Rx Drug Abuse Not Just a Campaign Slogan

Dear Colleague,

Next week has been nicknamed “Opioid Week” in Congress as more than a dozen opioid abuse-related bills will be considered by House committees.

The epidemic of prescription drug abuse is not new. As the epidemic has gone on, it’s hard to find someone who hasn’t been directly or indirectly affected. You probably know someone whose family has been devastated by prescription drug abuse whether that impact was addiction, loss of career, family, or worse. Since 1999 the number of opioid-related deaths has quadrupled.

Pharmacy more than any other occupation respects the power of prescription drugs, and pharmacists more than any other professional, can’t stand to see the core tool of our profession misused. Being on the watch for forged prescriptions and verifying with the prescriber that the quantity, dose, sig, or refills have not been manipulated are just some of the ways that pharmacists do their part to stop abuse. Some community pharmacists also speak to school or civic groups about abuse to discourage inappropriate use.

NCPA’s Dispose My Meds™ was on the leading edge when it launched five years ago. Since then, hundreds of thousands of pounds of medications have been taken out of medicine cabinets and disposed of properly. Even though controlled substances could not be returned to pharmacies until 2014 when DEA issued a final rule allowing for take-back of controls. Dispose My Meds also raised awareness of proper storage and disposal of controlled substances.

While community pharmacy is committed to stopping prescription drug abuse, the tactics must be well thought out and not a knee jerk reaction to this understandably emotionally charged issue. The majority of patients who are prescribed prescription pain medications have legitimate needs and should not be disadvantaged. Community pharmacies should not have to administer another unfunded mandate. DEA and other policymakers should focus on tracking overprescribing, prescribing unnecessarily high quantities, and the small number but highly damaging pill mills.

Congress has dabbled in this arena before. Hydrocodone was rescheduled to a C-II over a year ago. NCPA opposed rescheduling because we doubted that it would have the desired effect of curbing abuse and instead would limit access for the many patients with legitimate pain med needs. Unfortunately, rescheduling has done little to slow down drug abuse, but has added one more hurdle for patients in need of pain medications.

On the other hand, in March the Senate passed the Ensuring Patient Access and Effective Drug Enforcement Act, which would give pharmacies and wholesalers a mechanism to appeal some of the heavy-handed actions the DEA had taken.

Earlier this year, the Senate also passed an opioid bill, the Comprehensive Addiction and Recovery Act, so the two chambers will have to conference the legislation when it passes the House. Among the “Opioid Week” bills that are of particular importance to community pharmacy is one authorizing partial fills of Schedule II controlled substances as well as setting requirements related to the OTC sale of products containing dextromethorphan. Another bill of high interest would require that pharmacies serve as drug take-back sites with funding coming from manufacturers. NCPA continues to meet with committee staff on changes to bills to ensure there are no overly broad or burdensome requirements on community pharmacists.

States are also taking legislative action. New York’s ISTOP (Internet System for Tracking Overprescribing) went into effect March 27. It requires prescribers to e-prescribe controlled substances and to check an improved, real time prescription monitoring program registry. Maine also recently passed a similar law that goes into effect July 1, 2017.

The epidemic of prescription drug abuse is not new, but expect a lot of media attention next week. After all, it’s an election year so politicians will be looking for sound bites to get re-elected. That’s all well and good I suppose, but it’s important that the recent desire to do something results in meaningful changes and not just another campaign slogan.