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  1. Terrapinzflyer
    As opiates destroy lives, the state sits on solutions

    MAYOR THOMAS M. Menino said he “broke down crying’’ when he learned recently that his East Boston aide, John Forbes, was tangled up with the illicit use and alleged sale of OxyContin. Menino is hardly the first to shed tears. Over the last decade, the addiction rate for OxyContin has jumped 950 percent in Massachusetts, according to a recent report by the Legislature’s OxyContin and Heroin Commission.

    The power of OxyContin to relieve pain for legitimate sufferers seems matched only by its ability to create euphoria in abusers. Everyone and everything becomes subservient to the highly addictive drug. “I’ve never seen any drug that turned people into criminals more quickly than OxyContin,’’ said Boston Police Commissioner Edward Davis. “It’s worse than crack.’’

    Public health officials in Boston hope to neutralize OxyContin abuse in East Boston through neighborhood antidrug efforts similar to the ones used in Charlestown, South Boston, and the South End, with varying degrees of success. Expect to see a lot of emphasis on the usual tools - public education and drug treatment. But if the state Department of Public Health can rouse itself, it should be possible to disable the illegal flow of narcotic painkillers.

    OxyContin abuse is often a product of “doctor shopping.’’ It can work like this: a patient with legitimate medical complaints and illegitimate intentions - or good acting skills - visits successive doctors, presents the identical condition, and walks away with multiple prescriptions for OxyContin or other pain medications with high street values. Sometimes the quest can extend all the way to shady pain clinics in southern Florida. But the scam usually depends on the inability of legitimate prescribers to know a patient’s drug seeking history. And the less-experienced the doctor, the better for schemers, who long for July, when fresh-faced interns arrive at local hospitals for training.

    Federal agents occasionally make big seizures of diverted OxyContin. But unlike heroin and cocaine, which is managed by international cartels, OxyContin usually arrives in driblets of 20-200 pills. Still, the money isn’t meager. A single pill can sell on the street for up to 10 times more than a typical $5-$10 bag of heroin.

    The database designed to reduce this abuse - the Massachusetts Prescription Monitoring Program - is a bust. The system should operate in real time so that doctors and pharmacists can plug in patients’ names to determine if they are making the rounds looking for narcotics. Instead, the database is run by a skeletal staff that receives data on narcotic prescriptions from community and hospital pharmacies. Analysts from the state Department of Public Health highlight dispensing trends only for the use of regulators and law enforcement officers, who rarely consult it. The system is so cumbersome it didn’t even provide sufficient early warning on the notorious case of a corrupt Cape Cod doctor who prescribed a mind-boggling 288,859 OxyContin tablets in 2004.

    Meanwhile, thousands of doctors and druggists are none the wiser. Little wonder that the OxyContin commission calls the monitoring program “one of the greater tragedies’’ in the decadelong struggle against opiate abuse in Massachusetts.

    Grant Carrow, director of the state’s drug control programs, is trying to cobble together funds to update the system by the end of 2010. He estimates the initial cost of the software at $250,000. Compare that with the $325 million on state spending in 2007 for drug therapy for addicted patients.

    The drug abusers, at least, are cost conscious. Young and middle-class OxyContin users might start out viewing themselves as superior to street junkies. But once they start to crush the pills for smoking or injection, the delusions give way. Why pay $80 for a pill when heroin gets the job done for one-eighth or less the price? Would the status-conscious users launch straight into heroin? Not some. It should follow, then, that slowing down the abuse of prescription painkillers will close many gateways now open to heroin addiction.

    State officials shouldn’t need an entire year to create a usable prescription monitoring program, especially when successful models are already in use in Kentucky, Connecticut, and other states. Meanwhile, in Massachusetts - the mecca of medicine and technology - short-sighted policies and glassy-eyed addicts still go hand in hand.




  1. Helene
    I'm quite astounded that there isn't some sort of national prescription monitering database already in place in the States. I guess not having a nationalised health care system somewhat complicates things, when it comes to communication between different health professionals, and somewhat simplifies things when it comes to addicts manipulating prescribers.

    When you've got a system that is set up with the sole intention of turning profits, people are always gonna suffer. It's all orientated towards making money for the private medical and the pharmaceutical industries. Implementing stricter regulation is perfectly feasible, it just doesn't fit in with the profit-orientated mindset.

    The UK has far stronger regulation of its prescribing, and stricter control of its pharmaceutical manufacturers and suppliers. Precriptions of controlled drugs are vetted and stringent supervision is applied, both at the prescribing and dispensing stages. Yet the companies still make money here, don't they?

    In the US, unscrupulous pharmacists, corrupt doctors, prescription forgeries and large-scale theft are responsible for the fact that drugs like oxycontin are so widely available. Oxycontin, in particular, appears to have been not only widely distributed, but also aggressively advertised and marketed. But these factors are not impossible to address - if they really wanted to tackle the issue, they could. The US government should implement far stronger controls on pharmaceutical suppliers and prescribers, it's perfectly possible.

    It does come back to the fact that the US does not have a nationalised health service. Applying an appropriate level of regulation and scrutiny is more difficult with a private service as there is no national record of each patient's medical history, with each private prescriber having to take the patient's word on their medical record. So regional databases such as those referred to in the above article need to be set up, and it seems pretty obvious that they are seriously lacking - a national record of each patient's medical history is needed. This would be a big job, but again, not impossible.

    The purely commercialised nature of the medical system in the States has a lot to answer for. In the past, money has bought a huge amount of discretion, when it comes to people turning a blind eye to dubious prescribing practices and prescription pill addiction epidemics. But things seem to be getting out of control, and it's pretty obvious that something needs to change.

    Of course, it doesn't help when misinformed, ignorant British Tory MEP's go on US national TV saying they wouldn't wish the NHS system on anybody, scaring the hell out of everyone in the US, turning them against the idea of a nationalised health service. America actually has a chance of getting free, properly scrutinised national health care, universally available to all. But sadly, it doesn't look like it's going to happen.

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