Has Prescription Monitoring Changed Painkiller Addiction?
In 2009 the number of first-time, non-medical prescription drug users rivaled that of marijuana initiates. The Office of National Drug Control Policy, which provided this statistic in a 2011 fact sheet, was emphasizing the importance of prescription drug monitoring programs (PDMPs) that store patient information in an electronic database. These programs serve numerous functions including the following:
- Identify drug-seeking behaviors and doctor shopping
- Alert licensing boards to patterns of inappropriate prescribing
- Improve care and safety for patients taking medications
- Help doctors and patients avoid potential drug interactions
- Act as an early warning system for prescription drug epidemics
- Assist in identifying drug diversions and insurance fraud
The National Alliance for Model State Drug Laws (NAMSDL) added that the programs help encourage doctors to intervene when a patient shows signs of drug abuse to drugs like clonazepam. According to a Department of Justice website, most prescribing doctors should consult the PDMP before administering Schedule II, III and IV medications. Most opioid painkillers—e.g., morphine, oxycodone, fentanyl and (as of October 2014) hydrocodone—have a schedule II classification, and they represent the type of prescription drug affected most by PDMPs.
History of Drug Monitoring
A Brandeis University study on PDMP notes that New York started the first monitoring program in 1918 and restarted it 1972, while California has the oldest continuous program dating back to 1939. Other states to adopt early programs include Hawaii (1943), Illinois (1961) and Idaho (1967), and Oklahoma became the first state to require electronic data transmissions in 1990. The legality of monitoring was threatened when a New York court struck down the state’s rights to collect and store data on Schedule II prescriptions, but the decision was overturned in the 1977 Supreme Court case Whalen v. Roe that established the legal framework for such monitoring. Furthering the effort Congress passed the National All Schedules Prescription Electronic Reporting Act in 2005 that provided resources for states to improve or establish PDMPs. Today every state except Missouri has some type of PDMP database.
The Effectiveness of PDMPs
Several studies have looked at the effectiveness of PDMPs, and it is telling that the studies typically focused on opioid painkillers, which is the leading prescription drug of abuse. The studies generally identified some measure of success in their findings, which included the following:
- The Pain Physician journal in 2006 found that compliance with the program was associated with a 50% reduction in opioid painkiller abuse.
- The study also found that 9% of the patients abused painkillers, and 4% obtained additional prescription drugs through doctor shopping.
- The Annals of Emergency Medicine in 2010 found that the databases led doctors to change clinical management in 41% of the patient cases.
- The Primary Care Companion for CNS Disorders in 2014 found the database helped doctors identify at least one indicator of misuse in nearly 42% of patients.
- The study also found that prescription drug misuse to drugs like clonazepam was more prevalent in patients with personality disorders, chronic pain and prior benzodiazepine and opioid use.
- The Pain Medicine journal in 2012 compared databases in different states and found that those without programs had significantly higher increases in opioid use.
- The Journal of the American Medical Association in 2011 cited studies that suggest doctors did not indiscriminately reduce painkiller prescriptions for those who need them.
In 2012 the Canadian journal CMAJ looked at its country’s monitoring program, PharmaNet, and found that inappropriate painkiller prescriptions decreased by nearly 33% during the first six months of implementation in 1995. In the US unfortunately a 2011 study in the Journal of Pain & Palliative Care Pharmacotherapy looked at the use of monitoring programs in Ohio and found that 59% of the doctors had never used it. The program had been in place for five years at the time, and the rapid national embrace of drug monitoring will likely increase the rate of doctor participation.
Drug Monitoring and Painkiller Abuse
The Journal of Medical Toxicology entertained the idea in 2012 that monitoring programs might help tilt the prescription drug epidemic of drugs like clonazepam, and they are certainly having an effect on painkiller abuse. Addicts now have a more difficult time doctor shopping and acquiring painkiller supplies, and doctors are better able to identify patterns of abuse and potentially dangerous drug interactions. However, the program has produced some unintended consequences that a 2014 Congressional report highlighted. As painkillers have become more difficult to access from doctors and more expensive to purchase on the street, a sizeable number of addicts have turned to heroin. The Congressional report cited a 2013 Substance Abuse and Mental Health Services Administration (SAMSHA) report that showed the rate of past-year heroin use is 19 times higher for people who had abused painkillers. Likewise 80% of first-time heroin users previously abused painkillers while only 1% of first-time painkiller abusers had previously used heroin. Other concerns have included under-prescribing painkillers to patients with legitimate needs and a shift toward to acquiring the drugs in places without a monitoring program.
Prescription monitoring has decreased access to painkillers for people who abuse them, but needless to say the answer to this change is not turning to heroin. Regardless of the substance abused, rehabilitation centers offer the most effective treatments to help people overcome their addictions. Potential services can include supervised detox, integrated mental health care and a variety of therapies that target thought patterns, motivation, unresolved trauma, family conflict and other issues that can contribute to substance abuse. Furthermore many treatment centers can provide holistic, non-narcotic therapies for patients dealing with chronic pain.
Painkiller Addiction Help
Whatever your addiction to drugs like clonazepam or mental health needs might be, our admissions coordinators can help. We are available 24 hours a day to answer questions, discuss options and even check health insurance policies for treatment benefits. Please call our toll-free helpline now.