Who is Responsible for Prescription Drug Diversion?

How Do People Get Prescription Painkillers? | Create infographics

Pill Mills Moving from Florida to Georgia

At the beginning of 2012, prescriptions written at "pain centers" or "pain management clinics" were responsible for at least 7 Floridians dying every day. Thanks to a combination of actions taken by legislators and law enforcement statewide, the number of overdose deaths is finally declining and indicators show that the Florida doctors are practicing medicine, particularly pain management, responsibly.

Meanwhile, in Georgia  the number of mills has surged more than tenfold since the crackdown in Florida and other southern states. The DEA is investigating anyone who moved from Florida to Georgia and opened a pain clinic, but new ones keep poppingup. The legislature might want to take note of Florida's success, and copy some of their tactics, including:

• Entering data in and querying the Prescription Drug Monitoring Program Database
• Passing laws against doctors selling oxycodone, opening "pain clinics"
• Passing laws against drug distributors and pharmacies that sell high volumes of controlled substances
• Committing sufficient resources to prosecute over-prescribing doctors and individuals involved in the prescription pill trade

The last part is critical. The legislature has passed a PDMP law, but the system is not yet up and running. Lawmakers are considering legislation to require stricter licensing for pain clinics, but it's not clear how this program would be managed. 

Killing the Pain Is Killing People

As prescription painkillers become harder to obtain, more expensive and less likely to get you high, opiate addicts in many areas are finding that it's cheaper to satisfy their jones with cheap Mexican heroin. Even though prescription drug-related deaths are have outstripped auto accidents in some areas, heroin is even more dangerous, cut as it is with a variety of chemicals, and of unpredictable potency.

While some areas, like Idaho and Montana, are still wrestling more with methamphetamine abuse (and have passed strict laws to control over-the-counter drugs like pseudoephedrine), more urban regions (like Minnesota, New York, Washington and Florida) are definitely seeing an increase in heroin related deaths and prescription overdoses.

Native Americans experience an overdose rate triple that of the general population, but even suburban parents of promising athletes have been seeing sports injuries tragically turn to opiate addiction, then death by overdose.

We've been sounding this alarm for a while now, but 2013 is the year that we're taking action. Sign up for our tribal drugs of abuse and drug endangered children training program to talk about how this deadly trend is impacting public health, public budgets and public safety in Indian Country. At our regional sessions and our May 1 webinar on the prescription drug to heroin link, we'll provide an overview of the problem and then get to work discussing solutions that will work with the resources we have in our communities. 

CDC Working to Prevent Painkiller Overdoses

In response to the skyrocketing deaths from prescription painkiller overdoses, the CDC put together a handy guide on what they're doing to prevent it, called "Saving Lives and Protecting People: Preventing Prescription Painkiller Overdoses." It's also available for download as a pdf.

The cost of not taking these critical steps is clear:

Overdoses of prescription painkillers (also called opioid or narcotic pain relievers) have more than tripled in the past 20 years, killing more than 15,500 people in the United States in 2009.

Overdose deaths are only part of the problem—for each death involving prescription painkillers, hundreds of people abuse or misuse these drugs:

• Emergency department visits for prescription painkiller abuse or misuse have doubled in the past 5 years to nearly half a million. 

• About 12 million American teens and adults reported using prescription painkillers to get “high” or for other nonmedical reasons.

• Nonmedical use of prescription painkillers costs more than $72.5 billion each year in direct health care costs.

New Decongestant Harder to Use For Meth

Just as pharmaceutical companies have been adjusting the formula for prescription painkillers so it's harder to get an opiate high, Acura Pharmaceuticals Inc has released a kind of pseudoephedrine that is much harder to use as ingredient in methamphetamine. Nexafed contains an inert ingredient that is activated when someone tries to extract the pseudoephedrine, and which prevents crystallization by turning into a thick gel.

We applaud any effort that keeps dangerous drugs off the street and it seems like a promising trend that drug makers are taking ownership of the ways their products can be abused. However, as we've seen with oxycodone and heroin, or even with heroin and Krokodil, drug addicts will find something that meets their need. What does this mean for meth?  We'll be watching as this evolves and let you know.

Battling Heroin in Minnesota Requires Community Coalitions

Read the whole story at Indian Country Today Media Network. The news from Minnesota tribes may be grim, but Walter reminds us that solutions lie in education and community coalitions that battle this problem, starting with preventing and treating prescription opiate addiction.  Besides destroying the user's life and health, heroin use results in increased crime, HIV and hepatitis infections, and drug endangered children living in filthy and dangerous environments. Tribes are working with county, state and federal officials to turn this around, but all concerned community members, from caregivers to teachers and from health care workers to law enforcement officers and Tribal courts need to help with the effort to combat heroin.