While most single state authorities (SSAs) view prescription drug abuse as a top priority, few have very much input into prescription drug monitoring programs (PDMPs), according to the National Association of State Alcohol and Drug Abuse Directors (NASADAD).
In an inquiry conducted by NASADAD research analyst Cliff Bersamira and presented by executive director Rob Morrison at the national prescription drug abuse summit held in Orlando last week, 48 states reported on their involvement with the PDMP.
“Only about half the states are actually involved at all with their PDMP,” Bersamira told ADAW in an interview with him, Morrison, and NASADAD research director Henrick Harwood immediately following the presentation. “We were surprised.” However, three-quarters of the states found the PDMP data to be useful. “They don’t create it, they don’t run it, but the data is useful to their mission,” he said.
Almost one-quarter (11) of the 47 states who responded said prescription drug abuse was their highest priority. Of the remainder, 27 said it was very important, 7 said it was important, and 2 said it was moderately important. None said it was of little importance or unimportant.
Asked what is driving the SSA interest in prescription drug abuse, Harwood cited media reports of overdose deaths. Last fall, the Los Angeles Times reported that federal data show drug overdoses kill more people than traffic accidents (see ADAW, Sept. 26). “Governors started paying attention,” said Harwood. Still, in most states, the governor is turning to law enforcement, not public health, for housing the PDMP.
There were more than 700 attendees at the conference, with presentations from treatment, enforcement, education, medicine and public policymakers. Gil Kerlikowske, director of the Office of National Drug Control Policy, was there, calling prescription drug abuse the country’s number-one public health problem, while flanked by Gov. Steve Beshear of Kentucky, Rep. Hal Rogers (R-Kentucky) and Rep. Nick Rahall (R-West Virginia). The conference was brought together by Unlawful Narcotics Investigations, Treatment and Education, Inc. (Operation UNITE). Founded in 2003 by Representative Hal Rogers, Operation UNITE is a nonprofit corporation with the mission to combat prescription drug abuse in Kentucky.
It’s significant that NASADAD, representing the SSAs with control over the Substance Abuse Prevention and Treatment block grant, presented at this high-powered meeting, which involved many groups not traditionally working shoulder to shoulder with treatment, such as law enforcement. “When there’s a discussion about something that has a link to addiction, which this does, we should be front and center to help shape the debate,” said Morrison.
‘Opening a door’ for other SSAs
NASADAD supports increased resources for PDMPs, wherever they come from, said Morrison. PDMPs can help law enforcement track down pill mills and unscrupulous prescribers and dispensers. But, when the SSA is involved, they can also help steer the people who are addicted to opioids into treatment. Only three states — Vermont, Maine and, most recently, Maryland — have the PDMP housed in the office of the SSA (see ADAW, Feb. 20). “We do know that Vermont and Maine feel that they can play a productive role, and Maryland sees that as well,” said Morrison.
Usually the pharmacy board in the state is in charge of the PDMP, with SSAs the advisors, said Harwood. “Literally only three of our members have the intimate management oversight of PDMPs,” he said. “This inquiry is opening a door” for SSAs in the states, because the message — that they are very concerned about prescription drug abuse, even if not part of the PDMP — is loud and clear.
NASADAD, whose members comprise all the states with their huge variations in SSA influence, does not have one single position on the role SSAs should be assigned in terms of PDMPs. “But to the extent that a state’s SSA can be involved in anything involving addiction, that person can infuse the PDMP into their own plan,” said Morrison. “For example, what can the data do for referrals?”
Nationally, about 11.5 percent of the people who present for addiction treatment cite prescription opioids as their primary drug of abuse, said Harwood. This percentage represents a quadrupling from 1998 — about the time that OxyContin was introduced — and that has been the percentage since about 2003, he said.
But admission data don’t tell the whole story, noted Harwood. Data from the federal National Survey on Drug Use and Health shows a 40-percent increase in the number of people reporting they are dependent on prescription drugs, with 70 percent of these people saying they are dependent on painkillers.
Finally, national data are not representative of individual states, which in some cases can have much higher admission rates for prescription opioid addiction, noted Morrison. “That’s where the SSAs come in,” he said. “They know what the service needs are for their state.”
States spend 75 percent of their substance abuse budget on treatment, said Harwood. “Seeing the rates of treatment demand for prescription opioids quadrupling, they understand that it’s washing into their systems,” said Harwood. “They know their challenges. They know that methadone and buprenorphine are both very effective strategies. They want to promote access.”
Prescription drug abuse is not new — it has been obvious to SSAs for years, Harwood said. But sometimes, some “threshold event” is needed for policymakers to make changes, he said. Harwood recalled the crack epidemic of the 1980s, which only received attention after basketball player Len Bias died after a cocaine-induced heart attack.
“This was a wake-up call that was overdue, because the cocaine data in DAWN showed that cocaine emergency room admissions had been going up for some time,” he said. “It takes some kind of event to cross a threshold.” The overdoses may be the threshold for prescription drug abuse, he said.
“Our goal in doing this is to identify states that have good strong initiatives and practices and let other states know about that,” said Morrison. “We want to improve all of the state systems by exposing them to what’s working best.”
ONDCP Chief of Staff on prescription drug abuse
Last year, when Gil Kerlikowske, director of the Office of National Drug Control Policy (ONDCP), visited Kentucky, West Virginia and Georgia, Operation UNITE, the group launched in Kentucky to combat prescription drug abuse, discussed with him the idea of having a national drug abuse summit.
“They were very dynamic in putting together a comprehensive program with prevention, education, advocacy, treatment and law enforcement tracks,” said Regina Labelle, ONDCP chief of staff, in an interview with ADAW. “This was a wonderful opportunity to hear experts in the field talking about what can be done. I go to lots of summits and scientific conferences, but what is special about this one is you have parents who have lost their kids, members of the medical profession, policymakers coming together around what we put out in our strategy, the four pillars of education, monitoring, disposal and enforcement,” she said. “It’s great to see the energy and enthusiasm that is going to bear on this problem.”
LaBelle is particularly pleased that “everyone is committed to a wholistic approach — there is no one silver bullet,” she said. “A lot of science needs to go into tamper-resistant formulations. We need to get parents involved. There are steps we can take now.”
As for overdose deaths, most are occurring in white middle-aged men who have a substance use disorder who live in impoverished areas, said LaBelle. “The vast majority of the 20,000 or so fit into this cohort of older people who have had chronic substance abuse,” she said. “They would be candidates for drug treatment. But they are harder to treat because we haven’t intervened early.”