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Finding Balance Amid the Opioid Abuse Crisis

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I have been around long enough to say that the pendulum swings back and forth regarding the feelings of “experts” on prescribing and dispensing drugs. In the 1990s, it was discovered that Americans were being undertreated for pain, something that I think was valid then and is still valid today.

The pharmaceutical companies initially produced more powerful and longer-acting opioids, morphine and oxycodone. The most successful and most abused was OxyContin, a product that has been used widely by legitimate patients and, unfortunately, illegitimately by others. Purdue Pharma went on to spend millions to not only develop an abuse-deterrent formulation but also assist law enforcement and others in reducing the abuse of its own medication.

The new, reformulated OxyContin found its way to retail pharmacies in August 2010. However, the already-stocked old drug remained on the shelves and did not become almost entirely unavailable until late 2010 or early 2011. [Read more…]

The War on Drug Abuse A 3-Pronged Approach

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I have been in the business of fighting drug abuse for many years, just retiring for the final time from government after 49 years so I have seen the ebbs and flows. In the late 1960s, the heroin epidemic was raging in the inner cities, primarily affecting African-Americans. The heroin was 9% pure, compared with 50%-plus pure today, but the devastation was no different. Deaths due to overdose, violence in the form of robberies, and dealer wars were commonplace in some cities.

Along the way, the “War on Drugs” was announced. Ever since then, many of us have been asked if we are winning that war, with others deciding that we have performed dismally and that new efforts need to be initiated as the old ones aren’t working. Many think we lost the war on drugs some time ago. [Read more…]

Hydrocodone Prescribing and Quotas

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For many years, hydrocodone was the most prescribed drug in the United States—overall, not just among controlled substances—and available only in immediate-release form, mostly in combination with acetaminophen. These combination drugs, which were the vast majority of what was offered, were Schedule 3 opioids. However, in its pure form, hydrocodone was always a Schedule 2 substance.

Hydrocodone also was arguably the most abused pharmaceutical, partly because it was prescribed in such large numbers. As a controlled substance, therefore, it’s not surprising that a portion of the prescriptions was abused. In October 2014, hydrocodone combination products were rescheduled as Schedule 2, making refills impossible and requiring a trip to the prescriber for a new prescription. The reason for the rescheduling is hard to argue against: because of its abuse history and potential, hydrocodone should have been moved to the most restrictive class long ago. [Read more…]

The Swinging Pendulum of Opiate Prescribing

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In the several decades I have been in the business of following the diversion of pharmaceuticals, I have noticed a pendulum effect regarding this issue. In almost everything important in life, balance is usually paramount; extremes are rarely the answer. However, finding balance is difficult and requires work. Balance requires careful thought, weighing the pros and cons, and taking an action that can be accepted by most individuals because getting everyone to agree is virtually impossible. This holds true regarding the prescribing and dispensing of prescription drugs, especially controlled substances.

Sometime in the early 1990s, it was thought that our nation’s pain sufferers were being undertreated for pain. I think this was likely an accurate assessment, as I saw that my mother-in-law, a chronic pain patient, had been told by her health care provider to never take a controlled substance because she would become addicted if she did. So she, and likely millions of others, tried to get by with aspirin and other OTC drugs to relieve their excruciating pain. [Read more…]

Paying for Abuse-Deterrent Formulations: A Good Idea?

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With multiple pharmaceutical manufacturers now entering the market with abuse-deterrent formulations (ADFs) of opiate pain relievers, insurance carriers are getting up in arms at the costs of these drugs. This additional cost aims to make it much harder (or virtually impossible) to break down a drug for injection or snorting, two of the main methods used by addicts.

I have talked about these types of drugs in prior articles. In August 2010, OxyContin was the first one that came to market; its considerable abuse background makes it an ideal prescription drug to evaluate for success or failure. August 2015 will mark 5 years since the launch of the reformulated OxyContin, and the abuse level continues to be far less than before the crucial formula change. Someone mentioned to me the other day about hearing that some folks on the street had found a way to easily and quickly compromise the new drug and turn it into the OxyContin of old. I hear this from time to time or even see it claimed on some blog or in a comment by an anonymous source. [Read more…]

How BIG is the problem?

Year after year, state and local law enforcement statistics indicate that pharmaceuticals are almost 30% of the overall drug problem in the United States, running a close second only marijuana abuse. However, until recently, law enforcement, health care professionals, and the general public have placed little emphasis on this huge problem.

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Pharmaceutical Diversion Education (PDE) is designed to assist a wide range of the population in understanding the potential abuse and addiction that can be associated with prescription medication.

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