Problem
1. Opioid abuse increasing among older white women. While heroin overdoses are more common among blacks, prescription painkillers overdoses are more common among middle-aged, white females, according to findings reported at the American Public Health Association meeting.
Although prescription drug abuse has often been seen as a rural problem, urban hospitals saw 26 percent more prescription opioid abuse cases than rural hospitals, according to Jay Unick, PhD, of the University of Maryland’s School of Social Work, and his colleagues. The study, funded by the National Institutes of Health, looked at data from the Nationwide Inpatient Survey and included data from 5 to 8 million hospital admissions to 20 percent of U.S. community hospitals.
While hospitalizations for heroin remained the same from 1997-2007, the hospitalizations for prescription opioid rose from two per 100,000 people in 1993 to more than 12 per 100,000 people in 2007.
2. Medicare prescription drug abuse is rampant. Thousands of Medicare beneficiaries received multiple prescriptions painkillers and other narcotics, signaling an increase in prescription drug abuse, according to the Government Accountability Office. The report found that 170,000 Medicare beneficiaries received prescriptions from five or more medical professionals for 14 different frequently abused drugs, such as hydrocone and oxycodone products including OxyContin and Percocet. The drugs were obtained under Part D of Medicare, which covers prescription drugs.
3. High rate of pain drug abuse linked to heavy prescribing. Oregon had the nation’s second highest rate of non-medical use of prescription painkillers in a recent CDC report and the high usage can be linked to increased prescriptions.
According to an Oregon Live report, in 2010, the state of Oregon prescribed 11.6 kilograms of opioid pain relievers per 10,000 people — much higher than the national average of 7.1. However, the overdose rate in Oregon was 11.7 per 100,000 people, which is lower than the national average of 11.9.
4. Chronic pain and prescription drug abuse costing $323 billing per year. Chronic pain and prescription drug abuse cost the U.S. more than $323 billion annually, according to a study by consulting firm Laffer Associates and the Millenium Research Institute. The study authors proposes the increased use of urine drug tests to determine whether patients are taking their prescribed medication, additional medication or supplemental medication or illegal drugs or alcohol. The economic benefit of increased use could be as high as $25 billion — more than three times the cost of the testing itself. This study is the first cost-benefit analysis of UDT in the U.S.
Solutions
5. State regulations increasingly restrict pain management physician practices. New state regulations are moving away from regulating just “pill mills” to setting up restrictions for physicians practicing pain management, according to an American Medical News report.
Some of the strictest regulations are in Washington and Ohio, the report said. A new Washington law, which passed in July and which will go into effect in January, requires physicians and patients to sign “patient contracts” as well as provides guidelines for evaluating and treating patients with chronic non-cancer pain. In Ohio, physicians working at clinics where more than 50 percent of patients are prescribed opioids are required to complete 20 hours of pain medicine continuing education every two years.
6. Drug monitoring programs could lower healthcare costs. Congressional hearings were recently held on “Costs of Prescription Drug Abuse in the Medicare Part D Program,” according to an Ameritox news release.
The hearings point toward medication monitoring as a potential solution for improving adherence to pain medication, preventing drug diversion and helping to lower national healthcare costs. The company cites several studies supporting this position, including one that found patients on chronic opioid therapy were more likely non-adherent and had a 14 percent higher healthcare cost as well as 35 percent more hospital days.
According to the report, published in The American Journal of Managed Care, the study also found that patients who were adherent to their opioid regimen had approximately 12 percent lower annual costs than non-adherent patients.
7. Protein responsible for drug withdrawal response pinpointed. Researchers at the University of Sydney have pinpointed a protein in nerve cells that drives the withdrawal response, according to research published in the Nature Neuroscience journal.
The protein, called GABA transporter 1, produces excessive electrical activity in the brain that causes nerves to behave strangely and produce withdrawal symptoms such as chills, sweating, cramps and elevated heart rate. Researchers hope the findings will lead to new medication to treat withdrawal from opioids and other drugs.
8. Guidelines on opioids for pain can help avert adverse events. Individualized care plans, safe administration of pain drugs and appropriate monitoring practices can avert serious adverse events from opioid drugs for chronic pain patients, such as unintentional sedation and respiratory depression, according to a Pain Management Nursing report.
A panel appointed by the American Society for Pain Management Nursing also noted that combining analgesics to target different causes of pain, known as multimodal analgesia, requires more aggressive assessment and monitoring. The panel’s recommendations are based on current research and guidelines for opioid analgesics and a nationwide survey on current monitoring practices by nurses.
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