A January 2013 report revealed a disturbing statistic: Nationally, roughly 1 in 22, or 4.57 percent, of people aged 12 and older reported having used pain relievers non-medically in the past year. Texas fares slightly better with a rate of 4.33 percent, placing our state at 17th lowest in the country in our rate of abuse.
Still, this is a grave public health concern. The National Survey on Drug Use and Health by the Substance Abuse and Mental Health Services Administration shows that the highest rate of prescription drug abuse occurs in the young adult population. Nationally, 10.43 percent of this group reported misuse of the drugs in 2010-2011 compared to 9.21 percent of Texas’ young adults. In Texas’ 12-17 age group, the rate is 6.03 percent.
Experts have raised many contributors fueling this epidemic. Patients may be more likely to misperceive the safety of these medications since they’re prescribed by doctors and take them under circumstances not recommended by their physician. Also, prescriptions for stimulants and opioids have increased dramatically and are more readily available. Some physicians have said they feel pressure to get high patient satisfaction scores and are more likely now than in previous decades to strive to eliminate pain in their patients rather than conservatively manage it. And, patients more frequently seek out these now well-known medications, whether because they feel they will better treat anxiety, pain, sleep problems, or enhance focus, or for deviant purposes.
For family physicians on the frontline of prescribing, the solution will come from implementing changes in your practices, staying up to date on evidence-based pain management strategies and ways to identify potential abuse, and use of an online drug monitoring system like Texas’ Prescription Access in Texas (PAT).
Self-observation and assessment helped one Colorado primary care group practice take action to ensure proper prescribing. They identified a provider who had been prescribing large doses of narcotics without well-described indications and came together as a group to set a procedure. They now require a consultation with an appropriate specialist if one of their physicians uses long-term narcotics for treatments of conditions other than cancer pain or terminal illness. They also require patients to fill out a narcotic contract stating the intent of the medication, their responsibility, and potential risks. And they require physicians to use the Colorado version of PAT to make sure there is only one physician prescribing narcotics.
Ultimately, lawmakers may decide to increase monitoring and regulation of these medications, but physicians have the opportunity to educate yourselves and your patients on using these medications safely to ensure access for the patients who need them.