Illicit drug abuse garners headlines and hype, but prescription drug overdoses cause the majority of deaths, so the FDA has a plan for more restrictions.
Each day about 100 people die from drug overdoses in the United States. But it is prescription drug overdoses, not illicit drugs, that cause approximately three-quarters of these deaths.
According to the Centers for Disease Control and Prevention, drug overdose death rates have more than tripled since 1990 and have never been as high as now. In 2008, prescription drugs were involved in more than 14,800 overdose deaths, which is more than those involving cocaine and heroin combined.
In 29 states, the number of overdose deaths from prescription drugs has exceeded the number of vehicle-related deaths, tripled in 10 states, and quadrupled in four.
The misuse and abuse of prescription painkillers resulted in more than 475,000 emergency room visits in 2009 alone, which was about twice as many visits as reported five years prior.
It’s currently estimated that about 6.1 million people abuse prescription drugs in the U.S., with the most commonly abused drugs being prescription painkillers or opioid pain relievers such as Vicodin, OxyContin, Percocet, Xanax, Valium, Adderall and Ritalin.
Although not everyone who abuses prescription drugs ends up in a morgue, a new poll from the Pew Research Center found that most Americans believe that the U.S. is not doing enough to curb prescription drug abuse. Specifically, Pew’s national poll found that only 16 percent of Americans believe that progress is being made when it comes to dealing with the issue of prescription drug abuse.
One reason why so many people turn to these drugs is because they can create a feeling of euphoria. But the drugs often become physically addictive and attempts to quit often leads to painful, physical withdrawal symptoms.
“Patricia” says she used Xanax on a regular basis, and when she tried to stop she had to take time off from work.
“Without the knowledge I was addicted, I went ‘cold turkey,’” she said. “For four days and nights I was bedridden. I didn’t sleep or eat. I vomited. I had hallucinations. On about the third day without Xanax I started to become uncoordinated and unbalanced and bumped into things. On about the fourth day I became really worried when I started having twitching sensations.”
The more prescription painkillers taken, the more likely addicts will take a larger dose so they can experience that euphoric feeling again. The drugs already cause sedation and slow breathing — larger doses can slow breathing so much that it ultimately stops breathing and leads to death.
Additional oversight the key to reducing overdoses?
In an attempt to curb prescription drug abuse throughout the U.S., the Food and Drug Administration has proposed implementing more restrictions on how doctors prescribe narcotic painkillers, including those that contain acetaminophen or aspirin, and reclassifying painkillers that contain hydrocodone to a Schedule II drug from a Schedule III drug — meaning the potential for abuse and addiction is greater.
Under the proposed policy change, the number of refills a patient can obtain before having to check-in with their doctor would be reduced from six months to 90 days, and patients would be required to bring their prescription to a pharmacy instead of having doctors call it in.
But before it can be implemented, the changes would have to be approved by the Department of Health and Human Services as well as the Drug Enforcement Administration, which has long pushed for such a policy.
According to a report in the New York Times, one reason the FDA rejected similar proposals made by the DEA in years past was because the agency was concerned that implementing more restrictive policies related to prescription drugs may create “undue hardships for patients.”
The American Medical Association and pharmacy organizations have expressed their opposition to the proposed policy change, saying the impact on patients is too great and say that the policy may affect how pharmacies operate and who in the medical field can prescribe medications.
While some groups such as the American Chronic Pain Association agreed that some drugs such as Vicodin should only be given to patients with long-term pain, Penney Cowan, executive director of the American Chronic Pain Association said the new rules would make it harder for patients to find doctors to prescribe the medication and pharmacies to fill the prescriptions.
Dr. Janet Woodcock is the director of the FDA’s Center for Drug Evaluation and Research. She said FDA officials were aware that changing the prescribing rules would affect patients, but added that prescription drug abuse has become too big of an issue to ignore.
“These are very difficult trade-offs that our society has to make,” she said. “The reason we approve these drugs is for people in pain. But we can’t ignore the epidemic on the other side.”
Lobbyists for big pharmaceutical companies and pharmacies themselves have long argued that forcing patients to visit their doctors more often was not only an added burden, but would result in more medical expenses. But Woodcock said that any patient that has long-lasting pain should be meeting with their doctor more often if they are in need of “chronic therapy of this magnitude.”
Sen. Joe Manchin III (D-W.V.) agreed with Woodcock and said that failure to implement such a policy will negatively impact “young boys and girls in communities across the nation.”
The issue of prescription drug abuse is a bit more personal for Manchin, since West Virginia has one of the highest rates of prescription drug abuse in the U.S., with 28.9 deaths for every 100,000 people — a 605-percent increase since 1999.
Other states with high prescription overdose death rates include New Mexico, Kentucky, Nevada and Oklahoma.
The state with the lowest rate of prescription drug overdose deaths was North Dakota with 3.4 deaths per every 100,000 people.
Who is most at risk?
When it comes to the type of person that is most at risk for becoming addicted to or abusing prescription drugs, vulnerable members of the population include those who are prescribed prescriptions from multiple providers, those who take high dosages of prescription painkillers, low-income people, and those living in rural areas.
Another group at risk are those who have mental illnesses and/or a history of substance abuse. Mental illness is another public health issue that Americans believe the U.S. has failed to successfully address, with just 19 percent of respondents saying the nation is doing enough to combat the issue.
Although not all who abuse prescription drugs have mental health issues and vice versa, the National Alliance on Mental Illness said the medical profession is not properly equipped to treat patients who suffer from both, and as a result often times only one condition is identified and treated.
According to NAMI, as much as 50 percent of the mentally ill population has a substance abuse problem, but an individual is usually able to hide their drug dependency from family and friends, since most people chalk up unusual behaviors to mental illness and not drugs.