“In 2011 so far we have lost seven folks who were in treatment with us to drug overdoses,” said Joel Cunningham, a Certified Addiction RN (CARN) who is director of nursing, Decision Point, Bentonville. “All but one overdosed on opiates. These were young people who were relatively healthy. There was no reason for them to have passed away if not for the drug use.”

A common story from addicts is that they would visit the emergency room (ER) early in the morning, go to one pharmacy that called the ER to get the prescription, and then would take the written prescription to another pharmacy to have it filled again. “Doctor shopping” continues to be a common problem.

But a new law went into effect in Arkansas in late July that is expected to have a dramatic effect on people getting multiple prescriptions for the same opiate. The law establishes a statewide pharmacy database for prescription drugs.

“For people in the field of addiction, we have been waiting for something like this to come along and are hoping it will limit some of the doctor shopping tactics a lot of people abusing use,” Cunningham said. “The new law will help tremendously.”

While this will entail extra work for pharmacists, the regulations have been supported by the Arkansas Pharmacist Association.

“We participated in writing the legislation to make sure it is administratively simple to comply with,” said Scott Pace, PharmD, JD, associate executive vice president, Arkansas Pharmacist Association. “We are supportive of having all the information we need to make good medical decisions. This statewide data base will prevent patients from getting the same drug over and over from different pharmacists and different prescribers.”

Pace said prescription drugs have become widely abused. In kids, they are now the second most abused elicit substance behind marijuana. Sometimes young people get the drugs from their family medicine cabinets, which is why there has been a statewide effort with the Attorney General’s office and police departments to have people turn in unneeded prescription drugs.

The registry could also help cut down on problems with people taking medications that are contra-indicated. Patients are encouraged to use the same pharmacy. But with the new database, even if a patient uses different pharmacies, it will allow the pharmacist to know everything they are taking.

Sen. Percy Malone, a pharmacist from Arkadelphia who sponsored the bill in the Senate establishing the secured database, believes the program will be effective in addressing prescription drug abuse while also protecting patient privacy.

“Only qualified individuals can look in the database to see if there are patterns of doctor shopping,” Malone said. “The medical community accepts that concept. All patient privacy is protected.”

Malone said there is no doubt that the abuse of prescription drugs has been on the increase. In addition to taking drugs from home medicine cabinets and obtaining prescriptions from multiple doctors, pharmacy robberies are also a concern.

“We are having to contend with a new problem in our society,” Malone said.

Shane Frazier, chief nursing officer, Pinnacle Pointe Behavioral Center, Little Rock, said the prescription drug abuse problem has permeated all age groups of society.

“The latest studies show illicit drug use decreasing, but prescription abuse is increasing,” said Frazier, whose clinic is focused on treating children up to age 18.

To detect problems with drug and\or alcohol abuse in youths, Frazier recommends looking for bizarre behavior, or changes in behavior. Someone who was socially withdrawn might become very social, or vice versa. A change in a youth’s circle of friends can be a red flag along with criminal behavior.

Obvious indicators to check during an exam are tracks for needles and persistently abnormal vital signs such as a high heart rate in someone who is otherwise healthy. Skin lesions can indicate abuse of stimulants. Because people feel like they have bugs crawling on them, they will pick their skin.

Frazier said pinpoint or dilated pupils can be signs of opiate abuse, red eyes and coughing can be associated with marijuana use, and sinusitis and nasal issues can be signs of cocaine abuse.

Frazier also recommends being aware of neurologic changes in gait such as staggering or twitchy movements.

If there are suspicions, a physician might recommend a drug screen. Since drug screens are available over the counter, Frazier also recommends them for parents who have concerns.

Decision Point’s Cunningham has advice for doctors looking for drug or alcohol problems in adult patients. He said often patients seeking to abuse prescription drugs will be very direct. Within five minutes, they will tell the doctor exactly what kind of drug they want.

“One of the best things you can do in that situation is ask the patient if they have tried a non narcotic anti-inflammatory agent, or if they have tried other ways to deal with the pain such as meditation and relaxation,” Cunningham said. “Usually with this kind of person, you will see their eyes light up when you ask that question. They know they won’t get it from you, and will go somewhere else.”

A lot of people do have true, chronic paint that doesn’t respond to anything but the strong opiates that are drugs of choice for abuse. But even in a patient like that who may be in chronic pain and disabled from injury, doctors should be careful about prescribing large quantities of opiates since these may end up being sold on the street.

“They will take the three a day they need and turn around and sell the others,” Cunningham said. “The street value for Oxycontin is $1 a milligram, so an 80- milligram Oxycotin sells for$80. That high street price certainly creates a big temptation.”

Tags:

Bookmark:

Facebook

Technorati

Newsvine

Google

Related: