The rapid rise of the sale of prescription drugs between 1999 and 2010 has resulted in a corresponding problem: death. Sales of prescription painkillers have quadrupled nationally in that time, and so have overdoses. Now more people die from prescription drug overdoses than those from heroin and cocaine combined.
In Maine, the rate of death increased fivefold between 1990 and 2010. There were 2.2 overdose deaths per 100,000 people in 1990 and 12.4 per 100,000 people in 2005. It dipped to 10.4 in 2010.
Maine has taken steps to combat the problem, but there is more to do. Abuse causes not just heartache for Maine families but major economic losses for Maine communities.
On Oct. 7, the Trust for America’s Health released a report funded by the Robert Wood Johnson Foundation with strategies for how to combat prescription drug abuse. Researchers identified 10 promising state policies and then looked to see whether states have implemented them.
Only two states, Vermont and New Mexico, have embraced all 10. The largest number of states — 11 — have implemented eight. Maine ranks in the bottom 17 states; it’s one of eight to have instituted only five of the strategies. Lawmakers should wholeheartedly consider the remaining ideas if they wish to halt what has reached the scientific definition of an epidemic.
Here are the positive measures Maine has taken:
— Prescription drug monitoring program. Maine, along with 48 other states, has this program to eliminate “doctor shoppers” — people who visit multiple physicians to get the same drug. The state-run electronic database tracks when prescription drugs are prescribed and dispensed to patients.
— Doctor shopping law. Maine, along with every other state and the District of Columbia, makes it illegal to get prescription drugs from multiple doctors or pharmacies.
— Physical exam requirement. Forty-four states require doctors to conduct an exam or screening for signs of substance abuse, or have a real physician-patient relationship that includes an exam, before they prescribe medication.
— ID requirement. Pharmacists may ask for photo identification before releasing painkillers. Thirty-two states have the law.
— Pharmacy lock-in program. Forty-six states and D.C. require people with Medicaid who are suspected of abusing prescription drugs to use a single prescriber and pharmacist.
Here are the strategies Maine is not employing:
— Mandatory use of prescription drug monitoring program. While Maine has a prescription drug monitoring program, physicians are not required to use it. The program can be mandated for certain providers or in certain circumstances. Sixteen states have some kind of mandatory requirement.
— Substance abuse treatment. Maine has not expanded Medicaid under the Affordable Care Act, which would provide insurance coverage to those who need it to help pay for addiction treatment.
— Medical provider education law. Some studies have found medical students receive only about 11 hours of training in pain and pain management. Twenty-two states have a law requiring or recommending that providers obtain more in-depth training.
— Good Samaritan law. Seventeen states and D.C. have a law to provide a level of immunity to drug users overdosing or others witnessing the overdose, to encourage them to call 911. The Maine Legislature approved a good Samaritan bill last spring, but Gov. Paul LePage vetoed it.
— Support for rescue drug use. Seventeen states and D.C. have a law to expand the use of naloxone, which allows an overdose victim to breathe normally. It’s a prescription drug with no abuse potential that wears off in 20 to 90 minutes and can be and often is administered by a lay person. Some laws protect those who prescribe or administer the drug from liability. Others allow third-party prescriptions to family or friends who could help someone at risk of overdosing.
Drug abuse, including prescription drug abuse, can change the structure of the brain. The effects can be long-lasting and harmful, but addiction can be treated, and specific policies can help. The strategies listed above have potential to save lives, and lawmakers should thoroughly examine how they could work for Maine.