Treatment agreements, informed consent, and the role of state medical boards in opioid prescribing.

Abstract

The statistics regarding prescription drug overdose in the United States are shocking and clear. One hundred people die from prescription drug overdoses every day in the United States, with three out of four of these drug overdoses caused by prescription painkillers. Prescription drug deaths are, however, just the tip of the iceberg. For every death from prescription pain killers, 10 people are admitted to treatment for drug abuse, 32 emergency department visits take place, and 130 people abuse these drugs or are dependent upon them [1]. Notably, while 70% of people who abuse prescription pain medication report that they obtained the drugs from friends or relatives [2], long-term abusers of opioid pain relievers are most likely to acquire their drugs through a prescription from a physician [3]. In addition to the chronic pain and the prescription drug abuse epidemics that are well documented in the United States, another third interrelated epidemic is now requiring attention as well. Widespread opioid pain reliever abuse has been associated with a dramatic rise in heroin use in the United States. In March 2014, US Attorney General Eric Holder noted this connection while raising concern about the “urgent public health crisis”—a 45% increase in US heroin overdose deaths from 2006 to 2010 [4]. The Food and Drug Administration (FDA) recently has taken actions that both acknowledge these trends and raise new concerns. In October 2013, the agency recommended that many prescription opioids be reclassified as Schedule II drugs [5]. Later that month, the FDA approved for use a powerful new, pure hydrocodone painkiller, Zohydro ER, leading to an outcry from at least 28 state attorneys general and medical experts concerned about the medication's potential for diversion and abuse [6]. As a response to this epidemic of prescription opioid deaths …