Congress prods agencies to get aggressive on drug diversion

Washington Abuse of prescription drugs has drawn the attention of federal lawmakers, as officials said deaths from overdoses have surpassed those resulting from car crashes or gun violence.

The House Energy and Commerce health subcommittee is conducting a series of hearings to understand a crisis that costs the U.S. health system an estimated $70 billion a year. Nearly 17,000 overdose deaths occurred in 2010, which represented a 313% increase during the past decade. A June 14 subcommittee hearing examined federal government programs designed to counter the problem by curbing diversion of prescribed pain medicines, cracking down on doctor-shopping techniques and shutting down pill mills.

“It is abundantly clear that the prescription drug abuse epidemic is a crisis in the U.S.,” said Rep. Joe Pitts (R, Pa.), the panel’s chair. “However, while we discuss this complicated and dynamic issue, we need to keep in mind that many of these medications that are being abused are also critical for many patients living with chronic pain.”

The panel questioned why some federal government agencies have not been more aggressive in busting pill mills that lawmakers said are operating in broad daylight. Rep. Michael Burgess, MD (R, Texas), held up a tabloid publication during the hearing with advertisements for pill mills offering free initial visits and on-site drug dispensaries.

“They advertise, so we are very fortunate,” Dr. Burgess quipped. “They tell us where they are, their hours and they tell us their charges. So if I can find them … how come law enforcement can’t?”

Response on state and local fronts

Abuse of pain medicines is not just a big-city problem, hearing witnesses said. Federal law enforcement officials have worked with state and local agencies across the country to close pill mills and prosecute health professionals for illegal prescribing practices, said R. Gil Kerlikowske, the White House director of national drug control policy.

Policing and prosecuting these crimes falls to local authorities and state licensing boards, and more than 6,000 officers have received training to investigate pharmaceutical crime, Kerlikowske said.

“The real devastation has been in rural areas,” he said.

The evolution of state-run prescription drug monitoring programs soon could offer more timely data to track addictive painkillers such as opioids. The Substance Abuse and Mental Health Services Administration at the Dept. of Health and Human Services has launched pilot projects to test the integration of state monitoring programs and electronic health record systems in physician offices, emergency departments and pharmacies.

Basic programs are operating in most of the 50 states, except for Georgia, Maryland, Missouri and New Hampshire, according to the PDMP Training & Technical Assistance Center. Missouri is the only state that has not enacted legislation to create a monitoring program.

Increased prevention and tougher safeguards against diversion might be having an effect on misuse and abuse of medicines, said H. Westley Clark, MD, MPH, director of the Center for Substance Abuse Treatment at SAMHSA. The rate of nonmedical use of prescription drugs decreased slightly in 2011. However, the number of Americans abusing medicines each year still has averaged about 15.7 million since 2005.

“It suggests that national, state and local efforts to reduce prescription drug misuse may be having an impact, but there is still much work to be done,” Dr. Clark said.

The American Medical Association has offered free online seminars on prescribing opioids for chronic pain and on opioid overdose. The public health and prevention sessions are available on an AMA website (link).