Category: Prescription Drug Abuse

Epidemic Opioid Abuse in Southern Indiana– Continued.

Plenty of drugs to go around!

Louisville Magazine’s August issue included an excellent extended piece profiling the impact of narcotic addiction in Austin (Scott County) Indiana. The sensitive and insightful article by senior writer, Anne Marshall with the collaboration of photographer William DeShazer, is titled, “The Craving.”  The article deserves a wide readership and I recommend it to you.  [Not all browsers may open on-line version of the story available here.]  The title would be appropriate for a late-night horror show, but in real-life, the story is even more scary. This tiny town is ground-zero nationally for epidemics of opioid addiction, HIV and hepatitis, and the other medical and social side-effects of this class of drugs.

Based on visits and extensive interviews, the article makes clear the enormous cost of opioid addiction on entire communities. It is not just the users that pay the price.  Legal or otherwise, the presence of opioid narcotics in communities exacerbates the poverty and social isolation that provide an important foothold for drug addiction and accelerates its grasp on communities large and small. By no means, however, is opioid addiction limited to the poor. To believe otherwise is to to hide out heads in the sand and allow this horror to grow. Some accounts of the epidemics in Scott County worry that the problem might spread to Louisville. Bad news folks! I am reliably told it is already abundantly here. This story could have been written about hundreds of towns and cities, large and small all over the nation, including Louisville.

Admittedly hard to fix– Why tie our hands?
In addition to accounts of human heartbreak, the article highlights longstanding political and institutional barriers to most effectively confront a problem that has always been with us. Detox and treatment options are subject to limitations of both effectiveness and availability. Relapse rates are high. The cost of medical treatment is also high and treatment itself is subject to both provider and patient abuse. Hard to swallow is the ideologically driven political foolishness that ties the hands of those offering effective support like needle exchanges, or playing games with the funding of Planned Parenthood which was providing HIV screening to citizens of Scott County. Perhaps when it is acknowledged that opioid abuse is not limited to the poor, to minorities, or other socially marginalized people, we will hear both the public and their elected representatives singing a different song and making resources other than more prisons available. Sad to think that is what it might take! [Read today’s story in the Lexington Herald Leader about a new federal prison in Eastern-Kentucky promoted as an economic development issue and weep!] Continue reading “Epidemic Opioid Abuse in Southern Indiana– Continued.”

Is HB-1 Working To Decrease Prescription Drug Abuse And Diversion?

Summary.
House Bill-1 passed in 2012 was a landmark legialstive effort to deal with Kentucky’s exploding epidemic of substance abuse. It clearly was effective in acheiving some of its goals, but it seems to have had less effect in some parts of the state and may have done as much as it can. We have improved our ability to collect data about prescription of controlled substances, but we have lagged in taking advaitage of what we have learned. We need to keep trying to do other things. Not all will work as well as hoped for either, but doing nothing is a non-starter.

Press conference(s).
In July, Governor Steve Beshear, Attorney General Jack Conway, Senate President Robert Stivers and House Speaker Greg Stumbo presided over a press conference to provide an update on House Bill 1, the comprehensive prescription drug abuse legislation passed in 2012.  Details presented included that the number of overdose deaths were down, the numbers of prescriptions for commonly abused drugs had dropped, and that 20 pain clinics had been shut down since HB-1 took effect.  Recall that prescriptions for controlled drugs dispensed in Kentucky must be reported to the Kentucky All Schedule Prescription Electronic Reporting (KASPER) database. The number of prescribers enrolled in the KASPER program increased from 75,45 to more than 24,000 with a tripling of queries to the KASPER database for reports on their patients from 811,000 to 2.7 million.  Over a ten-month period, the number of doses of hydrocodone dispensed dropped 9.5% from 198 million to 179 million doses. The number of doses of oxycodone dropped 10.5% from 72 million to 64 million does. Some of the other improvements were not so impressive.  Overdose fatalities over the previous year dropped, but only from 1023 to 1004. The number of physicians disciplined for prescribing violations by the the Kentucky Board of Medical Licensure rose from 53 to only 64.  Some bad news was that the number of overdose deaths attributed to heroin rose from 22 to 143, a forerunner of worse to come.

There is no doubt that HB-1, enacted in July 2012, has had an impact in the right directions, but some of the observed effects were relatively modest and some of the major impacts were probably one-time benefits.  Most of the immediate impact of the bill was either predictable or the result of picking the low-hanging fruit.  The 20 or so “pain clinics” that were shut down were obvious pseudo-medical pill-mills in disguise.  Enrollment in KASPER by prescribers became mandatory with the new law which also required prescribers to make at least some inquiries about their patients before prescribing selected high-risk drugs.  A stunning number of out-of-state licensed prescribers all of a sudden discovered it was too risky to use Kentucky as the drugstore of choice for their prescriptions to abusing co-conspirators.  These changes to the prescriber population alone would be expected to decrease the overall volume of controlled substances entering the system.  The distressing observation remained that use and diversion of controlled prescription drugs remains huge and pervasive.

Oops— Start over!
Even though I had heard last week’s press conference live, I was a few paragraphs into the document summarized above before I realized I was erroneously reading a press release from July 25, 2013 that I had just downloaded from the Internet!   The players from last week’s press conference were the same, but the occasion was the release of a study commissioned by the Cabinet for Health and Family Services and prepared by a unit of the University of Kentucky’s College of Pharmacy.  The report compared two year’s prescribing of controlled substances before HB-1 to that of the following full year ending July 2013.  The July 27, 2015 press conference therefore had a longer follow-up to draw upon but the results were not all that different and not always better than those of two years before. Continue reading “Is HB-1 Working To Decrease Prescription Drug Abuse And Diversion?”

Potpourri of Health Policy Issues in June.

My cup runneth over with potential issues to explore.

June has been a busy month both locally and nationally insofar as things I like to write about. The shame-on-me is that I have not carved out enough time to do so!  In part I am still picking up the pieces after my early spring travels. Exploring how to unpack and deal with the new Medicare prescription drug data base also took a lot of time.  The truth is that I am a slow writer handicapped by a default and probably over-wordy professorial style.  I haven’t even been able to update the Institute’s Facebook and Twitter pages!  What follows is a list of things that occured during the month that I wanted to write about and hope to do so in more detail later.  These are not necessarily in chronological order or of importance.

The Supremes Rock & Rule!
We were presented with two back-to-back major decisions by the U.S. Supreme Court. The first, King v. Burwell, allows federal subsidies of health insurance premiums for low income individuals and their families to continue even if their insurance was purchased in states that chose to allow the federal government to operate their health insurance exchanges.  The lawsuit brought by Obama/Obamacare-haters to limit premium support to insured individuals in states like Kentucky that chose to operate their own exchanges would have essentially gutted the Affordable Care Act (ACA) and tossed millions back into the uninsured category. For the time being, Obamacare stands intact for at least the next year and a half, despite promises by opponents to throw up additional challenges. All our legislators should be working together to deal with a major remaining deficiency of the ACA.  The Act has been very successful in decreasing the number of uninsured people, but it makes little headway against the exploding costs of unnecessary, marginally effective, or for that matter even necessary medical care.  Continuing to forbid the federal government to negotiate over the prices of drugs is a case in point. Subsidies were deemed necessary for a reason! Continue reading “Potpourri of Health Policy Issues in June.”

Narcotic Analgesic Drug Use By Medicare Patients: Continued

What drugs and by which specialties?
When I first looked at the recent release of outpatient prescription drug utilization by Medicare patients, I was immediately struck by how many narcotics were being prescribed by physicians and other medical providers for so many patients. The vast majority of providers prescribed a handful of different and mostly inexpensive opioid drug products to a relatively few patients, On the other hand, a smaller number of providers wrote for many different opioid formulations, some fantastically expensive, for large numbers of patients.  Is good medicine being practiced?  Is it possible to tell? Should we even care?  Of course we should. In this analysis I break down further the utilization of a subset of the most common opioid analgesics, show which medical specialties prescribe the most, and begin to highlight the vast discrepancy in narcotic use among individual providers. From the full CMS database, I extract and make available an Excel file enumerating  prescriptions of selected narcotic analgesics by Kentucky medical providers . Continue reading “Narcotic Analgesic Drug Use By Medicare Patients: Continued”