National Strategy to Reduce Prescription Drug Abuse

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The White House released its plan last week entitled "Epidemic: Responding to America's Prescription Drug Abuse Crisis" [LINK to pdf of this 10-page plan]. Below are some of the elements in this plan that is part of the National Drug Control Strategy (like that has worked so well :-/).

The areas of this plan involve education of prescribers and users, monitoring programs, making it easy to dispose of controlled dangerous substances (CDS for short), and enhancing enforcement. The plan establishes thirteen goals for the next five years, and also creates a coordinating body, the Federal Council on Prescription Drug Abuse, to oversee and coordinate it all.

If any of our readers have comments on specific items (I've numbered them for ease of reference), including unintended (or even intended) consequences, please chime in.

1. EDUCATION
1. require training on responsible opiate prescribing
2. require Pharma to develop education materials for providers and patients
3. require professional schools and organizations to include instruction on balancing use of opiates for pain while reducing abuse
4. require state licensing boards to include relevant ongoing education in their licensure requirements
5. help ACEP develop guidelines for opiate prescribing in the Emergency Department [this should be a big help]
6. increased use of written patient-provider agreements
7. facilitate public education campaigns, especially targeting parents
8. encourage research on low-abuse potential treatments, epidemiology of substance abuse, and abuse-deterrent formulations
2. TRACKING AND MONITORING
1. encourage effective PDMP (Prescription Drug Monitoring Programs) in every state, including use of HIEs and connecting with federal health care systems (VA, DOD, IHS, DOJ), and expanding interstate operability of PDMPs
2. support reauthorization of NASPER, which funds PDMPs
3. explore provider insurance reimbursement for checking the PDMP database before writing CDS prescriptions [interesting...might work]
4. reduce "doctor shopping"
5. issue Final Rule on electronic CDS prescribing [finally!]
6. increase use of SBIRT programs, including via EHRs (Electronic Health Records)
3. DISPOSAL
1. expand on "take-back" programs (eg, allowing pharmacies to accept unwanted pills for disposal)
2. develop DEA regs on CDS disposal and educate public on it
3. get Pharma involved
4. ENFORCEMENT
1. increase training for law enforcement personnel and prosecutors
2. aggressive action against "pill mills" and inappropriate prescribers
3. establish a Model Pain Clinic Regulation Law for states to use
4. increase surveillance of prescription drug trafficking
5. use PDMP data to identify "doctor shoppers" and do something about it

This is long enough, so I won't list the plan's thirteen goals; these begin on page 9.

While I am concerned that the enforcement aspects will continue to criminalize actions against people with addictions (which should be viewed more as a health problem rather than a criminal problem, IMO), the increased use of Prescription Drug Monitoring Programs to increase identification of and assistance for people with prescription drug abuse problems should be helpful. Recent articles about the diversion of opiates, even by elderly folks who are supplementing their fixed income by selling their Percocets to neighbors, make it clear how deep this problem is. Some of these interventions have a decidedly Big Brother feel to them. But people are dying, so something must be done.

What I Learned Part III

• More on social media and medicine today. One survey of a surgery department showed half of residents and faculty had public Facebook accounts and a third posted professional information.
• People are using "mindfulness" therapy to treat sex offenders. No studies on efficacy.
• Offenders with bipolar and psychotic disorders are twice as likely to have more than two additional arrests than non- SMI offenders.
• Some criminal defendants try to claim that the government is a corporation, and that they should be tried under contract law rather than criminal law. This is sometimes called a "straw man defense" and may prompt judges to request a competency assessment.
• Defendants who graduate from mental health courts demonstrate improved life circumstnaces with regard to housing, quality of life, symptoms and compliance. Some studies have shown mental health courts to result in improvement for as many as 78% of defendants.
• Court ordered custody evaluators are more likely to recommend paternal custody if the mother is poor or has a history of psychiatric admissions. They are more likely to recommend maternal custody if the father has a history of arrests.
• No suicide prediction tool has a predictive validity greater than 3%.
• Forty percent of patients given opioids for non-cancer pain misuse their meds, 5% become addicted.
• In the UK people with ASPD may be subject to multiagency public protection agreements, sharing information between government agencies.

Coming up tomorrow:
      Correctional risk management and the forensic sciences sampler. Good luck to everyone without power in the snow!