Report: States lack strategies to curb prescription drug overdoses

McClatchy Washington BureauOctober 7, 2013 

— Prescription-drug overdose deaths have risen sharply in recent years, and a majority of states are not implementing the best strategies to curb them, according to a new report from a health-care advocacy group.

The report from the Washington-based Trust for America’s Health, which was released Monday, found that 28 states – including Alaska, Pennsylvania and Texas – and the District of Columbia had put in place six or fewer out of 10 promising strategies to lessen prescription drug overuse.

According to the report, prescription drugs are now to blame for the majority of fatal drug overdoses in the U.S., surpassing the number of deaths related to heroin and cocaine combined. Since 1999, overdose deaths from all kinds of drugs have at least doubled in 29 states, and in 10 of those – including South Carolina, Mississippi, Missouri and Georgia – the rate has tripled. In Kentucky, the rate has quadrupled.

“This is a very real epidemic – and warrants a strong public health response," Andrea Gielen, the director of the Johns Hopkins Center for Injury Research and Policy, said in a statement accompanying the report’s release.

The study acknowledges that prescription -drug overdose deaths have grown so quickly that extensive research is lacking on the best ways to prevent them. Even so, a range of methods have been developed based on recommendations from medical, public health and drug prevention experts.

Florida, for example, is proof that a comprehensive approach can lead to improvement, according to the report.

By initiating a range of public health strategies and legislative changes – such as starting a prescription-drug monitoring program and closing “pill mills,” which prescribe and dispense drugs outside the usual standards of medical practice – Florida saw a decrease in prescription drug-related deaths in 2011, the report said. Deaths from oxycodone, a powerful narcotic, alone decreased by more than 17 percent.

The majority of states, though, have been slow to implement strategies.

Only two states, Vermont and New Mexico, scored 10 out of 10 on the indicators the group examined. Four states scored 9 out of 10, including Washington and Kentucky. California, Illinois and North Carolina were among the 11 states that scored 8 out of 10. Five states, including Florida, scored 7 out of 10. Missouri and Nebraska scored 3 out of 10, and South Dakota scored the lowest, with just 2 out of 10 indicators.

Monitoring programs such as the one Florida started are one strategy states can use. According to the report, they can “help identify major sources of prescription drug diversion such as prescription fraud, forgeries, doctor shopping and improper prescribing and dispensing.”

While nearly all states now have such monitoring programs, the report found that they vary dramatically in terms of their funding, use and capability. Only 16 states, for example, require medical providers to use the programs. The District of Columbia has legislation pending to start a program; Missouri is the only state without any at all.

According to the federal Centers for Disease Control and Prevention, bolstering these programs could lead to significant reductions in overdoses, since more than 3 out of 4 people who misuse prescription painkillers use drugs prescribed to someone else.

States also were evaluated in the report on whether they have a requirement that people show identification when picking up prescriptions, along with whether a physical exam was required, whether there was support for substance abuse services and whether there was a pharmacy lock-in program, which requires suspected abusers of controlled substances to use single prescribers and pharmacies.

States such as Kentucky indicate how quickly this epidemic has progressed: While it scored 9 out of 10 in the report’s indicators, it also has the third highest death rate from overdoses due to all kinds of drugs.

“Some places have higher rates of prescribing than others, and also the actual deaths from overdoses tend to be higher in rural communities,” said Laura Segal, a public affairs official with the group.

“A lot of the policies and strategies to try to reduce (the epidemic) are just starting to be put in place, so they are often relatively new, which accounts for some of the lag,” Segal said. “Public health officials expect as more of the strategies are put in place and implemented, that we’ll start seeing more results.”


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