The Portland Press Herald / The Maine Sunday Telegram

July 24

State gets a partner in fighting pill abuse

A new national focus may boost programs in Maine, where more people die from ODs than car crashes.

By David Hench dhench@mainetoday.com
Staff Writer

State officials say a new national effort to tackle prescription drug abuse could help officials in Maine, where the diversion of prescription drugs took hold earlier than in most states.

"There is a huge access issue here," said Guy Cousins, director of the Maine Office of Substance Abuse. "The average Mainer has at least one prescription, and when we take a look at where people get (abused) medication, the number one place is either family or friends -- it's either given, sold or they're stealing it."

The Office of National Drug Control Policy announced last week that the number of people in the United States seeking treatment for painkiller abuse jumped 400 percent from 1997 to 2007.

The agency also said that in recent years, more people used prescription drugs recreationally for the first time than tried marijuana for the first time.

"Parents, law enforcement, the medical community and all levels of government have a role to play in reducing prescription drug abuse," Gil Kerlikowske, director of the Office of National Drug Control Policy, said in remarks to Congress last month.

Maine and 15 other states have more people dying from prescription drug overdoses than from car crashes, said Roy McKinney, director of the Maine Drug Enforcement Agency.

"If you speak to the families of those people, it's just heart-wrenching," he said.

"When we think of drug trafficking, we think of cocaine, marijuana, methamphetamines. Now we're talking about an epidemic of medicine that is being diverted for nonmedical purposes," McKinney said.

The top abuse-prevention recommendation from the drug-control policy office is to increase drug return, take-back and disposal programs to reduce access, particularly by young people. The strategy also includes:

• Educating physicians about ways to avoid diversion and on how to instruct patients in the proper use and disposal of medicine.

• Expanding drug monitoring programs to prevent people from "doctor shopping."

• Helping states work together to prevent cross-border doctor shopping.

• Shutting down illegal Internet pharmacies.

"This is the national strategy, and of course Congress and the president listen to that in their allocation of funds," McKinney said. The strategy also should lead to states sharing the most successful programs, he said.

Maine is one of the few states in the country that have a statewide drug mail-back program, in which residents can obtain envelopes from their pharmacy or health care provider to ship unused medicine back to authorities.

That keeps it out of groundwater, out of landfills and out of the hands of people for whom it's not prescribed, said Donna Gormley, spokeswoman for the Department of Environmental Protection, which oversees the mail-back program.

"We feel very strongly it is an issue of public health, public safety and environmental protection," she said.

The service, which started as a pilot program last year, has so far collected 2,300 pounds of drugs -- 250 pounds of controlled drugs like painkillers -- in almost 4,000 envelopes.

The program, which costs $150,000 per year, is funded through next year. The DEP sought legislation last year that would have required drug companies doing business in Maine to pay about $5,000 per year to fund the collection program, but the measure was defeated in the Senate, Gormley said.

The national strategy may lead to federal funding going forward.

Maine has been in the forefront in finding solutions because it has been on the leading edge of the problem, said Cousins, of the Office of Substance Abuse.

Maine has a long tradition of physical labor, which can lead to chronic pain. In many types of physical labor, if you don't work, you don't get paid, so access to strong painkillers can affect a person's livelihood, Cousins said.

Mainers also have a reputation for frugality and a dislike for waste, so excess medicine is often kept for later use, either by the patient or someone else in the family, he said.

Efforts to stem drug diversion and abuse are not about catching people doing wrong, Cousins said. Educating patients about the dangers of misusing addictive drugs is important to prevent problems in the first place.

"Nobody starts taking prescription drugs the first time saying, 'Oh boy, I can't wait to get addicted to this,"' he said. "We're really trying to disrupt that cycle of drug use, delinquency and crime."

Addiction is a major cause of property crimes, and increasingly that addiction is to prescription painkillers, authorities say.

In another effort to reduce excess drugs, the state's MaineCare program requires first-time prescriptions to be for just two weeks so they can be changed if necessary without having a lot left over.

Maine has a prescription monitoring program through which health care providers and pharmacies can submit and obtain information about patient prescriptions. The program reduces the chance that patients can go to multiple doctors for the same prescription, which is often a source of diverted pharmaceuticals.

More than 30 states have prescription monitoring programs, and the federal government would like to see those programs linked. Maine already coordinates its prescription monitoring program with the other New England states except for New Hampshire, which has not yet joined.

Not all Maine prescribers participate in the voluntary program, however.

State statistics show that as of early this year, only 31 percent of the 6,276 people who can prescribe controlled drugs have enrolled in the monitoring program. Just 19 percent of the state's 1,155 pharmacists have enrolled.

Andrew MacLean, deputy executive vice president of the Maine Medical Association, says the relatively low percentage of prescribers enrolled is misleading. Many doctors, like pediatricians, radiologists or pathologists, rarely if ever prescribe controlled substances, so they don't enroll.

The medical community recognizes the severity of the problem, he said, but there probably still are physicians who should be enrolled but aren't.

"It's one of the hottest topics in continuing medical education these days," said MacLean, who gives presentations on the topic. "We advise physicians this is the standard of care in the state today."

 

Staff Writer David Hench can be contacted at 791-6327 or at:

dhench@pressherald.comn