Effort on to curtail prescription abuse

States, agencies urged to share ideas

Dr. Gregory Bledsoe once found himself arguing with a woman who was angry because he refused to refill her prescription for the pain medicine that had almost killed her.

"She was brought in to the emergency room unconscious from an overdose and had to be revived," said Bledsoe, formerly an emergency room doctor. "Her history showed that was the third time she had been resuscitated. There had been two incidents before."

As Arkansas' surgeon general, Bledsoe is now the state's chief health officer and adviser on health policy. He hopes to get changes in state policy to address the problem of people addicted to legally prescribed pain medicine. Overdose cases are the most extreme example, he said, but wide use of the medicine creates a broad range of problems, from dependency to skewing the health care system's priorities.

Pharmacists and drug abuse treatment professionals agree abuse of legal pain medicine has become a serious problem. So does U.S. Secretary of Health and Human Services Sylvia Mathews Burwell, who invited leading health officials from all 50 states to a two-day conference in Washington last month. Burwell promised support and asked for states to come up with ideas on how to address the problem.

Drug overdoses are responsible for about 38,000 deaths in the United States a year, according to federal figures. Of those, more than 16,000 involve prescription painkillers. Those are only the most extreme cases of abuse.

"The case I'll always remember is that of a young child, less than 3 years old, who died after being run over by a family member who was under the influence of these drugs in their front yard," Bledsoe said.

Legislating a solution will be difficult, said Nancy Hairston of Youthbridge, a Fayetteville-based counseling service. The problem has become so pervasive that many youngsters across the country have at least experimented at "pill-popping parties," she said.

"You can't legislate good parenting," Hairston said. "One of the best things a parent can do is just keep track of what's in your medicine cabinet and keep a check on how many pills you have."

"Another real problem is with the elderly," Hairston said. As a group, they often obtain a wide variety of prescriptions from a variety of doctors, with no one doctor overseeing the mix.

"Those medicines often have undesirable effects when used in combination," she said. "The pharmacists are very aware of this problem and tell the patient about it when they see it."

Efforts to reduce the abuse of pain medicine have the full support of the Arkansas Pharmacists Association, spokesman Scott Pace said. The association is the chief lobby for the prescription drug providers in the state. That group and law enforcement agencies around the state already participate in the Arkansas Take Back Program, encouraging people to clear out their medicine cabinets. Teenagers who abuse painkillers often find them at home. The program collects and safely incinerates the drugs.

Gov. Asa Hutchinson and state Attorney General Leslie Rutledge have also declared they will make curtailing illegal use of prescription drugs a priority. State Sen. Jeremy Hutchinson, R-Benton, chairman of the Senate Judiciary Committee, has said it will be a legislative priority of his.

Bledsoe said people erroneously think a few doctors cause the problem by writing too many prescriptions.

"The real problem was some well-meaning but badly done research in the late 1980s that said if the patient says he's in pain, to treat it," Bledsoe said. "Inadequate science led to ineffective policy, which led to unintended consequences."

He also said that people who were legitimately in pain often struggled to get prescription medicine before those studies came out.

"The pendulum can swing too far either way," he said. "I don't want anyone to suffer unnecessarily, and I don't want any family to suffer because of addiction problems."

Bledsoe attended the Health and Human Services conference called by Burwell, which began Sept. 17. Burwell announced her agency would cooperate in any way to stem the problem of abuse of legal, prescribed opiate pain medicine.

Burwell told the conference attendees that her agency would make anti-addiction and overdose treatment drugs more available by revising restrictions. She also asked states to come up with solutions and policies for the federal government to participate in. The problem has become both nationwide and severe, she said in her speech.

In Arkansas, Act 901 of 2015 was a vital first step, Bledsoe and Pace said. The law allows tracking of how many prescriptions for pain medicine a single patient gets. However, a doctor does not know if a patient is going to more than one doctor for pain medicine unless the physician uses a cumbersome and slow database search, Bledsoe said. Checking any significant number of patients for duplicate prescriptions is too time-consuming to be practical, he said. Updating that system would be expensive.

A deeper problem is how doctors are evaluated, Bledsoe said.

"A big part of how we evaluate a doctor's performance has become patient satisfaction," he said. That factor is part of a metric used by hospitals and clinics, a trend that started in the 1990s, he said.

"That certainly needs to be a part of it, but there's a difference between being a good clinician and giving the patient what he wants," Bledsoe said.

The studies in the 1980s calling for more aggressive treatment of pain and the trend in the 1990s to emphasize patient satisfaction reinforced one other, Bledsoe said. A patient's ability to his pain medicine prescription refilled affected his level of satisfaction.

"When those studies came out that said we ought to be doing more to treat pain, the addictive aspects of these drugs was not fully known," Bledsoe said. "This is not a case of doctors prescribing something they know their patients don't need," he said. "You can't measure someone else's pain. If you ask somebody to rate a pain from 1 to 10 and he rates a hangnail as a 10, you can't prove he's wrong."

Counteracting a problem that has grown for decades will not be easy, Bledsoe said.

"After she was revived, she was sitting up and said she needed her prescription refilled," Bledsoe said of the three-time overdose case. "Her husband and her mother were there. I said no, and she became very upset. Her husband started arguing with me. He demanded to know why. Finally, I said it was because she had a drug problem and that he was her enabler. They started screaming at me and then left.

"The mother was still there. The mother looked at me and, tears in her eyes, thanked me. She said I was first person to be honest with them."

Metro on 10/05/2015

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