First the first time, two trends in preventable death have crossed data paths, one highlighting a public health success and the other a growing problem.
According to recent data from the Centers for Disease Control and Prevention, poisoning deaths now outnumber deaths due to motor vehicle crashes, with 89 percent of such poisonings due to drugs. And a large and growing chunk of those deaths are because of prescription drug overdoses.
“This has become…something that should have the attention of every single public health official in the country,” said Terry Cline, commissioner with the Oklahoma State Department of Health, during a Friday morning session at the annual meeting of the Association of State and Territorial Health Officials in Austin, Texas.
In 2011, CDC reported that prescription painkiller overdoses were reaching epidemic proportions, surpassing deaths from heroin and cocaine combined. The agency noted that sales of prescription pain medicines to pharmacies and health care providers have grown by more than 300 percent since 1999.
In Oklahoma alone, there are about 700 annual deaths attributable to prescription drug misuse, Cline said. It’s a complex problem, he said, especially as a primary source of such drugs isn’t street-level drug dealers, methadone clinics or Internet sellers; it’s our medicine cabinets.
“There’s not a simple answer; there’s not a one-silver-bullet response,” Cline said.
Deaths from drug overdoses are growing in Tennessee too, where more than 1,000 such deaths occurred in 2010, up from about 340 deaths in 1999, reported John Dreyzehner, commissioner at the Tennessee Department of Health. The percentage of Tennessee residents who say prescription opioids are their primary substance of abuse went up from 5 percent in 1999 to 23 percent in 2009.
“When somebody’s addicted to an opiate, it’s the most important relationship in their lives,” Dreyzehner said.
With most things that people want and need desperately, robust and adaptable markets develop to meet that demand, he said. That’s why the public health response must include treatment, control and prevention — if all three components aren’t implemented, the market will simply shift and adapt to fill the gap, Dreyzehner said. Fortunately, Tennessee lawmakers enacted the Prescription Safety Act of 2012 in May, which requires all doctors to check a state-run controlled substances database before prescribing certain drugs.
“The act is not going to solve the problem,” Dreyzehner said. “But it gets at prevention, treatment and control all at the same time.”
Ohio is experiencing similar problems, with the rate of drug overdose among its residents higher than the national rate.
“(It’s) the one time I didn’t want to be ahead of the country,” said Theodore Wymyslo, director of the Ohio Department of Health.
Wymyslo said Ohio health workers haven’t seen anything like the prescription drug abuse epidemic now unfolding, even when compared to past problems with heroin and crack-cocaine abuse. From 1999 to 2010, there’s been a 342 percent increase in drug overdose deaths in Ohio — that’s four deaths a day, he said. The rate of opioids being prescribed and the unintentional overdose death rate have increased alongside each other, Wymyslo said, noting that in 2010, 773 million opioid doses were dispensed through Ohio pharmacies, which is enough to provide every Ohio resident with 67 doses each.
Ohio is home to an automated prescription drug reporting system, which helps public health workers follow the trail of prescriptions and where they’re being filled. After marrying that data with data gleaned from state death certificates, researchers found that 16 percent of fatal overdoses were among people with a history of “doctor shopping,” or going from doctor to doctor to obtain prescription drugs.
Ohio’s governor signed legislation earlier this year that Wymyslo said effectively shuts down “pill mills” by, among other measures, placing new limits on prescribing. In addition, Wymyslo and fellow members of a state opiate abuse task force have developed new opioid prescribing guidelines for physicians in emergency rooms and urgent care centers. He reports that the one-pager is now being used at urgent care centers throughout Ohio.
According to CDC, prescription drug abuse is the quickest growing drug problem in the country. For more information, visit www.cdc.gov/HomeandRecreationalSafety/Poisoning.
For additional coverage of the ASTHO meeting, visit New Public Health.