What Happened in West Virginia
Over 20 million pain killers were discovered to have been shipped to Williamson, West Virginia, a small town with a population of 3,000. The hydrocodone and oxycodone pills were provided to patients by two pharmacies just four blocks apart. Court documents are indicating that the prescription providers sent an exorbitant 39,000 hydrocodone pills in a two-day period in 2007. To see the letters Congress sent to the pill providers, click here.
According to the CDC, 884 people died of drug overdoses in West Virginia in 2016, which is the highest rate in the United States. The amount of drug related deaths is so prevalent that families are experiencing funeral complications because morgues are inundated with an overload of bodies.Opioids were identified as the main driver of these drug-overdose deaths.
Is This a Problem of Patient or Provider?
While many are acknowledging the tragic deaths associated with opioid overdoses, there is little agreement as to what underlying problems are contributing to these deaths. Should patients be extending care to prevent addiction when taking these medications? Do these deaths indicate the opioids oxycodone and hydrocodone should no longer be prescribed?
The answer is not clear.
One of the wholesale distributors involved, H.D. Smith, said it “operates with stringent protection of our nation’s healthcare supply chain. The company works with its upstream manufacturing and downstream pharmacy partners to guard the integrity of the supply chain, and to improve patient outcomes. The team at H.D. Smith will review the letter [from Congress] and will respond as necessary.”
What Does This Mean for Providers Now?
In a study conducted by the American Health and Drug Benefits, researchers explained that the following methods would be affective for providers:
- Educating Physicians and Patients: This would mandate that physicians be educated on Screening, Brief Intervention, Referral and Treatment (SBIRT) guidelines for patients with substance abuse disorders and those at risk.
- Use of Prescription Monitoring Programs: These data collection systems determine the number of physicians who prescribe opioids for each patient and the number of pharmacies where opioids are dispensed for that patient. Prescription monitoring is currently operational in only 33 states.
- Checking Patients’ Photo Identification at the Pharmacy: This would combat the amount of increasing cases of abuse that involve identity theft. Virginia is currently considering passing a bill that will require individuals to present this identification.
- Referral to Pain Specialists: While this approach may cost more in the short term, in the long term this could significantly reduce costs associated with opioid abuse.
- Use of Abuse-Deterrent Formulations: By using the “fortress approach,” opioid formulations would maintain their extended-release characteristics despite attempts to crush or dissolve the pills. The study also mentions the “neutralizing approach” where tampering with pills will release a neutralizing agent, and the “aversive approach” where misuse of opioids results in unpleasant side effects.
If you’re interested in other means of combating opioid abuse you can read more about the CARA Act and preventative care here.
How the United States Could Improve Policies
This case in West Virginia has made it clear that education is not enough to end this epidemic. Is this the fault of the provider or the strict policies the United States places on drugs?
Decades ago, both the United States and Portugal took drastically different approaches to the war on drugs. While the United States worked to vigorously incarcerate drug users, Portugal decriminalized all drugs in 2001. This proved essential to Portugal’s ability to execute a major public health campaign to combat addiction and treat it as a medical challenge as opposed to a criminal justice issue.
The results? Portugal has significantly reduced the number of drug related deaths while the United States, in comparison, has a strikingly high number. In 2016, 64,000 Americans died from drug overdoses—the same as the number of soldiers that were killed in the Vietnam, Afghanistan and Iraq Wars combined.
2015 data except: U.S. (2016); Belgium, Britain, Denmark, Ireland, Norway, Poland, Spain (2014); France (2013)
By The New York Times | Source: European Monitoring Center for Drugs and Drug Addiction
This, of course is not a perfect solution, and there are users who continue to succumb to their addictions. If, however, the United States could decrease drug related deaths to Portugal’s numbers, we would save one life every ten minutes.