Devil in the Medicine Cabinet: Some Solutions for Ending the Prescription Drug Epidemic

A mother who lost her son. A cop who lost his career. A family who lost their home. These are just a few of the devastating human costs we uncovered in the course of delving into the prescription painkiller epidemic that grips Washington state. Their stories are shocking, but not rare.

While Washington has just passed the strictest state law in the country to try to curb the epidemic, and while we have launched a number of innovative pilot programs here, the experts we spoke with, including addicts themselves, said there is still much work to be done before we can remove ourselves from the list of worst states for prescription drug deaths.

Some of the challenges that remain

• Washington's Prescription Monitoring Program, a step in the right direction, still lacks permanent funding, and clinicians are not required to consult it before prescribing narcotic pain medication. Nor is the data shared, yet, with licensing agencies, or with neighboring states along the corridors where prescription drugs are trafficked.

• Washington's emergency rooms, which have long been a place where people hooked on prescription painkillers have sought drugs to feed their habits, have no way to systematically share data across the state about multiple users of the ER.

• Insurance companies don't yet provide enough coverage for alternative forms of pain treatment, including physical therapy, counseling, acupuncture, massage, or other alternatives.

• Patients continue to demand painkillers, believing they are the only or the best solution for pain.

• There's not enough treatment available – either through methadone clinics, or office-based programs – to help those already addicted to opiate medication.

• An overburdened medical community, already struggling with massive changes, paperwork, cost constraints and patient overload, has increasingly abandoned pain patients out of frustration.

• A growing number of people who get hooked on prescription drugs are advancing to heroin use because it's cheaper.

• There is no readily accessible, statewide program for disposing of unused medications, one of the primary sources fueling the epidemic.

• Pharmacies have become targets for violent robberies.

• Our Good Samaritan laws provide legal coverage for people to carry Narcan, a drug that can reverse overdoses, but those most at risk for witnessing an overdose have no easy access to that lifesaving drug.

• There are still not enough certified pain specialists to meet the demand for second opinions created by the state's new pain management law.

And the solutions

There's no magic bullet here. It's going to take some combination of approaches to solve the prescription drug abuse crisis. But here are some of the proposed solutions that we heard about, repeatedly, in asking what would help.

• Make sure the Prescription Monitoring Program is adequately funded.

• Enact legislation to require clinicians to actually use the Prescription Monitoring Program

• Create a statewide emergency-room data-sharing program.

• Allow pharmacists to prescribe Narcan to people at risk for overdosing, or observing one in a friend or family member.

• Negotiate a data-sharing program with neighboring states to cut down on drug trafficking across state borders.

• Require insurance companies to pay for alternative pain treatments.

• Address the shortage of pain management specialists.

• Enact legislation requiring drug companies to pay for safe disposal programs for unused drugs.

• Address the shortage of treatment programs.

• Enact legislation to increase penalties for robbing pharmacies to match those for robbing banks.

• Adopt the "oxy-free" emergency room approach pioneered in Seattle, and promote education about effective pain care in the ER.

Clearly there are cost-benefit analyses to be done for each of these. But the "costs" that seldom get factored in are the human ones. For every death these drugs cause, there are hundreds of wrecked lives.

A note about this project: This project is part of an ongoing collaboration between InvestigateWest, an independent nonprofit newsroom covering the Pacific Northwest, and  public broadcast station KCTS 9.

Photo credit: Steve Snodgrass via Flickr