Reply to Study of Rx Drug Monitoring Programs – Health Affairs – June 2016 – David L. Evans, Nurse Practitioner
I’m encouraged by this professional’s response to yet another study about opioid prescribing that refuses to acknowledge that none of these restrictive policies are diminishing overdoses.
More money is still being spent on creating and studying methods to reduce opioid prescribing, which only serves to deflect our attention from the real problem, which is the increasing rate of addiction in America.
It seems blatantly obvious that to decrease overdoses, we must decrease addiction.
All our expensive and draconian efforts to restrict the supply of this era’s drug of choice only drives addicts to seek out a new or different drug to soothe their compulsive cravings.
Creating supply shortages has no effect on addiction because the addiction resides in the person, not the particular drug, and countless other mind-altering substances either exist already or can be created in a lab.
Addiction has been present in humans (and some animals) for millennia and opioids, first prescription medication and then much cheaper heroin, are only the latest substances being abused after previous eras struggled with addiction to cocaine, crack, and methamphetamine.
Here is the useless, misdirected, and pointless study:
State prescription drug monitoring programs are promising tools to rein in the epidemic of prescription opioid overdose.
No, it’s an epidemic of heroin overdoses, which far surpass the number of overdoses of prescription opioids.
We used data from a national survey to assess the effects of these programs on the prescribing of opioid analgesics and other pain medications in ambulatory care settings at the point of care in twenty-four states from 2001 to 2010.
We found that the implementation of a prescription drug monitoring program was associated with more than a 30 percent reduction in the rate of prescribing of Schedule II opioids.
This has mainly affected pain patients who need these medications. It has no effect on people who overdose on heroin.
This reduction was seen immediately following the launch of the program and was maintained in the second and third years afterward. Effects on overall opioid prescribing and prescribing of non-opioid analgesics were limited.
Increased use of these programs and the adoption of new policies and practices governing their use may have contributed to sustained effectiveness. Future studies are needed to evaluate the policies’ comparative effectiveness.
Effectiveness at doing what? These programs are certainly not preventing heroin overdoses.
When effectiveness is judged by the number of opioid prescriptions, only pain patients are targeted because the CDC’s own statistics show that most opioid addicts have moved on to heroin by now.
Below is a nurse’s critique of the efforts to restrict opioid prescribing:
Opioid prescribing has been decreasing for the past 3 years, according to the Centers for Disease Control and Prevention.
During this period, deaths due to drug overdose have increased, in some communities dramatically. In our efforts to serve as moral arbiters for our patients’ pain, using invasive monitoring of medical information — some of which should probably remain private — we have no evidence that our opioid reduction efforts have reduced overdoses.
Indeed, what evidence we have suggests that as opioids and subsequent clinician monitoring decreased, heroin use increased substantially.
Thus, this article is relatively meaningless unless statistics regarding heroin use in lieu of opioids are also included.
Lumping together prescription medication users and heroin users makes it impossible to develop effective policies to address the ever increasing numbers of heroin overdoses.