Drug overdoses in 2010
Ohio: 1,544
Death rate 2o06-2010 per 100,000: 12.2
Butler: 59
Death rate 2o06-2010 per 100,000: 15
Champaign: 7
Death rate 2o06-2010 per 100,000: 8.6
Clark: 19
Death rate 2o06-2010 per 100,000: 13.6
Greene: 27
Death rate 2o06-2010 per 100,000: 14.5
Miami: 14
Death rate 2o06-2010 per 100,000: 13.2
Montgomery: 113
Death rate 2o06-2010 per 100,000: 23.6
Warren: 126
Death rate 2o06-2010 per 100,000: 12.2
Ohio is curbing painkiller abuse through drug monitoring programs, but the methods need to be used more effectively to fight the state’s prescription drug abuse epidemic, researchers said Thursday.
In 2007, when the problem was first widely identified in Ohio, state officials reported that more adults died of prescription drug abuse overdoses than car accidents.
Efforts since then to collect, analyze and share prescription data are working, but better analysis could give health professionals and law enforcement help in locating at-risk individuals and pill mills, researchers concluded in a report issued Thursday.
“Being proactive is the key to the success in the fight against prescription painkiller abuse,” said one of the researchers, John Eadie, director of the Brandeis University’s Prescription Drug Monitoring Program Center of Excellence. “While doctors may routinely collect and report data to a state program that signals where and when prescription painkillers are likely being misused, the program might not share that information with others who can best use it.”
The Ohio Automated Rx Reporting System (OARRS), begun in 2006, helps prescribers, including physicians and dentists, identify possible drug abuse. It tracks patients’ prescription histories, medications and dosages. Prescribers and pharmacists request information from the system about 20,000 times a day.
A 2010 study found that 41 percent of Ohio physicians altered their prescription patterns after consulting the system; of those who changed, 61 percent either prescribed fewer pills or none, and 39 percent prescribed more pills than if they hadn’t used the system.
Miami Valley practitioners have been active in trying to cut down on prescription drug abuse and deaths.
In Montgomery County in 2011, 130 fatal drug overdoses were reported. Prescription opioids were found in 62 percent, compared to 74 percent in 2010. An opioid of any kind, including street drugs like heroin, was found in 88 percent of the deaths, and 49 percent of the deaths involved both a prescription opioid and a tranquilizer, such as Valium, said Russel Falck, an author of the report and an associate professor at the Center for Interventions, Treatment and Addictions Research at Wright State University.
“There’s absolutely no question” that prescription monitoring programs like OARRS work, Falck said. “It’s a good thing that they’re around.”
Ohio is one of 41 states with a prescription drug monitoring program.
The Brandeis report identified several strategies to make the programs more effective:
- Adopt national standards for data quality.
- Establish a process to link prescription records to individual patients to eliminate errors and deliberate misinformation.
- Establish "unsolicited reporting" to find if providers are writing too many prescriptions or prescribing dangerous combinations of drugs.
- Establish criteria for identifying doctor shopping and other questionable behavior.
- Link provider prescription data to licensing boards to identify patterns that might indicate questionable practices.
- Consider requiring providers to check monitoring programs before prescribing controlled substances.
Dr. James Huizenga, an emergency room physician at Kettering Medical Center, said the systems are effective but they can be cumbersome.
Huizenga helped develop his own software, NarxCheck, which reviews patient prescription records through OARRS and other similar systems and scores a patient’s risk for abusing prescription painkillers, sedatives and stimulants. NarxCheck is in use in several emergency departments in the region, and was used in a federal pilot project to study its impact on prescription practices in a family practice setting.
Greater scrutiny of prescription drug practices is important to cut down on abuse, said Dr. Townsend Smith, medical director of the pain clinic at Miami Valley Hospital, but it’s had an unintended side effect. More patients are being told by their primary care doctors that they’ll need to see pain management specialists to get long-term treatment with prescription painkillers like OxyContin. And publicity about prescription drug abuse has some patients scared of taking the medications, Smith said.
“The whole discussion of over-prescribing has put these people into a scenario where they’re fearful of taking their medications, or they’re primary care physicians are uncomfortable with continuing to try to manage them,” he said.
The Brandeis study was funded by the Pew Health Group, a division of The Pew Charitable Trusts.
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