Prescription Drug Abuse

Prescription drug abuse is a growing problem, both in New Hampshire and in the United States. Three categories of prescription drugs are those most likely to be abused:

• Stimulants
• Central nervous system depressants (tranquilizers)
• Painkillers

Of late, there has been particular concern over the abuse of opioid painkillers. The remainder of this article focuses on facts and policies related to opioid abuse.

What are opioids?

Opioids are drugs that work by attaching themselves to special receptors in the  brain and other areas of the nervous system, causing a reduction in the perception of pain and a feeling of well-being or euphoria. Opioid drugs include oxycodone (OxyContin, Percocet), hydrocodone (Vicodin), meperidine (Demerol), and fentanyl.

It's generally agreed that these drugs can be a safe and effective means of treating acute pain or pain related to cancer or end-of-life.

However, use of opioids to treat other forms of chronic pain, such as back pain or arthritis, is more controversial.  Long-term use of opioids can result in a patient’s body becoming desensitized to the drugs, an effect called ‘tolerance’. This may lead to long-term patients being given higher and higher doses. Additionally, long-term use can inhibit the production of natural opioids in the body, which contributes to negative symptoms (withdrawal) when the patient tries to stop.

Risks of addiction

Opioid drugs target the same areas of the brain as heroin and morphine, both highly addictive drugs, but there is some debate over the addictiveness of prescription opioids. The risk of addiction certainly increases when the drugs are used improperly: for example, when they are crushed and snorted, or combined with other substances. Taking opioids in larger or more frequent doses than prescribed also increases risk.

There is also a growing body of evidence connecting opioid abuse with increased risk of heroin abuse. Some users report turning to heroin after developing tolerance for their prescription painkillers, or when they can no longer afford or acquire prescriptions. Heroin is both cheaper and, in many areas, easier to acquire than black market prescription drugs.

The abuse of prescription opioids has been rising across the United States in recent years, as has the rate of deaths related to these drugs. Some experts argue that the rapid increase in the rate of prescribing opioids in recent years has made them more readily available, and point to surveys that reveal that a majority of those using painkillers for nonmedical reasons acquire them from a friend or relative. 

Other potential contributing factors include the greater social acceptability of taking opioids and aggressive marketing campaigns by pharmaceutical companies. 

Current policies in NH

The following are policies that have been enacted in New Hampshire to combat prescription drug abuse:

• Pharmacies and other licensed dispensers of prescription drugs are required to submit weekly reports to the state's prescription monitoring program, and medical professionals are required to access data for their patients before writing a prescription. 
• State law forbids someone from knowingly attempting to acquire a controlled drug through “doctor shopping”: consulting with multiple physicians for the same ailment as a way of getting larger quantities of medication.
• Doctors and nurses have to do an addiction risk assessment and create a written pain treatment agreement with patients before issuing a prescription.
• Prescriptions written in an emergency room, urgent care or walk-in clinic can only be for seven days or less. 
• Patients using prescription opioids for chronic pain for more than 90 days are subject to random urine tests to check for unexpected drug use (except for patients in long-term care homes or who have very low-dose prescriptions).
• Starting in January 2020, all prescription opioid containers have a bright orange sticker identifying them as 'opioid'. The bottles or boxes will also need to sport a label warning of the risks of addiction.

Additional potential policy responses

• Limiting the quantity of opioids a doctor can prescribe at a given time in regular practice.
• Requiring medical professionals who prescribe opioids to take part in training and education programs.
• Restricting Medicaid reimbursement for opioid prescriptions.
• Laws regulating pain management clinics by specifying personnel requirements, inspections, license procedures, standards of care, or other practices.