The solutions are simple yet complicated.
[Editor’s Note: This article was contributed by Kent Runyon. Runyon is Vice President and Chief Compliance Officer at Novus Medical Detox Center, a Joint Commission Accredited inpatient medical detox facility]
Let’s begin by talking about the scale of the problem. Most of us would agree that gun violence is a significant problem in the United States. We know that per the Gun Violence Archive, in 2015 a reported 13,471 people died because of gun violence. This is compared to the 17,536 people who, per the Centers for Disease Control, died in 2015 as a direct result of prescription opioids. This number does not include all the deaths from people who overdosed and died, whose addiction began with prescription opioids but transferred to heroin. It is also not counting the many people who contract serious infections such as endocarditis because of IV drug use and later lose their life to the myriad of health conditions related to IV drug use.
The United States does a good job of categorizing drugs by classification. The Controlled Substance Act classifies drugs into five distinct categories or schedules depending upon the drug’s acceptable medical use and the drug’s abuse or dependency potential. This schedule then is tied to controls that are set into place to reduce the likelihood that the most dangerous drugs would fall into the hands of someone that legally should not possess it. There are differences in opinion regarding how some drugs are classified, but that is an argument for another writer at another time. Today, we are just going to focus on the issue of “control.”
When our elected leaders decided to use the word “controlled” to name the Controlled Substances Act, I am quite certain it was with the intention of it meaning something. The word control per the Merriam-Webster dictionary means to: “exercise restraining or directing influence over or to have power over.” Let’s keep that in mind as we talk about prescription drug diversion in the U.S. and solutions to this problem. Hint: we need to work on our ability to exercise control at every level.
Per SAMHSA’s 2009 National Survey on Drug Use and Health, 70% of people who used prescription pain relievers non-medically got them from friends or relatives, in contrast to approximately 5% who purchased them from a drug dealer or from the Internet. In this same survey, they found that 7 million Americans reported the use of a prescription medication for non-medical purposes in the past 30 days.
This suggests that we need to focus a fair amount of our time and resources on the friends and relatives portion of the problem. I must admit that there was a time when I would keep unused prescription opioids in my medicine cabinet. You never know when you might have an unexpected pain, right? That was before I fully appreciated the dangers of opioids and the risks of having such drugs unsecured in my home. This problem is huge in our society. No different than leaving a loaded pistol unsecured in the top drawer of the nightstand with children in the house. We must change our behavior and view controlled substances as dangerous to our friends and family and as highly attractive valuables to thieves. I once talked with a woman who would intentionally find excuses to use the restrooms of her neighbors simply to steal pills from their medicine cabinets. Once she identified her targets she could not resist going back for more until the neighbors finally figured it out. Therefore, pill destruction programs, medication safes and general education on this topic is a major piece of the puzzle. These solutions are not complicated, yet changing longstanding behaviors of an entire country is quite challenging.
This same common sense must be applied to prescription drug manufacturing, distribution and prescribing. We must insure that our laws and our professionals follow simple solutions to mitigate the risk of theft, pilfering, doctor shopping, burglaries, robberies, forgeries, shorting, and medication recycling by pharmacists. Our system is full of holes and I am not confident that we are behaving like the boat is sinking. We seem to be casually talking about a few of the holes while noting that the water is now getting very deep. Our public leaders need to begin behaving as if it is the crisis that in fact it is.
We have a law that attempts to place controls on what are identified as dangerous and addictive drugs, yet give access to those who may need access to them under certain medical conditions identified by a licensed Physician. Yet, we are seeing that the law in practice is largely ineffective in doing so. Then we have also learned that the more effective we are with controlling access to prescription drugs the more we see the illicit drug market grow such as what we have seen with heroin and synthetic drugs in recent years.
So, what do we do? The answer is we must do everything. This epidemic of addiction that is hurting our economy, breaking apart families and prematurely taking lives cannot be resolved with a few targeted initiatives. When you are in a boat with holes you’re not satisfied with filling 3 of the 10 holes in the boat or 7 of the 10 holes. No, you know that you cannot rest until you have addressed all 10 holes. This epidemic has many holes. It is my hope that our nation continues to grown in its knowledge and principles that addiction is not a moral failing. Addiction is a chronic brain condition in need of treatment. We are amid an epidemic worthy of our attention as it will take all of us to make a difference.