Addiction and overdose deaths are seldom the stuff of presidential campaigns, but with an estimated two people dying every hour from overdoses of prescription pain medications, this primary season is different.
At one of Gov. Chris Christie’s New Hampshire stops, a teenager talked about his father’s death from an overdose. In Keene, N.H., a grandmother told former secretary of State Hillary Clinton that addiction has left her to care for her grandson because the boy's mother "can't be quite so responsible." At the Republican debate last month, business executive Carly Fiorina had her own wrenching story: “My husband, Frank, and I buried a child to drug addiction.” And Jeb Bush has spoken in New Hampshire of his "personal experience" grappling with the substance abuse problems of his daughter, Noelle.
Addiction to pain relievers containing opioids and to heroin — which many medication addicts turn to when opioids become more expensive and harder to obtain — is ravaging communities across the country. In New Hampshire, site of the first presidential primary, overdose deaths from opioids have doubled since 2009 and deaths from heroin have quadrupled.
Voters are looking for solutions to an epidemic that is as vexing as it is virulent, in part because the same drugs that can addict and kill when misused can offer miraculous relief to patients in dire pain. That is why doctors are at the center of the problem and need to be at the center of any solution. Yet, too few have even joined the battle.
One of the most promising tools is state prescription monitoring databases, where a doctor can check whether his patient is seeking multiple prescriptions from other physicians — a sure sign that the patient is either addicted or selling pills on the black market. Besides preventing “doctor shopping,” database queries may make physicians more cautious about the number of pills they prescribe. After surgery, for example, a seven-day supply might suffice, but many automatically prescribe for 30 days.
Databases now exist in every state but Missouri. Trouble is, many doctors don’t use them — a failing both mystifying and outrageous. More appalling, in several states, physicians' trade associations have opposed laws to make the checks mandatory, even after a handful of states have demonstrated the value of mandates and fighting this plague.
Kentucky, the first state to adopt a mandate, saw queries rise from about 811,000 in 2011 to nearly 5 million last year. In the same period, prescriptions for hydrocodone — the most widely prescribed opioid in the U.S. — dropped by 17%. It’s hard to chalk that up to coincidence. After mandates, Tennessee and New York saw similar increases in queries from doctors and declines in opioid prescriptions.
Educating doctors about how easily patients can become addicted is another valuable tool needed to counteract years of false marketing by the makers of OxyContin, who initially played down the addictive properties of their opioid pain reliever. Yet, even here, some physicians balk. In New York, the state medical society opposed a mandate for three hours of education every two years, not exactly a burdensome amount.
So what can this year’s huge crop of presidential hopefuls do? They can break the problem into two parts: how to help people who are already addicted, and how to prevent people from becoming addicted in the first place. They can press for treatment over incarceration, as several Republican candidates have. Clinton has put forward a plan that would include $7.5 billion in federal funds over 10 years to support federal-state partnerships, some of it for prescription databases. Any federal funds ought to provide incentives for states to make education and database checks mandatory for doctors.
Doctors can’t win this fight alone. It will take teamwork. But when 16,000 people a year die from overdoses of drugs that physicians frequently prescribe, it’s time for them to join the front lines of this battle.
Editorial Board of USA Today/Oct. 18, 2015
Graphic: USA Today from IMS Health National Prescription Audit