Drug Monitoring Programs Are Driving More People Toward Heroin, Says Study

Opioid prescription drug monitoring programs (PDMPs) are driving more people toward heroin use, a recent research at Columbia University (CU) has indicated. The researchers at CU’s School of Public Health reviewed 17 studies and discovered that as prescriptions run dry, people move to more potent street drugs.

Although 10 studies found that post implementation of drug monitoring programs, there were reduction in opioid overdose deaths, three found that with restricted opioid prescribing heroin use and overdose deaths have increased. The study was published in the Annals of Internal Medicine in May 2018.

PDMPs are used by physicians and pharmacists to identify doctor shopping behavior, over-prescription rates and risk of misuse to help curb the opioid epidemic. These programs are either in place or passed by legislation to start afresh in all 50 states and the District of Columbia. According to lead author David Fink, it is important to understand if these programs are instrumental in alleviating the number of opioid overdose cases.

At places where the programs were effective, the researchers found that the databases was updated at least once a week and there were well-monitored systems for authorization. Additionally, the system was also updated with those drugs that do not feature on the Drug Enforcement Administration’s (DEA) list of scheduled controlled substances.

Co-author Silvia Martins was of the opinion that the “programs aimed at reducing prescription opioids should also address the supply and demand of illicit opioids.” Consequences like people substituting opioids with heroin shouldn’t go unnoticed.

Heroin use often begins with prescription opioids

Many people addicted to opioids progress to heroin use as it’s cheaper and easily available. Moreover, it doesn’t require a prescription. A recent paper even suggested that after the introduction of OxyContin in 2010, “each prevented opioid death was replaced with a heroin death.” Fentanyl use has also increased in recent years and PDMPs are not yet equipped to track or control its rapid rise.

Patients are generally prescribed opioids after a surgery or when they are in deep pain from some chronic illness. But they are often not educated about the potential harm of misuse and abuse by them and their families. Some patients might be prescribed unnecessary refills when they do not need them.

A recent survey by Mayo Clinic established that a majority of patients (63 percent) who were prescribed opioids after surgery did not use them and only 8 percent disposed their leftover medications. The leftover pills could be misused or ingested by children and pets at home.

The monitoring of database necessitates that the doctors check the number of prescriptions being written, the duration for which they are being prescribed, and types of opioids being given to the patients. Additionally, patients should be educated about safe storage and disposal practices.

Recovering from opioid addiction

Opioids are potent drugs which not only numb pain, but also produce a euphoric effect. Their long-term use can cause tolerance and dependence. Addiction to opioids can ruin a person’s life affecting his/her psychological and physical health in various ways.

The risk of discord in relationships, loss of productivity at work and school due to daytime sleepiness and absenteeism, as well as incidents of driving under the influence, unsafe sexual practices and violence also increase. It is important that an individual addicted to opioids seeks support from a certified drug abuse clinic and avails the best drug abuse facilities at the earliest.

Prescription Drug Monitoring Programs Are Unable to Combat Overdose, Finds Study

Prescription drug monitoring programs are now being used extensively in several American states, but there is a dearth of data on their effectiveness in curbing the number of opioid overdoses, as found out by a recent study. The rationale behind using these programs is to prevent the replication or overlapping of prescriptions for opioids – the practice commonly known as doctor shopping.

Chris Delcher, from the department of health outcomes in the University of Florida College of Medicine, said that it is important to understand if these programs are helping in any way by curbing the fatal and non-fatal overdoses. According to him, in an era where the changes are being made and implemented at the federal level to combat the opioid epidemic, it is natural to assess the utility of such programs.

Delcher and his team published their findings in the journal Annals of Internal Medicine in May 2018. The study was sponsored jointly by the Bureau of Justice Assistance and the National Institute on Drug Abuse (NIDA) and it was led by the scientists from the University of California, Davis and the Columbia University.

The team of researchers investigated as many as 2,600 scientific publications and found that only 10 linked prescription drug monitoring programs to overdoses. Even in these 10 studies, the team found an exceedingly low evidence of the effectiveness of the programs in reducing fatal overdoses, leading to inconclusive outcomes.

Inadvertent outcomes

The study authors came across some surprising findings. Three studies showed that after the implementation of the prescription drug monitoring programs, there was a rise in overdose-related deaths due to heroin. A 2013 study showed that in Philadelphia and San Francisco, there was a transition from prescription drugs to heroin because of the latter’s easy accessibility and cheap cost.

Moreover, in 2011 in Florida, after the implementation of the program, the number of overdoses dropped due to oxycodone, but there was a concomitant rise in overdoses related to fentanyl, heroin and morphine. Delcher explained this by stating that crackdown on prescription opioids facilitates transition to other drugs.

The researchers found three parameters from the prescription drug monitoring programs that impacted the number of fatal overdoses. These were:

Reviw of patient’s medical history by the doctors before writing a prescription.
Increase in frequent updation of patient’s prescription data.
Increased accessibility of patient data to the providers.

Delcher shared that investigating the efficay of the prescription drug monitoring tool is one of the ways to improve its efficiency and usability. He said that the tool could be made more refined and spontaneous so that it comes handy to the busy physicians, and they are better able to classify patients’ risk of misuse, abuse or overdose. Delcher is presently striving to improve the patient-risk algorithms, overlying medication dashboards, and other data-influenced methods to enhance the database.

Opioid overdose deaths on the rise

Nearly 350,000 people succumbed to opioid overdose – both prescription and illicit – between 1999 and 2016. The overdose-related deaths manifested through three phases:

The first phase began in 1999 when the prescriptions for opioids increased (methadone, natural and semi-synthetic opioids).
The second phase commenced in 2010 when overdose deaths increased due to heroin.
The third phase began in 2013 when overdose related fatalities increased due to fentanyl. Many times, fentanyl is laced with heroin and cocaine, and sold in counterfeit pills.

Road to recovery

Addiction usually begins from a prescription and when the prescription runs dry, people fuel their addiction through illicit drugs. These drugs can have a catastrophic effect on every area of one’s life. Thus, one should take drug abuse help from a good drug abuse clinic before it is too late.

The Inner Island Of Addiction

Addiction recovery is developing right now. New and older but still effective treatment plans are being researched and honed. Each type of addiction is studied to unlock the chemical hooks that entrap the user.

Prior research on the neurobiology of addiction has focused on the subcortical systems, such as the amygdala and mesolimbic/dopamine system, to understand the motivation to seek drugs. Recent evidence indicates that a largely overlooked structure, the insula, plays a crucial part in the conscious urges to take drugs.

The insula has been highlighted as a region that integrates bodily states into conscious feelings and into decision-making processes that involve uncertain risk and reward. It has been dubbed ‘the hidden island of addiction’ by researchers.

Addiction to drugs is at epidemic levels. Mobile morgues are handling overdose victims in some states hardest hit by the opioid crisis. By itself, cigarette smoking is the most common addictive behavior and is the largest preventable cause of death in the developed world. Some say nicotine is harder to give up than heroin. Its chemical hooks plunge that deep.

Drug addiction is a psychological imbalance that turns into a physical addiction. Compulsive use of drugs that persists despite negative consequences is the hallmark of addiction. Impaired driving is the awful choice many make.

‘Chemical use disorder’ is set of physiological and psychological processes, such as tolerance, withdrawal, constant urges and poor decision making. Each have distinct yet complementary roles in the development and maintenance of addiction.

For now, an addict’s best friend is knowledge. Choosing who to share information with is critical in getting actual help and not a damning lecture. Exposing an issue leads many to immediately shun the user. What has been described as ‘tough love’ has led straight to the cemetery or morgue for thousands upon thousands of families.

These ‘accidental addicts’ are the product of a profit-driven drug industry that is crippling our country. Oxycontin was introduced with a ‘low risk of addiction.’ My little sister ‘accidentally’ believed them and took what her doctor ‘accidentally’ prescribed. We buried her two years later.

There is no more time to blame the user until we preserve the innocent victims. Treat addiction as an imbalance, instead of a moral failing, that must be addressed by professionals. MAT-medication assisted therapy-is new but starting to prove effective in curbing active addiction.

Every addict tells the same story. Not one planned to get up, ingest a soothing chemical and completely destroy his life and everyone around him. It is a nightmare that is shared in recovery groups around the world.

Addiction treatment is like fishing in the boat with Jesus. If you’ve tried it before and it didn’t work, cast your net again. This time, a treatment option that works may be within reach. Be ready for it.