouble sorting the "legitimate from the illegitimate."

 "Doctor-hopping and the number of prescriptions [patients can get] from other locations are always at issue," Pankey said. Because of legal repercussions, he added, "There are more than a few doctors who are afraid to take on chronic pain patients."

At Swope Health Services, health care workers manage chronic pain patients but handle each one individually, sometimes verifying records with the State Medicaid Claim database in Missouri and with K-TRACS, Kansas' new system for prescription drug monitoring. K-TRACS became fully operational in September and is one of 35 prescription drug monitoring programs in the country. 

Although these systems are helpful, Pankey doesn't believe the problem can be solved with monitoring alone. As long as there are paper charts, his clinicians will face tough choices in writing prescriptions. Patient history is important in dealing with patients, particularly chronic pain patients, said Pankey. "But getting medical records from another practice is not rapid," he explained. "That can leave the provider with the decision whether to prescribe narcotics during the visit or not, with incomplete information."

Mom's Medicine Cabinet is the New Liquor Cabinet

Drug Enforcement Agency division program manager Scott Collier said the prescription drug abuse problem is particularly acute for teens. Misuse of prescription drugs is the new gateway to more familiar illicit drugs like heroin, he said. 

Collier said people often mistakenly assume prescription drugs are safe, believing "they're not drugs, they're medicine."  As a result, he said, teens are more likely to obtain drugs from their parents' medicine cabinets.  Once teens get addicted to the high, some are making a switch to heroin, according to Collier, which is cheaper in some areas than Oxycontin but produces the same effects. "The brain doesn't care if they're prescription opiates or heroin," Collier said.

 "You don't think it could be your kid," said Overland Park pharmacist Connie Redmond, a mother of two teenagers, who said after attending the summit, she planned to properly dispose of any addictive substances in her medicine cabinet. Redmond said she was surprised to hear some of the ways legal prescription drugs were being misused, such as mixing crushed pills with water to eliminate the time-release mechanism from pills like Oxycontin. "It takes experience to catch prescription drug abuse as a pharmacist, but I'm not trained in the illegal uses of drugs," said Redmond.

A collective problem calls for a collective solution

 At the summit, U.S. Attorney Grissom called on all professionals to solve what he called the nation's fastest growing drug problem by working together.  The solution, Grissom said, has four key components: public education about the problem; the establishment of high-quality drug monitoring programs; proper disposal of unused medication; and the assurance that law enforcement agencies will prosecute anyone who violates prescription drug laws.

"No one can solve this problem alone," said Grissom. "We must build partnerships across bureaucratic and political lines to make a difference."

Last modified: Oct 25, 2011