Prescription Drug Harm and Death: An Epidemic. What Is Being Done?

Safe use of prescription drugs continues to be a key topic for discussion and education. As part of the 2013 Medication Safety Collaborative, this presentation provided a federal-, state-, and local-level overview of ways healthcare providers (physicians, prescribers, nurses, pharmacists) and individuals can take part in contributing to solutions.

In an educational seminar, “Prescription Drug Harm and Death: An Epidemic. What Is Being Done?”, a panel spoke on the perspective of and efforts by federal, state, and local government agencies to address the epidemic of prescription drug overdose in the United States, and ways that pharmacists can contribute to reducing the harm and death caused by prescription drugs.

Marie Link, PharmD, medication safety officer, Aspire Resource, Cleveland, Ohio, opened the session with an overview of the strategy that the federal government is using to address this problem.

Dr Link explained that the White House is leading the strategy with its implementation in 2011 of a new initiative called the Prescription Drug Abuse Prevention Plan. The initiative is in response to data that show an ongoing increasing trend in unintentional deaths by drug overdose from 1970 to 2007, with abuse of opioid analgesics accounting for most of these deaths and causing more unintentional deaths than cocaine and heroin use combined. Among the components of the 2011 Prescription Drug Abuse Prevention Plan are opioid training as a precondition to drug enforcement administration (DEA) registration, substance abuse curricula for medical professionals, opioid prescription guidelines for all emergency departments, and public education programs.

“A number of federal agencies will implement these components,” said Dr Link, who focused her talk on 3 of these agencies: the National Institute of Drug Abuse (NIDA), the US Food and Drug Administration (FDA), and the Centers for Disease Control and Prevention (CDC).

Dr Link explained that the big push from NIDA is to develop incentives for companies to pursue pain management that is addiction free. The agency is in the process of developing a program for pain education within Educational Centers for Excellence in Pain Education (COPE) that will require 12 separate educational components and will cover all clinical disciplines. It also has developed Prescription Drug Monitoring Programs (PDMPs), with 48 currently approved and 44 currently active.

Key efforts by the FDA include its Risk Evaluation and Mitigation Strategy (REMS) programs. Dr Link emphasized that the FDA REMS process is constantly changing, with 100 REMS drugs identified as of March 2013. The FDA requirements for REMS drugs include shifting the responsibility and accountability of drug management from the inpatient nurse back to the prescriber, including the patient in the decision to prescribe the drugs, and forcing the knowledge on the package insert.

Dr Link emphasized that the FDA REMS drug programs are complex and pharmacists and other healthcare professionals need to provide feedback on ways to practically implement these programs. She urged pharmacists to support compliance with REMS, educate patients on the FDA’s guidelines for drug disposal and community drug “Take Back” day, and remind patients that sharing prescriptions is against the law. She commented that nothing should be assumed when educating patients and emphasized the need to reiterate the basics.

Citing a number of statistics from the CDC, Dr Link closed her presentation with a discussion on the strategy by the CDC to reduce abuse and overdose of opioids and other controlled prescription drugs. This includes recommending enhanced surveillance on drug abuse at all levels of government, as well as improving clinical practice by, for example, educating pharmacists and other healthcare professionals on the REMS programs.

Lawrence S. Quang, MD, medical director, Northern Ohio Poison Center, discussed activities under way in Ohio to highlight one state’s approach to handling the prescription drug abuse problem.

Explaining that the statistics in Ohio mirror those found on the federal level in terms of unintentional drug overdose deaths, Dr Quang focused on an initiative in 2010, by the Attorney General’s Office, which identified key areas that needed to be addressed to help reduce prescription drug abuse.

An internal prescription drug abuse working group identified several key areas, and an outside advisory group was then appointed to implement action on the areas. The key areas included working with border states, prosecuting illicit prescribers, improving and increasing the use of the state’s drug monitoring program, developing a drug “take-back” program, and strengthening education and outreach efforts.

According to Dr Quang, who served on the advisory group, the state achieved success in all key areas. One key success was working with border states to control, for example, doctor shopping and identifying patients with potential drug abuse problems. Dr Quang added that Ohio led the way on border control as the first state to implement the interstate data sharing software prescription monitoring program (PMP) developed by the National Association of Boards of Pharmacy PMP InterConnect.

Jeffrey Fudin, PharmD, clinical pharmacy specialist and PGY2 pain residency director, Stratton VA Medical Center, Albany, New York, wrapped up the session with a discussion on the risks of opioid therapy, encouraging participants to mitigate opioid overuse and abuse by, among other things, knowing the advantages and pitfalls of conversion schematics when switching opioids and slowing escalation of opioid doses upon conversion.

Dr Fudin emphasized that pharmacists need to act as ambassadors for the healthcare team and work with regulatory agencies to achieve a balance between effective and safe use of opioids.

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