Overdose Deaths
Opioid drugs -- which include OxyContin and Vicodin -- were the biggest problem, contributing to 3 out of 4 medication overdose deaths.
(AP Photo/Toby Talbot)
Dr. Amol Soin, is a member of Gov. John Kasich's Opiate Task Force
The abuse of prescription pain pills is a leading cause of preventable death. It kills more people than automobile accidents, and the numbers are growing.
I know this. I worry about it every time I write a prescription for an opioid painkiller. But as a pain physician, I also know many people have legitimate pain, and my job as their doctor is to help them be comfortable.
This is why I am a strong proponent of the new abuse-deterrent opioids (ADOs) being introduced into the market. By making prescription painkillers much harder to abuse, we can give people in pain the treatment they need without contributing to the accidental or purposeful overdose problem.
The average abuser will crush a pill into powder and snort it, or melt and inject it. Many prefer the extended release form designed to be taken once or twice a day.
As you might imagine, a pill that can relieve significant pain for 12 to 24 hours contains a lot of medication. When it's abused, the user gets the whole dose at once, producing a strong high. Abuse-deterrent opioids provide a significant barrier to this kind of tampering. They make the pills difficult to crush, or cause them to melt into a form that can't be injected.
The U.S. Food and Drug Administration has done a lot to encourage more ADOs to be brought to the market. When most of the prescribed opioids on the market are hard to abuse, we will have taken a significant step toward stemming the tide of pain pill addiction.
This is not to say that abuse-deterrent opioids are a panacea. A sophisticated chemist could probably still get around the deterrent properties. But for the average abuser, prescription pain pills with abuse-deterrent features are significantly harder to abuse, and data show this prevents overdose deaths. By preventing the immediate release of the whole dose, the deterrent mitigates the likelihood of an overdose.
Because tamper-resistant pills are more expensive than their counterparts, many insurance companies will not pay for them, even though they save lives.
This should change. State Reps. Robert Sprague, a Repubilcan from Findlay, and Nickie Antonio, a Democrat from Lakewood, have introduced House Bill 248, which prohibits health plans from denying coverage of ADOs based solely on cost. Of particular note, this bill includes the way Medicaid, the government health insurance program for low-income people, covers pain prescriptions.
I treat Medicaid patients and I can tell you that some of them are in this situation because they got hurt and lost their jobs. Their pain keeps them from working again, and their lack of income means they must rely on Medicaid for health insurance coverage.
In Ohio, Medicaid is provided through managed care providers that specify what medical providers a patient can see, what treatments he or she can have, and what medications are allowed. These are vulnerable people who deserve to have their pain managed appropriately. Doing so can substantially improve the quality of their lives, perhaps even allowing them to resume productive activities.
Every patient who takes a prescribed painkiller is at risk of becoming addicted to it, and society runs the risk of having that medication diverted into illegal use. Seventy percent of the opioid painkillers abused are taken from a relative or acquaintance.
We are not going to control the human factor in this equation - the temptation some people have to divert and abuse opioids. But now we can control the formulation of the pill itself, making it much less attractive to those who might want to abuse it. I commend lawmakers for promoting access to abuse-deterrent opioids. Their efforts will decrease abuse, reduce overdose deaths, and make legitimate pain treatment available without worry to patients who need it.
Dr. Amol Soin, a member of the state opiate task force on prescribing guidelines, did his fellowship training in pain management at the Cleveland Clinic and is now medical director for the Ohio Pain Clinic, a private firm with offices in the Dayton area.