On any given morning I can open up my laptop and find probably half a dozen articles on our opioid abuse problem going on in the U.S. The words in the headlines change, but the content and message are sadly always the same: Opioid and heroin addiction are rampant.
Sometimes the article is simply reporting the facts:
- A pharmacy robbery in Oklahoma
- A pain clinic closed in Tampa
- A physician/pharmacist team exposed for pill mill prescribing
- A grieving family over the loss of a loved one due to an overdose
Sometimes the article is trying to uncover solutions:
- Focus on prescribers to solve the problem
- Focus on pharmacies to solve the problem
- Secure our borders to solve the problem
- Open more recovery and treatment facilities to solve the problem
- Educate the public to solve the problem
Not only do we have lots of information describing the problem and proposing solutions, but we also have taken several steps to try and deal with the issue.
- Nationwide Prescription Monitoring Programs and Mandatory Reporting
- Naloxone emergency kits
- Abuse deterrent narcotic formulations
- Rescheduling of Hydrocodone to CII status
- Improved prescription security (tamper resistant prescriptions, mandatory electronic prescribing is coming soon)
But something about all this information and activity has always bothered me. Something is missing in all our reporting about overdose deaths. I feel like I’m trying to solve a puzzle with a missing piece.
What is missing is data that traces the prescription medication involved in the death back to the source.
In other words, to put it bluntly: Where did the victim obtain the drug? Who gave it to him/her? That information is almost never revealed.
We NEED to know where the drugs involved in DEATHS are coming from. The source is significant! But everything we read online is typically general and non-specific. We’re told we have a “diversion” problem and an “overprescribing” problem and that prescription opioids are being “stolen” and “sold.” That’s not data. That’s not research. We have thousands of these terrible overdoses going on every year, but frankly we have NO reliable data upon which to design our strategy.
For example (this list is not comprehensive), did the medication involved in the overdose death come from…
A) A legally obtained prescription for themselves by a doctor and pharmacy
B) A stolen bottle of medications from an otherwise legally obtained prescription (e.g. from a friend or family member)
C) An illegally purchased bottle of prescription medication on the street or from a pharmacy
D) A fake or stolen prescription blank
E) An emergency room prescription
F) Pharmacy theft
Can you see how the SOURCE of the offending substance should logically determine our strategy for correction? But if you happen to have read the article this far (you are a hearty soul!), I warmly invite you to search online for this data. Google it. Look for studies. Search for hard data, not “general” lists of possible sources for opioids that lead to addiction and death. Actual numbers. Percentages. Figures. Find the study that says “___% of overdose deaths came from prescription drugs obtained legally by the victim from his/her doctor, and ___% came from illegally purchased prescription drugs from an illicit source.” Once you find that study, please send it to me. I’m eager to see it.
Maybe you will have more success than I have had. I can’t find that information. Maybe I’m not that good at doing online research. I will gladly concede that fact if someone can come up with answers and data that is verifiable.
Maybe the sad reality is that the answer is unknown. Maybe we have no idea where the drugs are coming from. Maybe these awful deaths are made even more terrible by the deafening silence of information about how the poor victim obtained their lethal dose.
If so, that breaks my heart. And if that is the case, I’m not very optimistic about our efforts to combat this growing crisis.
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