Everyone knows someone who has been seriously affected by prescription drug abuse. Yet, when a report issued late last year revealed that the leading cause of accidental death in the United States is drug overdose -- primarily from prescription drugs -- the public at large was shocked.
The idea that overdose surpassed motor vehicle accidents as the leading cause of death is almost unfathomable. After all, we are a commuter nation, and virtually all of us ride in passenger vehicles or mass transit vehicles at some point. Throw in the proliferation of cell-phone distractions, and you'd think we would have a clear cut champion. Hell, even those who choose to travel as pedestrians or cyclists at least encounter motor vehicles, putting them at risk of being injured or killed in an automobile accident.
Comparatively speaking, there is a much smaller percentage of individuals whom abuse drugs, legal or otherwise.
So how could this be? How can unintentional poisoning from drug overdose kill more people than car accidents in at least 29 states? And how can we stop what The Trust for America's Health, issuer of the aforementioned report, calls "the epidemic" of prescription drug abuse? Well, I'm sorry to say, but some questions just don't have easy answers.
Indeed, prescription drug abuse does seem to have reached somewhat epidemic proportions, with approximately 50 people dying every day in the United States from a prescription drug overdose. More than 6 million Americans abuse prescription drugs, and both the number of prescription drug sales and the number of prescription drug overdose deaths have quadrupled since 1999. Exponentially, those numbers are simply staggering over a 15-year period.
Consequently, The Trust for America's Health listed 10 "promising strategies" for reducing prescription drug abuse in the states:
- An active Prescription Drug Monitoring Program
- The mandatory use of the program by prescribers
- Doctor shopping laws prohibiting patients from withholding information about other prescriptions
- Support for substance abuse treatment services through Medicaid Expansion
- Prescriber education requirements or recommendations
- Good Samaritan laws offering immunity or mitigation of sentencing for those helping someone get treatment for an overdose
- Rescue drug laws providing expanded access to naloxone, a drug that can counteract overdose
- Required physical exams to demonstrate a bona-fide physician-patient relationship before a doctor can prescribe controlled substances
- ID requirements mandating or allowing a pharmacist to check a patient's identification when dispensing a prescription
- Lock-in programs that require a Medicaid patient suspected of abusing prescription drugs to use only a single prescriber and pharmacy
Sadly, at the time of the report only two states, New Mexico and Vermont, had all 10 indicators in place.
Ironically, New Mexico also had the nation's second highest rate of prescription drug overdose deaths, with 23.8 deaths per 100,000 people. Only West Virginia had a higher rate of fatal prescription overdose, with 28.9 deaths per 100,000 -- a rate 605 percent higher than it was in 1999. Now that might not surprise anyone familiar with the Wild and Wonderful Whites of West Virginia, but it doesn't hide the fact that prescription drug abuse in the United States is quickly growing out of control.
While Oklahoma had eight of 10 promising indicators, it still ranked fifth in the nation in overdose deaths. Regardless, local experts say the number of deaths is shrinking after the enactment of a law requiring pharmacists to enter data for the dispensing of a controlled substance into the online Prescription Monitoring Database within five minutes of filling the prescription.
But being ranked fifth in the nation in prescription drug deaths presumably doesn't sit well with the Oklahoma Legislature, and the state is seeking ways to further reduce the prescription drug abuse. As with most problems my state encounters regarding drugs, the favorite ways to combat the issues are (1) more laws and (2) harsher penalties.
In fact, these two "means to an end" are playing out in Oklahoma as we speak.
Late last month, the Oklahoma Senate passed HB 2589, which amends the Oklahoma Trafficking in Illegal Drugs Act to include four of the most commonly abused prescription drugs. Possessing the following prescription drugs in the following quantities will now be punishable by a minimum of 10 years to life in prison on the first offense:
- Morphine - 1,000 grams of a mixture containing a detectable amount of morphine
- Oxycodone - 400 grams of a mixture containing a detectable amount of oxycodone
- Hydrocodone - 50 grams of a mixture containing a detectable amount of hydrocodone
- Benzodiazepine - 15 grams of a mixture containing a detectable amount of benzodiazepine
Consequently, if Oklahomans (or anyone passing through the state) possess more than their "fair share" of a prescription drug, he or she could easily wind up spending the next decade, or the remainder of his or her life, in the state penitentiary. As a criminal defense attorney, idealistically I see that as a potential step in the right direction if the amendment can serve as a hearty deterrent for those individuals pushing prescription drugs.
In all reality though, I know the new law will do nothing more than continue to fill Oklahoma's prisons with individuals serving even lengthier sentences. It's already against the law to illegally possess or distribute prescription drugs, and that hasn't stopped the number of deaths from sky-rocketing over a short period of time. A better option would be to try and attack the source of the problem: Oklahoma, and the rest of the nation, need to keep these drugs from falling into the wrong hands in the first place.
So what about punishing the distributors of these drugs who sit higher up the chain? What about investigating and charging the doctors who don't examine patients and prescribe on a cash-only basis? How about mandatory monitoring of the number of prescriptions individual prescribers are pushing?
Well, Oklahoma has hopefully started to take steps towards that goal.
One former Oklahoma City physician, William Valuck, has been charged with 72 counts of illegal distribution of a controlled substance and nine counts of first degree murder. The murder charges come from the overdose deaths of eight of Valuck's patients and the DUI death of a man who was struck by one of Valuck's patients who was under the influence of prescription drugs at the time of the accident. Some of these deaths occurred within days of Valuck prescribing the controlled substances.
Can Valuck's case serve as a deterrent to other doctors who may consider illegally prescribing narcotic painkillers and anti-anxiety drugs? Perhaps. Only time will tell if Oklahoma, or any other state in the nation, will continue to prosecute doctors caught contributing to the epidemic. Will sentencing prescription drug "traffickers" to a minimum of 10 years in prison curb the state's high rate of prescription drug abuse? Maybe. But the most likely outcome of higher penalties for illegal prescription drug distribution is further overcrowding of the state's prisons. That is not a solution. That is likely part of the problem.
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