Health Care: an Unwitting Drug Cartel?

Health Care: an Unwitting Drug Cartel?

By Dr.Fourkan Ali

The war on drugs has waged on for years. Despite monumental efforts, significant victories have yet to be realized. The biggest changes occur in the types of drugs abused and the arena where the activities are played out.

One of the great plagues facing our society today is opiate abuse. Many drug users have a history of starting their path by becoming dependent on prescription medications such as opiates. This frequently starts after an illness or injury resulting in significant pain. Once the addiction begins, turning back is a difficult task.

The U.S. prescribes the most opiates in the world. These drugs include things like oxycodone, hydrocodone, morphine and methadone. In 2012, 259 million prescriptions were written for opiates, representing a 340 percent increase since 1991. The prescribing of other drugs such as stimulants, also frequently abused, increased from 5 to 45 million in the same period.

And, hand in hand with increased prescribing, there has been a concomitant increase inunintended overdose deaths by 137 percent in 14 years. In 2014 alone, there were over 47,000 deaths attributable to unintended overdose, or one death every 11 minutes. Add to this that heroin, a serious drug of abuse, often follows opiate abuse. In fact, 80 percent of heroin users have a past history of opiate use. Once the prescriptions run out or the supply dries up, users turn to such street drugs. And, if the result is not mortal demise, downstream effects are rampant; increased risk-taking behavior associated with drug abuse can result in destruction of health with infections such as hepatitis and HIV, poverty, loss of family, friends, and employment, and the despair and depression that naturally follows.

One must question how so many Americans get their hands on these drugs. To be transparent, most are obtained through the health care system. While we are diligently working on the culture of patient safety, we have created other realms as well: a culture of trust and a culture of catering. Generally as prescribers, we take patients at their word. It can be difficult to discern people's tolerance of pain. When they state they need medication to control it, we trust that they are truthful. In the medical-education system of decades past, little time was spent on recognizing and managing drug-seeking behavior. This is evident in the fact that many of the current drugs are prescribed by longtime health care practitioners.

In addition, there has been tremendous emphasis on patient satisfaction in the last decade, such that institutions with lower scores are even penalized by the threat of withholding payment. This has led to a blurred line between appropriate care and catering to the patient demands more often than in years past. The result of this equation is often increased prescribing of narcotics, thus feeding the addiction.

Another aspect of increased access occurs in health care facilities themselves. Opiates and other narcotics have their place in medicine: For those with true need, they provide adequate pain management. They are available to those in the acute care setting. However, since 1 in every 10 health care workers has a history of drug abuse or alcoholism, you can see an equation for danger.

Drug diversion is a medical and legal concept involving the transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for illicit use; health care workers are not immune from this process, either when supporting personal use or selling and supplying drugs to others. This is a very different scenario than the drug cartels we typically associate with the illegal drug trade, but it's a real scenario nonetheless.

The U.S. has stepped up efforts to control prescription drug use in the last few years. Federal agencies such as the Drug Enforcement Agency have led efforts to curtail the accessibility of these drugs on the streets and in hospitals. The duty of the DEA is to prevent diversion and abuse of drugs while still assuring adequate supply for those with true need. Not an easy task, but by partnering with local authorities and hospitals, inroads have been made.

Programs such as the National Take-Back Initiative occur semiannually in all 50 states. On these days, drugs can be dropped off at designated police and fire stations as well as pharmacies with no questions asked, so that unused medications may be taken out of circulation and destroyed.

Hospitals and medical practices are counseled to always see patients prior to prescribing; limit the dose and duration of medications prescribed; use and lock up tamper-proof prescription pads at all times; and consult addiction specialists when there's concern that drug seeking is occurring. Pharmacies are also tasked with careful oversight to monitor who is giving out medications and to recognize anyone who seems to be giving lots of opiates to patients. The goal is to identify potential diversion in this high-risk population and get them the necessary assistance if addiction is indeed identified. With the high rate of physician burnout and suicide, careful attention must be paid to any evidence of high-risk behavior.

Most states now have Narcan available for use by law enforcement and fire rescue. This drug has the potential to reverse the effects of some medications and can prevent death due to unintentional overdose. While some may find this controversial, it certainly has saved lives, since time is crucial during overdose scenarios. In addition, several states have drug-monitoring programs, where prescriptions for opiates are placed into a database, allowing tracking by the DEA. Several states like Florida and New York have seen major success with these programs, decreasing drug overdose related deaths by 35 to 75 percent.

Yes, the war on drugs rages on, adding new twists to the plot with each passing decade. There is definitely a place for these medications in health care but we must be aware how the medical field is an accomplice in the supply that feeds addiction, at times unwittingly. We need to trust but still dissect. We need to satisfy pain needs but not cater to drug-seeking behavior. We need to just say no.

Source: Website