Heroin is Bigger than the Velvet Underground Song–It’s an Epidemic
February 19, 2015
If someone had mentioned heroin to me two months ago, my first thought would’ve been the classic Velvet Underground song. However, after spending my summer interning for Senator Barbara Mikulski, a member of the Senate Health, Employment, Labor and Pensions Committee, I’ve learned that not only is heroin a catchy tune, but also an epidemic plaguing this nation.
By Evan Cernea, SAS’17
One of the first things I learned during this internship is that Senate committee staffers have the ability to act as their own think tank. The HELP Committee organized and mobilized officials from multiple agencies and centers, including the NIH, ONDCP, SAMHSA, Pew Research and the American Medical Association to give presentations on their view of the crisis for this prescription drug abuse working group. Their weekly commitment to getting the full picture of the prescription drug epidemic and the subsequent reports they had to write for their respective Senators demonstrated to me the incredible importance of any Senate staffer.
What I learned about prescription drug abuse, however, was a lot less encouraging. I compiled a list of three issues and three solutions that multiple presenters identified to the working group:
Prescription Drugs and Opioids are Readily Available: As I learned, opioids prescriptions often include more pills than necessary for most patients. This means that most people end up having additional pills that sit in their medicine cabinets, easily accessible to family members that may be addicted to opioids. In West Virginia, a state that has been especially plagued by the epidemic, 70% of abusers get their pills through family members who were legally prescribed the opioid. CITATOIN When pills run short or get to expensive, abusers often turn to heroin. While pills go for a dollar per milligram, a baggie of heroin can sell for as low as $5 while providing the same fix. This dangerous spiral can often lead to overdoses, as heroin is often more potent than pills.
State Agencies Are Underfunded and Poorly Coordinated: All states except Missouri have programs called Prescription Drug Monitoring Programs (PDMPs), which allows the state to track doctors who overprescribe drugs or patients who “doctor shop” for multiple prescriptions. Unfortunately, there are myriad problem with the system. First, there are no best practices established nationally and the lack of guidance makes it hard for states to gather the most informative data. Secondly, there is very little coordination and interoperability among different state PDMPs, meaning that abusers can cross state lines to doctor shop easily. Third, information from PDMPs are not incorporated into doctors’ workflows, meaning that it is less likely they will get the information at the appropriate time. All of these problems compound and allow many abusers to slip through the cracks.
There is Little Doctor or Patient Education about Addiction: Doctors are certainly educated about the dangers of opioid addiction, but the education often ends after they leave medical school. This can occasionally translate into prescribing practices that put the patient at risk. More pressingly, however, many patients are not educated about the incredibly addictive nature of opioid medications and how to protect themselves and others from their negative side effects. There is still a stigma of addiction and patients need to be educated about seeking proper treatment
Refund NASPER: NASPER, which stands for National All Schedules Prescription Electronic Reporting Act, provided block grants for the establishment of PDMPs. The program was unfunded in FY 2010, but was identified as one of the most important sources of innovation for the future of PDMPs. Currently, PDMPs are funded through block grants through the Department of Justice, but they get much less money than they did through NASPER and have more restrictions on how the funding may be used. NASPER would allow for innovation in the delivery of PDMP data to doctors and improve coordination between states by allowing for updated systems.
Better Treatment Education for Patients and Doctors: Patients need to be educated about the dangers of opioids and the potential for escalation to heroin usage. Emergency revival treatment drugs, such as Naloxone or Suboxone, need to available to consumers so that they can revive those experiencing opioid overdose. Moreover, patients need to be educated on how to administer these drugs and also that they need to call emergency services immediately after administration. Doctors need continuing medical education to learn about the changing habits of addiction and be reminded of appropriate prescription habits to reduce the number of excess pills. Local governments need to broadcast PSAs about the dangers of addiction and hold drug take-back days where members of the community can drop off excess pills.
Establish Drug Courts: Inevitably, some people will be jailed because of their distribution, purchase or abuse of opioids/heroin. Those people present the greatest opportunity for rehabilitation because they will be under constant supervision. The current criminal justice system, regretfully, does not provide appropriate rehabilitation sentencing for drug abusers. A consequence of this is that many addicts finish their time in prison and go back to abusing opioids, which in many cases leads to quick overdose due to reduced tolerance. Rehabilitation and education would allow abusers to re-enter society in a productive fashion and constitute less of a burden on our hospital and prison systems.
Currently, most of the solutions that were proposed at this working group are pipe-dreams that require bipartisan effort and, most importantly, funding. However, the amount of effort put in by the staffers involved in the working group demonstrates that there is a devotion to solving the prescription drug abuse epidemic.
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