USA TODAY International Edition
FDA cracks down, finally, on deadly painkillers
The deadliest drug problem in America is not heroin or cocaine or even crack cocaine. It’s the abuse of perfectly legal prescription pain medications — familiar names such as Vicodin and Lortab and generic hydrocodone.
Last month, federal regulators finally got around to recommending stronger restrictions on access to these medications by limiting refills and mandating more frequent visits to doctors to obtain prescriptions. Now doctors, who helped create the problem, need to do their share to control it.
Doctors should be at forefront of curbing abuse
Fourteen years have passed since Ronald Dougherty, a doctor and addiction specialist, noticed something odd at his clinic in suburban Syracuse, N. Y.: More patients were addicted to legal drugs than to illegal narcotics. He petitioned the federal government to treat these drugs as the growing danger they were.
Dougherty, it turned out, was as prescient as the federal government was sluggish. Since 1999, overdose deaths from narcotic painkillers in the U. S. have quadrupled. Every day, they kill 45 people and send 1,370 to emergency rooms. By contrast, cocaine kills 12 people a day and heroin kills eight.
One addictive painkiller, hydrocodone, is the most prescribed medication in America — 4 billion prescriptions a year at last count. Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said “doctors caused” this epidemic. “We’re prescribing massive amounts of opiates,” he told us last week, “and patients are getting hooked.”
Dealing with the problem has been tricky. That’s because these medications are indispensable for some people with extreme, chronic pain — particularly from terminal illness that renders addiction meaningless. And because easy access has powerful support from patient groups, drug chains, drug makers and many physicians. These lobbies have impeded the most promising responses.
One of the best solutions is state prescription monitoring programs designed to prevent addicts from doctor- shopping. Some physicians, unaware that a patient is getting multiple prescriptions from several sources, become unwitting accomplices to addiction. Others get rich running pill mills.
Databases to monitor prescriptions and prevent overlap are finally running in almost every state. Pharmacists can record when they fill certain prescriptions, and doctors can check patient histories. But most doctors don’t use these registries — a failure both mystifying and outrageous. Doctors should be in the forefront of combating abuse.
To deal with this, a few states — Kentucky, New York and Tennessee, with more in the works — require doctors to query the database. New York’s database used to get, on average, 10,000 queries a month. In the two months since the mandate, there have been 2.7 million requests.
Florida’s approach — which targeted pill mills and made use of a strong database — cut hydrocodone deaths by 16% in the first half of 2012, compared with the preceding six months.
The Food and Drug Administration’s recommendation can do the same. Patients can only receive three, 30- day prescriptions at a time. They must see a doctor every 90 days to get new prescriptions.
The strict limits could make it harder for some rural or homebound patients to get necessary relief, suggesting a need for some narrow exemptions. But that shouldn’t be used as an excuse for further delay in dealing with such a deadly public health problem.