Balance, Pain, Palliative Care

A Public Health Approach to Prescription opioid abuse and diversion.

Yesterday, I attended a Drug Poisoning Summit sponsored by both the City of Madison and Dane County.

Poisoning is now Dane County’s number one cause of injury death, surpassing motor vehicle crashes. 85% of these poisoning deaths are caused by misuse or abuse of prescription, over-the-counter or illicit drugs. Of particular concern are opiate pain medications: they represent a significant proportion of deaths and non-fatal poisonings, can be overprescribed and can lead to dependence and abuse. This is true in many other communities around the United States.

While there is much to be done in Dane County, it was opportunity for the launch of a new report, “Reducing Wisconsin’s Prescription Drug Abuse: A Call to Action.”  This report from the State Council on Alcohol and Other Drug Abuse had 32 recommendations, which are shared below.

One of the most reassuring things I heard yesterday from both city, country and state presenters.  We need to ensure that those who need opioids for pain control have access.  A great example of balance.

Fostering Health Youth

  • 1. Support communities to foster healthy youth

Community Engagement and Education.

  • 2. Launch a public outreach and education campaign
  • 3. Support community coalitions as the vehicle through which communities will successfully prevent and reduce prescription drug diversion, abuse and overdose deaths.

Health Care Policy and Practice

  • 4. Mandate education and training for health care professionals.
  • 5. Ensure that chronic pain sufferers have safe and consistent access to care
  • 6. Establish standard prescribing practices for urgent care and emergency departments.
  • 7. Develop standard screening methodologies for drug-test- ing labs to use in detecting the pres- ence of drugs to include all commonly misused opioids, benzodiazepines, psychostimulants, and related agents, and assure that drug-testing method- ologies used in clinical settings and in post-mortem settings (including the State Crime Lab system) are aligned in order to generate the most consistent and useful data.
  • 8. Develop a standard set of treatment protocols for Opioid Treatment Programs (OTPs).
  • 9. Establish guidelines to reduce the diversion of prescription drugs by those who handle prescription medications in the course of their daily work.
  • 10. Equip healthcare providers and first responders to recognize and manage overdoses.
  • 11. The Wisconsin Dental Association and Wisconsin Dental Examining Board should endorse and implement the findings of the Tufts Health Care Institute Program on Opioid Risk Management and the School of Dental Medicine, Tufts University.

Prescription Medication Distribution

  • 12. Convene a work group to develop recommendations to increase security measures in the dispensing of prescriptions for controlled substance.
  • 13. Implement a system to ensure that, for controlled substance prescriptions, patients are identified in a manner similar to photo identification as required to obtain pseudoephedrine.
  • 14. Support a system that increases security and traceability of controlled substances from manufacturer to patient.

Prescription Medication Disposal

  • 15. Establish a coordinat- ed statewide system for providing se- cure, convenient disposal of consumer medications from households.
  • 16. Integrate medication collection with the Wisconsin Drug Repository.
  • 17. Create an infrastructure for the destruction of drugs in compliance with state and federal environmental regulations.
  • 18. Identify the causes for prescription drug waste and implement proactive solutions.
  • 19. Identify a sustainable means for funding collection and disposal in cooperation with key stakeholders including pharmaceutical producers, local governments, law enforcement, waste management companies, health care providers, pharmacies and consumers.
  • 20. Establish a system for effective disposal of consumer medications in all care programs and facilities which complies with state and federal waste management laws.
  • 21. Establish regulations that would permit registered nurses employed by home health agencies and hospices to transport unused medications, including controlled substances, to designated drug drop-off and disposal facilities, so that when patient medications are no longer needed, such nurses are allowed by law to assist in their safe destruction.

Law Enforcement and Criminal Justice

  • 22. Build bridges between law enforcement and community-based prevention efforts.
  • 23. Make drugged driving a priority issue
  • 24. Support Drug Courts

Surveillance System

  • 25. Design and implement an electronic Prescription Drug Monitoring Program.
  • 26. Develop a community early warning and monitoring system that tracks use and problem indicators at the local level.
  • 27. Develop a community monitoring and early warning system that tracks overdoses at the local level.
  • 28. Improve consistency in reporting drug use and abuse across the state.

Early intervention, Treatment & Recovery Across Lifespan

  • 29. Establish guidelines to screen for substance use in all health care settings.
  • 30. Promote and support evidence-based screening and early intervention for mental health and substance abuse.
  • 31. Integrate high quality medication management and psychosocial interventions for substance use disorders so that both are available to consumers as their conditions indicate.
  • 32. Make addiction treatment and recovery support services available both on a stand- alone basis and on an integrated basis with primary health care services, as well as in other relevant community settings.

The Working Group is be commended on what I would consider a rational public health approach to this current problem we are facing in the US. Exactly what my colleagues were calling for in 2006 in their paper,  A public Health Approach to Prescription Opioid abuse and Diversion.

About Pain policy & palliative care

Improving global pain relief by achieving balanced access to opioids worldwide


3 thoughts on “A Public Health Approach to Prescription opioid abuse and diversion.

  1. But yet, I see very prominetnly in the chart “Reduce the supply of Opiates” this needs more nuance, but I fear this will affect pain patients first. What are the safeguards that pain management will remain of good quality?

    Posted by Willem Scholten | February 1, 2012, 3:18 AM
    • Good Pick Willem. It is a nuance.
      The object, as I understand it, is not to write a clinical guideline.
      In the US, a land of plenty (for some), opioids are often freely written for procedures, including dental.
      These are a common cause for misuse/abuse.
      We have unused opioids in our house from dental procedures.
      I was prescribed 30 oxycodone following a wisdom tooth extraction.
      So we need to find ways to reduce this pool, without effecting pain control.

      Posted by Pain policy & palliative care | February 1, 2012, 6:59 AM
  2. “A Public Health Approach to Prescription opioid abuse and diversion.

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    Posted by | February 3, 2013, 6:55 PM

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