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Wednesday, April 4, 2012

Ending the Unacceptable American Pain

Drug Overdose Rates by State, 2008

Source:  CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, 1999-2008. MMWR 2011; 60: 1-6.

The Purple People Eater

Let' s look closely at this graphic of drug overdose rates. Particularly, review those states with the highest Age-adjusted rate per 100,000 people (the deep purple states).

The Top Eleven

New Mexico (27)
West Virginia (25.8)
Nevada (19.6)
Utah (18.4)
Alaska  (18.1)
Kentucky (17.9)
Florida (16.5)
Oklahoma (15.6)
Ohio (15.1)
Louisiana  (15)
Pennsylvania (15)

The drug overdose epidemic is most severe in the Southwest and Appalachian region, and rates vary substantially between states. The highest drug overdose death rates in 2008 were found in New Mexico and West Virginia, which had rates nearly five times that of the state with the lowest rate, Nebraska.

Who is most at risk? Understanding the groups at highest risk for overdose can help states target interventions. Research shows that some groups are particularly vulnerable to prescription drug overdose:
  • People who obtain multiple controlled substance prescriptions from multiple providers—a practice known as “doctor shopping.”
  • People who take high daily dosages of prescription painkillers and those who misuse multiple abuse-prone prescription drugs.
  • Low-income people and those living in rural areas.
    • People on Medicaid are prescribed painkillers at twice the rate of non-Medicaid patients and are at six times the risk of prescription painkillers overdose. One Washington State study found that 45% of people who died from prescription painkiller overdoses were Medicaid enrollees.
  • People with mental illness and those with a history of substance abuse
It is mandatory for those who enter the war against drug abuse to be aware of particular areas of concern. Conquering the enemy is a colossal task, and, if Americans are going to succeed, they must apply their talents and skills to the appropriate missions in order to make lasting differences. A grass roots commitment is vital. In fact, anything less will prolong the unacceptable death and destruction caused by the misuse of prescription drugs.

Our community of Scioto County, Ohio, has been maximizing efforts to make one of the most drug devastated areas in the nation a place free of abuse. For years now, community-based task forces, support groups, law enforcement personnel, health officials, treatment facilities, politicians, and others have built a multi-faceted action force that has become a model for other areas of the state and nation.

We, in Southern Ohio, certainly are not abuse free. We understand that the battles we have won are only preliminary successes that will eventually lead to major achievements. And, we have committed ourselves to continue this fight that is long and both physically and mentally exhausting. Without the cooperation of so many concerned citizens, we would have remained mired in an epidemic that eventually would have destroyed our beloved community by uprooting its values and killing its youth.

If the top eleven most stricken states want to place their efforts at the most vulnerable areas, they must:

1. Kill pill mills (pain clinics run by greedy, unscrupulous doctors). And, in conjunction, enact and enforce laws to prevent doctor shopping and the operation of these pill mills. States must also enact other laws to reduce prescription painkiller diversion and abuse while safeguarding legitimate access to pain management services.

2. Tighten up and strengthen existing Prescription Drug Monitoring Programs (PDMPs)  -- electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients.  

3. Insure that state benefits programs (like Medicaid) and workers’ compensation programs monitor prescription claims information and PDMP data (where applicable) for signs of inappropriate use of controlled prescription drugs. For patients whose use of multiple providers cannot be justified on medical grounds, such programs should consider reimbursing claims for controlled prescription drugs from a single designated physician and a single designated pharmacy.

4. Insure that all providers follow evidence-based guidelines for the safe and effective use of prescription painkillers.

5. Take swift regulatory action against health care providers acting outside the limits of accepted medical practice to decrease provider behaviors that contribute to prescription painkiller abuse, diversion, and overdose.

6. Create effective, accessible substance abuse treatment programs that reduce overdose among people struggling with dependence and addiction. And, states must increase access to these programs.

The order is tall; however, as each concerned citizen helps fill even a tiny portion of the list with their crucial assistance, rx drug abuse suffers a tiny chink in its black armor. And, as the community increases its awareness and care of those most vulnerable to the disease of addiction -- the dependent, the financially deprived, the people on Medicaid, the mentally ill -- the work pays dividends for all. So many ills stem or are at least associated with drug abuse. Consider its effect on crime, housing, jobs, education, and health care.

A Monumental Commitment

America must change its fundamental attitude about the treatment of pain. This change must extend to all ages and to all the diverse segments of the population. We must make ourselves, our loved ones, our FDA, our lawmakers, our pharmaceutical companies and lobbyists, our medical community, and our critics more responsible about every aspect of prescription drugs.

As evidenced in current statistics and reports, the problem of abuse is at flood stage. Unfortunately, in some areas of the country (those deep purple states above), the deluge has already drowned vast numbers. These lives are lost; their families are devastated; and their communities shortchanged. And still the killing fields are nourished every day with new bodies. Enough is enough.

I am calling for a march on Washington D.C. to create maximum awareness of the state of our Prescription Nation. This movement must involve the voice of millions and reflect the faces of hundreds of thousands of concerned citizens. The grass roots of America have historically poured from the distant streets, the avenues and the back roads to congregate in our nation's capital in order to give a timely, united voice for desperately needed change. We must commit to make this pilgrimage.

I am one, the smallest segment of any crowd, who gives his word today to gather with others on the National Mall and stand for change. This blog, in particular but certainly not in whole, calls upon the eleven states most affected by overdose to swell the ranks of the concerned. New Mexico, West Virginia, Nevada, Utah, Alaska, Kentucky, Florida, Oklahoma, Louisiana, Pennsylvania, and my native Buckeyes -- Will you come en masse? And the rest of the nation, all the other states so racked with abuse, will you represent your communities and come too?

We should consider the words of Garrett C. Maloney, a local young man who lost his life in a tragedy of rx drug abuse. Every time I read his words, I am strengthened and revitalized in the movement. We must always do our best to spread love.

"We're meant for something greater than all of this.
Let the compassion in your heart
and the discontent with this average life remind you:
the talents we possess and the struggle we have seen,
they are meant to help others.
We were made to spread love.
Fulfill that desire."

-Garrett Maloney, August 17, 2010. 

Garrett C. Maloney
Courtesy of the Maloney Foundation
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