David Post: The perils of legal drug abuse

Published 12:00 am Saturday, February 25, 2012

Whitney Houston. Michael Jackson. Heath Ledger. Anna Nicole Smith. Amy Winehouse. Died after 2000.
John Belushi. Kurt Cobain. Chris Farley. Died before 2000.
Famous people. Names we know. Another 450,000 names you don’t know have died in the past decade from the abuse of FDA approved drugs.
An imaginary line between these famous people reflects a change in the times.
Before 2000, most drug abuse was illegal drugs. Heroin, cocaine, crack. Since 2000, most drug abuse has been with prescription drugs, often bought legally.
Two years ago, one of our pharmacy’s patients — it could have been your child or next door neighbor — became depressed and swallowed a bottle of prescription drugs with alcohol. Fortunately, she got scared and called us. We called 911. An emergency responder was there within minutes and got her to the hospital immediately, saving her life. Since then, she’s built a happy, productive life.
Whitney Houston didn’t seek help.
Rush Limbaugh’s maid reported that she got him thousands of pain pills, mostly Oxycontin, with prescriptions from multiple doctors through questionable channels. Limbaugh objected to efforts by prosecutors to obtain his prescription records, so criminal charges were eventually dropped. One report said he was taking 30 a day. A normal dose is one per day. Ironically, Rush Limbaugh may owe his life to his maid. Had she not gone public with her allegations, he may have overdosed. Instead, public exposure led him into rehab.
Oxycontin is known on the street as the poor-man’s heroin. With its street value rising in recent years to $50 or $100 per pill, hydrocodone at $5 to $10 per pill is now the preferred, most abused, and most commonly stolen street drug. (Several years ago, a thief broke into our pharmacy stealing 10,000 hydrocodone pills worth $50,000 to $100,000. Local law enforcement simply ignored it, and those pills were immediately absorbed onto our city streets.)
Prosecuting criminals does not prevent the distribution of illegal drugs. Can government do anything? Yes.
In 2002, Congress created a framework called the Prescription Drug Monitoring Program (PDMP), which tracks prescribing, dispensing and consumption patterns of controlled prescription medications. These programs allow states, not the federal government, to collect data in the hopes of identifying — and prosecuting — fake prescriptions, pill-mills, doctor shopping and insurance fraud. Almost three-quarters of the states have adopted the program.
The problem is that this is a state-by-state program and inter-state sharing among that many states just can’t happen. Abusers are smart. They learn to hop from state to state or go to unregulated states. Or online.
Most proposed solutions tackle distribution channels rather than consumption. By analogy, government efforts to reduce tobacco and gun deaths are at the consumption level. It’s not reasonable to believe that drugs can be kept away from people who want them. Solutions need to interact with the patient.
Governments maintain national and state databases for tax returns, pensions, Medicare, Medicaid, Veterans Services, bankruptcy, credit reports, and the list goes on through Social Security numbers. If every prescription were linked to a Social Security number, any number of problems could be intercepted.
More and more doctors are sending their prescriptions to pharmacies electronically and almost every prescription is handled electronically. Doctors and pharmacies have patient Social Security numbers. Registering and cross-referencing all prescriptions before dispensing with Social Security numbers — both by the physician and by the pharmacy — could become routine.
The infrastructure exists to do this, and other benefits would accrue. Drugs are chemicals and can interact dangerously. When patients have different prescriptions from different doctors filled at different pharmacies, bad or fatal interactions are inevitable.
But we live in a strange world where we don’t want Washington involved in any solution. And privacy is an obvious concern (unless, of course, the issue is abortion).
The drugs found in Whitney Houston’s hotel room were just like those in everyone’s medicine cabinet at home. Heath Ledger died from an overdose of prescription pain pills. A national database would not have saved them. But each year, it could save thousands of those names we don’t know. Or maybe someone you actually know.
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David Post is a co-owner of the Salisbury Pharmacy and an adjunct professor at Georgetown University.