Balance

Balancing medical use with the growing danger of Prescription Drug Diversions.


Balance, yes, balance. Even Gil Kerlikowske, the Director of National Drug Control Policy in the Executive Office of the President,  used the term “balance” in his testimony to a hearing of the House Committee on Energy and Commerce Subcommittee on Commerce, Manufacturing and Trade this morning.   That committee heard submissions from a number of people on the topic “Warning: The growing danger of prescription Drug Diversion.”

“Although potentially beneficial when used as prescribed by a healthcare professional for legitimate medical purposes in the usual course of professional conduct, prescription drugs can be just as dangerous and deadly as illicit drugs when misused or abused. We must ensure that prescription drugs are only used as prescribed and by the person for whom they were prescribed. A comprehensive, multifaceted approach is required to address this epidemic. Because the prescription drug abuse problem poses unique challenges, it is important to balance prevention, education, and enforcement with the need for legitimate access to controlled substances.”

But I am sure that balance is not a word that resonates at all in the minds or hearts of the families of Mark, Ryan and Joey, three of the many young Americans who have died as a result of prescription drug abuse and whose family members spoke personally about deaths associated with prescription drugs.  I read the testimonies they delivered today with a heavy heart, looked at the photos and felt for their great loss.  I know parents who have lost a child to prescription drugs and know the dramatic impact it has had on their lives. I would not wish it upon anyone.

Nor would I wish upon anyone, the severe pain that can be endured by the millions of cancer patients globally who suffer needlessly as they approach death from cancer. This was a sentiment shared by Patrick Coyne, an outstanding nurse from Virginia speaking on behalf of the 35,000 members of Oncology Nursing Society.

“ONS has a long-standing position that regulatory, legislative, economic, and other barriers to effective cancer pain management must be eliminated, but ONS also advocates steps must be taken to ensure that prescription pain medications, particularly opioids, do not fall into the wrong hands. It is this delicate balance that must be struck for patients, families, and society.

It would be naïve not to recognize that the problem of opioid diversion is a severe one, and can destroy families and communities. More must be done to treat this significant issue. However, what about those who live daily with intractable, unrelenting pain?”

Director Kerlikowske drew the committee members attention back to “balance.”

“Any policy response must be approached thoughtfully and must strike a balance between our need to prevent diversion and abuse of pharmaceuticals with the need to ensure legitimate access. As science has successfully developed valuable medications to alleviate suffering, such as opioids for cancer pain and benzodiazepines for anxiety disorders, it has also led to the unintended consequence of increased medication abuse. The Administration has created an inclusive Prescription Drug Abuse Prevention Plan which brings together a variety of Federal, state, local, and tribal groups to reduce prescription drug diversion and abuse. Our prescription drug abuse prevention plan has four parts: education, prescription drug monitoring programs, proper medication disposal, and enforcement.”

We, in the clinical disciplines, need to do our part to minimize the risk of diversion and work with Mr Kerlikowske and his colleagues to reduce the growing danger of prescription drug diversion. But we also cannot neglect our responsibility to alleviate suffering.

About Pain policy & palliative care

Improving global pain relief by achieving balanced access to opioids worldwide

Discussion

3 thoughts on “Balancing medical use with the growing danger of Prescription Drug Diversions.

  1. Another good post.

    Posted by Jodie Cleary | April 14, 2011, 7:53 PM
  2. All discussions about the issue of opioid pain medications need a balanced exploration of the risks, but also the benefits, of these medications when used appropriately. Limiting a pain medication, any pain medication, might take a very safe option away from countless patients living with moderate or severe pain. This was the mainstay of my comments, a fair balance must be struck.

    Posted by Patrick Coyne | April 15, 2011, 1:47 PM
  3. Some media reports paint prescribers as either naive or uncaring in their prescription of opioids, when the vast majority are acting in good faith to prevent or alleviate severe pain. Better education regarding how long pain is likely to persist after procedures would decrease the number of unused doses remaining in the medicine cabinet. Even more important would be simplified procedures for returning unused opioids to pharmacies for disposal, such as allowed in S.3397 – Secure and Responsible Drug Disposal Act of 2010 sponsored by Sen Klouchar of MN and signed into law by PresO. As I understand it, the DEA is trying to figure out how to implement it. A likely barrier would be the variable willingness of pharmacies to receive these opioids (concerns of security, cost of storage & disposal, etc). It would help if folks encouraged their local pharmacy to participate when the opportunity arises.

    Posted by Paul Hutson RPh | April 15, 2011, 2:17 PM

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