By: Marcus J. Hopkins, Blogger
Every so often, I get the opportunity to speak with the hospice nurses who provide care services for my grandfather, and when they discover the focus of my research, I consistently hear the same thing – we have a huge problem with opioid addiction, abuse, and heroin usage in the state of West Virginia. Because their jobs specifically focus on providing hospice care, they’re not too engaged with the HCV aspect of the issue, but they have horror stories about relatives, friends, and neighbors looting their patients’ supply of opioid prescription drugs (from OxyContin to morphine) and either using it themselves or selling it on the street. But, the consensus is the same – this opioid epidemic is way out of control, and there doesn’t seem to be anyone doing anything about it.
This aspect – the “doing something about…” – is, perhaps, the most contentious issue within the opioid abuse conversation: what’s going to work, what is working, and who’s going to pay for it. These questions plague not only the people on the ground dealing with the fallout from opioid abuse, but the legislators tasked with combating a burgeoning problem. Additional concerns are raised about how to best cope with the growing addiction to opioid drugs, and frankly, there are simply no easy or cheap solutions to the problem.
Tensions are further increased when “no nonsense”-style elected officials in the vein of Maine’s Paul LePage go off the rails talking about drug pushers coming to impregnate their white girls and bringing back the guillotine to deal with them. While this type of fast and loose language plays well with a certain segment of [mostly conservative] constituents, it plays a harmful role in demonizing not the repercussions of drug abuse and addiction, but the people who are involved. This creates (and reinforces) a social stigma, which research suggests serves as an internal barrier to seeking addiction treatment.
Two of the most successful legislative harm reduction strategies are Prescription Drug Monitoring Programs (PDMPs) that collect, analyze, and monitor electronically transmitted prescribing and dispensing data and Doctor Shopping Laws that attempt to prevent patients from seeking multiple prescriptions from multiple physicians for controlled substances.
PDMPs are highly effective tools for monitoring the rate of prescriptions being issues by physicians, as well as for tracking which patients receive those medications. Unfortunately, many states with those laws do not make reporting to PDMPs mandatory, which leaves it up to the physicians and pharmacists in those states whether or not they will participate. If there is less than an optimal participation rate, the purpose of monitoring the issue is not being served.
Doctor Shopping Laws are designed to penalize patients who visit multiple doctors in order to increase their on-hand supply of controlled substances (most frequently, opioid drugs). They make it illegal for patients to procure or attempt to procure controlled substances by fraud, deceit, misrepresentation, or subterfuge, and the penalties for getting caught vary by state. But, again – these laws only work if physicians and pharmacists are participating.
Another interesting aspect in relation to those harm reduction methods is how those laws affect law abiding citizens. There are concerns that these laws create a hostile environment, in which physicians are less likely to prescribe medically necessary medications for fear of violating state law. This could potentially leave patients in the lurch when trying to obtain a prescription to for valid use as prescribed. Should those patients be unable to receive a prescription from one physician, they may run the risk of running afoul of doctor shopping laws if they go to another physician in seek of help. While these scenarios are, at this point, purely anecdotal, it raises a serious concern about access to necessary treatment methods.
Sadly, this is one of the prices we must potentially pay if we wish to legitimately attempt to conquer our nation’s issues with opioid addiction. The consequence of making these drugs more difficult to obtain is that people who legitimately need them face the same hurdles as those attempting to procure them illegally. Good policy is, however, made when there is data and research to back up the initiative, whereas bad policy is often made when we cave to arguments of Pathos – stories, inspirational quotes, and vivid, emotional appeals.
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.