Georgia now tracking drugs to address abuse

 

Sylvia Dunham starts to list the painkillers she once took to combat the pain in her feet, then stops.

“You name it, I’ve been on it,” she said. At one point, she was downing 20 to 30 pills a day. “It was just like eating candy.”

Eventually, she was referred to the Au­gusta Pain Center and found an alternative treatment in a spinal cord stimulator whose constant pulses block the pain signals and offer her drugless relief.

“That is one thing I never liked to do, is take pills,” Dunham said.

For thousands of other women, the drugs lead to a darker end. Prescription drug abuse is a “huge” problem that Georgia is only now implementing a system to monitor and curb, the second-to-last state to do so, an official said.

The U.S. is awash in painkillers – in 2010, enough opioid painkillers were sold to drug every adult every four hours for a month, said a report from the Centers for Disease Control and Prevention. Sales of those painkillers increased 300 percent during the past 11 years, and with that has come a dramatic increase in the rate of prescription drug deaths, particularly for women, the CDC found.

More men died from drug overdoses than women in 2010 – 23,000, compared with 15,000 – but the death toll for women was five times greater than what it was in 1999 and 3.6 times greater for men, the CDC report stated.

“The women are catching up, so to speak,” said Dr. Richard Epter, the medical director for the Augusta Pain Center.

In 2010, the rate of drug overdose deaths for women was four times the death rate from homicide, and since 2007 more women have died from drug overdoses than from car accidents, according to the CDC report.

Women are more likely to engage in what is called doctor shopping, going to several providers to get prescriptions, the CDC report said, and often those prescriptions will be filled at several pharmacies.

Having a system in place to catch that has been in Geor­gia for only a short time.

The Prescription Drug Moni­toring Program has been available to pharmacists a little less than a month and for physicians less than two weeks, said Rick Allen, the director of the Georgia Drugs and Narcotics Agency, which administers it.

“We were the next-to-last state to get it, but we’ve been trying to get it through the Leg­is­lature for 10 years,” he said. Missouri is the only other state without it, Allen said.

PHARMACISTS AND physicians can register with the system – about 2,000 have signed on so far – and submit prescriptions for patients. They can then check to see whether patients are getting prescriptions from more than one doctor and using several pharmacies, which some pharmacists in Georgia have already found, Allen said.

That is part of the due diligence that physicians should do with new patients, said Epter, who was part of a lobbying effort to get a national database, only to see it defunded and referred back to the states.

At the Augusta Pain Cen­ter, new patients are never given narcotics on the first visit and – in addition to other exams and record reviews – must undergo a urine analysis, Epter said. That analysis will turn up drug use the patient had not admitted to at first, he said.

It can be surprising what else it turns up, Epter said.

“Some people who have very good jobs, or who are teachers or who are bus drivers for some kids, that (test) will come out positive for THC, marijuana, cocaine and other illicit substances in addition to taking prescription medications that they don’t tell you about,” he said. “It’s not that it’s that rampant, but it does happen not infrequently.”

The pain center takes the extra step of having its own pain psychologist, who will do a risk assessment to see whether the patient fits a drug-seeking or addictive personality profile, Epter said.
“That’s a huge help to me as a practitioner,” he said.

 

PAIN CENTERS and law enforcement are up against increasingly sophisticated forces trying to divert drugs for illegal resale, Epter said.

“Some are professionals,” he said. “Some will come in knowing exactly what they need to say and knowing exactly how they need to behave on a physical exam in order for a physician to believe that they’ve got the problem.

“We’ve got people that have trunkloads of medical records, including X-rays,” Allen said. “They know what they’re doing.”

Because other states began monitoring programs years earlier, it was believed those patients would flock to Georgia.

“They did,” Allen said. “We know they did.”

The new monitoring program means “they’re going to think twice, anyway,” he said.

“They can’t come into Georgia, thinking, ‘They’re not going to pay any attention to us,’ ” he said. “They’re going to have to realize that their doctors and pharmacists are paying attention to what’s going on.”

Epter said having the program will be “a huge thing.”

“We as practitioners are very, very happy that it is finally here, just being implemented,” he said. “I believe it will make a major impact, decreasing the number of deaths, decreasing obviously a number of other problems that patients have.”

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