Prescription Opioid Drug Abuse Monitoring Still Lacking

The prescription drug abuse epidemic is sweeping the country, and what was once considered a silent epidemic is now a regular front-page headline, but despite efforts to contain the issue more work is still needed, according to a study by the Pennsylvania Medical Society.

Pennsylvania sought to fight the silent epidemic from the beginning, however, at the time their efforts were thwarted by legislation.

Pennsylvania House Bill 1651 wanted to establish the “Pharmaceutical Accountability Monitoring System,” which would provide physicians with a tool to determine whether patients were experiencing actual pain or not.

Unfortunately, the bill did not receive a vote on the floor of the state house of representatives.

“It was disappointing back then that no one would listen,” said President of the Pennsylvania Medical Society, Scott Shapiro MD. “Members were coming to us and indicating that doctor shopping seemed to be increasing. They suspected an increasing number of addictions. We knew something had to be done. We knew that this silent epidemic was going to get worse before it got better, and we knew we had to be louder if we were going to be successful.”

The Pennsylvania Medical Society launched a campaign called “Pills for Ills, Not Thrills” prior to the 2012-2013 legislative session. This campaign hoped to push for a database of controlled substances, by using news releases, editorials, educational materials, and meetings with legislators.

Currently, York County in southcentral Pennsylvania has one of the highest numbers of overdose deaths in the state. In 2014, a DEA Intelligence Report found that York County had nearly double the amount of overdoses at 118, compared with other counties nearby.

Heroin is commonly thought to be found in low income urban areas. However, despite the stereotype, York County is a rural area with an average unemployment rate and an above average graduation rate.

"Not too many people would think this is a rural health issue, but it happens here too," said CMRO of York County Medical Society and member of York County Heroin Task Force, Bradley Levin, MD, FACC, FACS, FASAM, DABAM.

Although heroin was more commonly found in those who overdosed, 33% of the deaths were attributed to opioids. The abuse of prescription drugs for managing pain has fueled the heroin epidemic in not only York County, but across the country as well.

In 1996, Purdue Pharma launched a campaign informing physicians and patients of a new drug, OxyContin, which could fight pain. It was deemed safe because of its slow release of narcotic ingredients, making it unlikely for an individual to become addicted.

"We were told that this new drug would be the answer to many issues related to pain, particularly since a year earlier pain became the fifth vital sign and the American Pain Society recommended it be added to the indicators that assess overall health," said Dr. Levin.

At one point, physicians were even being penalized for not prescribing opioids.

The most common way for individuals to acquire pain pills without a prescription is from friends and relatives. Approximately 54.2% received the medication for free, while 16.6% would either steal them or buy them off of someone.

In 2007, Purdue Pharma plead guilty to criminal charges in federal court for misleading doctors, patients, and regulators on OxyContin’s high risk for addiction and abuse.

"We know better today, but the beast was unleashed and as addictions grew so did doctor shopping and other illegal activities," said Dr. Levin. "Those seeking pills got really good at finding what they wanted and in some cases pushed the drug out onto the street."

The Pennsylvania Medical Society was not the only one fighting for the controlled substance database. The Pennsylvania College of Emergency Physicians also saw the urgent need for something to be done and helped lobby for the state to pass the legislation.

"It's pretty safe to say that if you work in emergency medicine, you've seen more than enough overdose victims," said the President of the Pennsylvania College of Emergency Physicians, Todd Fijewski. "It's a problem that impacts so many different types of people, whether you live in rural or urban settings. It was getting hard to ignore. There was suddenly a greater awareness of the issue and the media made it clear that Pennsylvania lagged behind other states in passing prescription drug monitoring legislation."

In 2013, Harrisburg Rep. Matt Baker and Rep. DiGirolamo, were able to successfully push House Bill 1694 to a successful 191-7 vote.

Meanwhile, Sen. Pat Vance was able to introduce and push along Senate Bill 1180, which established the Achieving Better Care by Monitoring All Prescriptions Program (ABC-MAP). The bill was officially signed into law by Governor Tom Corbett in October 2014.

Several steps have been taken to help spread awareness and address Pennsylvania’s opioid abuse crisis, such as the passing of the Senate bill in 2014 and medication drop boxes becoming available throughout the state. Pennsylvania Physician General Rachel Levine even signed a statewide prescription for Naloxone, a drug designed to save lives by reversing an overdose.

However, the Senate bill that enabled Pennsylvania’s prescription drug monitoring tool has yet to go live, meaning physicians are continuing to practice without it.

Despite this, the Pennsylvania Department of Health introduced Appriss during a mid-February meeting of the ABC-MAP Board.

Appriss manufactures the PMP AWARxE system, with 23 states utilizing the PMP solution. The National Association of Boards of Pharmacy used Appriss to create and manage their PMP InterConnect system. This system is designed to facilitate interoperability and interstate data sharing between different prescription monitoring programs.

"When you factor in all that health care professionals and state officials are doing, there likely is no other public health issue in Pennsylvania getting as much attention," said President of Allegheny County Medical and family physician, Lawrence John, MD. "This crisis hit us like a tidal wave. It was the perfect storm of misunderstanding at a time when pain was being undermanaged. Time has shown us more now than we were able to see back then about the potential for misuse and abuse."

The Pennsylvania Medical Society hopes that state will receive the system by summer and become available for physicians to use not long after.

“It's going to take some time to see the benefits of all these initiatives, but we are on the right path and we will see results," Dr. Shapiro added.