One thing we can do about the opioid epidemic

May 5, 2016

It's a modest proposal with potential for significant consequences. And all it will cost is a little more time.

Most people today do not understand how to reduce the access to these addicting medications. Here’s how the government thinks: “Create a program, give it several billion dollars, and the problem will be resolved.”

Nothing could be further from the truth.

Here is a suggestion that is simple to carry out and won't cost anything near billions of dollars.

Two different issues

First, let's make clear what we're talking about. There are two types of substance abuse.

One is called “tablet abuse” and is exemplified by abuse of medications such as Percocet, Vicodin, Oxycontin, etc.

The other is called “powder abuse,” and involves drugs such as heroin, cocaine, opium, etc.

Tablet abuse consists of three components: a prescriber to write the prescription, a pharmacy that will fill the prescription, and a wholesaler that will resupply the pharmacy.

It's tablet abuse we're talking about. So what can be done to counter it?

See also: High-quantity Rxs for controlled substances

Prescribers

1. Anyone who writes large quantities of prescriptions for controlled substances must be board-certified in pain management.

2. Once they receive board certification, prescribers must obtain an additional license, indicating that they can prescribe controlled substances. This license would include a prescriber number that pharmacists would have to verify in order to secure authorization to dispense.

3. In writing or e-mailing prescriptions, prescribers also should be required to spell out all numbers, e.g., “twenty,” not “20,” which can be altered to “120.” This would prevent any possibility of confusion or suspicion.

4. For those patients who need an emergency supply, the physician can write out a 5-day quanity.

Pharmacists

When the pharmacist calls in to verify the prescriber’s authorization number, the pharmacist should also check the specialty of the prescriber.

Why is this important?

Here's an example from my own experience.

I was once asked to fill a prescription for 120 Percocet. The patient was 46 years old. The prescription was written by a pediatrician. Did this rouse my suspicions? You bet!

If you analyze all the specialties in the healthcare field, fewer than 5% would require a prescriber to write a prescription for large quantities of painkillers. Legitimate prescribers would include oncologists, orthopedists, etc.

So when a pediatrician writes an Rx for 120 Percocet for a middle-aged man, that’s a red flag.

The excuse of the pharmacist that “I am being paid to fill prescriptions, not to be a detective” is invalid. Verification of prescriptions when necessary is part of the job.

See also: Simple rules for preventing sound-alike drug mixups

 

Wholesalers

Lastly, the wholesaler has to look for red flags, such as abnormally large orders for controlled substances.

The wholesaler’s excuse that “As long as the forms are written properly, I will ship to the pharmacy” is invalid. All parties involved in transactions involving controlled substances - wholesalers, pharmacists, and prescribers - are accountable and must be vigilant.

National standards

All laws that are passed must be for all 50 states with no exception. All 50 states must subscribe to and comply with the same standards.

 

The result

These are the basic steps of this plan. If there is no legitimate prescription, these medications will never reach the streest.

Will this process of verification be time-consuming for pharmacists? Maybe. Will it save lives? Absolutely.

The naloxone factor

Any time a drug like naloxone can save a life, that’s outstanding. However, drug addicts are very keen on naloxone. They think it will enable them to keep using with relative impunity, because a first responder can literally bring them back to life after an overdose. So this miracle drug may be having the unintended consequence of encouraging illegal drug use.

Now addicts want to have their own supplies of naloxone. Why? So that they will not have to call for medical assistance in the event of an overdose. They will have the naloxone right on hand - along with the Rx meds or street drugs they plan to get high on. There's something wrong with that picture.

One thing naloxone cannot do is enable these people to get hold of controlled substances and become addicted. Very strict laws such as those I have outlined will keep the majority of these addictive and often deadly drugs off the street and out of the hands of potential drug abusers.