Pills, Polices, and Predicaments: The Unintended Consequences of a Health Care System's Policy toward Opioids

Abstract

Prescription drug abuse has escalated to a crisis in the United States. According to the Office of National Drug Control Policy, young people abuse prescription drugs second only to marijuana, and one-third of people who start using illicit drugs begin with prescription drugs [1]. Moreover, prescription analgesics were associated with more than 16,000 deaths, with frequent contributions from other medications, including benzodiazepines (involved in 30% of opioid-related deaths), antidepressants (13%), anticonvulsants (close to 7%) and antipsychotics/neuroleptics (almost 5%) [2]. In many cases, the problem is too outsized for the federal policies in place to be effective. To address the prescription drug crisis directly and effectively, five public health initiatives are imperatives. First, we must aggressively disseminate information through far-reaching public and patient educational programs about the dangers of overusing prescription medications. States and localities that have initiated successful public and patient education programs can serve as models. Utah's “Use Only As Directed” campaign is a good example of successful public education that, when combined with provider education, coincided with a reduction in overdose deaths in the state [3]. Second, we must create the right incentives to facilitate the research and development of safer, abuse-deterrent formulations for treating chronic pain. Eventually, the opioids being prescribed today must be replaced either by new mu agonists with less potential for serious adverse effects or with non- mu molecules that have highly effective …