Addressing Prescription Drug Abuse

Christopher M. Jones, PharmD, MPH, LCDR, USPHS, a subject-matter expert on prescription-drug overdose in the CDC Injury Center’s Division of Unintentional Injury Prevention explained in a CDC blog posting that CDC believes that improving the way drugs are prescribed can help reduce the number of people who are abusing and overdosing on prescription painkillers. 

Prescription drug monitoring programs and patient review and restriction programs also are measures that can address prescription drug abuse in the U.S., he said.

“Prescription drug monitoring programs — which track controlled substance medications in a state — are a tool used by healthcare providers to identify patients who may be at risk for an overdose. Patient review and restriction programs require patients who are inappropriately using controlled substances to receive them only from one physician and one pharmacy,” he wrote. “Both of these programs can improve patient care while also helping to reduce abuse and overdose.” 

The Indian Health Care Improvement Act, enacted in 2010, requires the creation of a prescription drug monitoring program for IHS, tribal and urban healthcare facilities. IHS is working on implementing the monitoring program, the agency told U.S. Medicine.

According to the IHS, the agency “has set in motion a plan that will establish electronic connectivity between IHS facilities and the Prescription Monitoring Program database of the state in which the facility resides,” IHS officials said in a statement. “Connectivity will be completed for all IHS and urban Indian programs and will be offered to tribal programs by January 1, 2013. So far, connectivity has been established for all IHS facilities in North Dakota, South Dakota and Minnesota. Test sites are being selected for all other states containing an IHS, urban Indian or tribal program. Work is ongoing.”

Other efforts also are in place, according to IHS. From 2002 through 2011, the IHS reports it has provided 29 training sessions for Office-Based Opioid Therapy. IHS also has trained 200 physicians and 200 midlevel practitioners in the use of buprenorphine, which is employed to manage drug addiction.

IHS officials also said the agency has increased surveillance of in-house controlled-substance utilization at the facility, area and headquarters levels.

“IHS Service Units are required to perform perpetual inventories of all CII drugs, and monthly or more frequent verification of the validity of all controlled-substance prescriptions. All controlled substances are ordered electronically. These orders are now monitored by the National Supply Service Center, the Prime Vendor and individual Area Offices. Area pharmacy consultants are required to review Service Unit control systems annually.”

The agency also charged a multidisciplinary Pain Management Taskforce with studying the problem and developing a national pain management policy. That policy now is going through an approval process, according to officials.

“The policy details system controls that should be in place at the area and service unit levels, requires the signing of a pain agreement between the prescriber and the patient, defines what should be done if the agreement is broken, requires urine drug testing, requires medication counts, requires a local Chronic Pain Management Review Committee and generally empowers the prescriber to enforce the agreements,” IHS officials said. “In addition, the policy encourages facilities to join state run controlled substance reporting systems that monitor patients going to multiple providers.”

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