Abuse of narcotic painkillers and other prescription drugs is a growing problem in the United States, and a leading doctors' group is urging members to exercise tighter control on the medications.
The American College of Physicians (ACP) says its recommended changes will make it tougher for prescription drugs -- painkillers such as Oxycontin and Vicodin, as well as drugs used for sleep problems and weight loss -- to be abused or diverted for sale on the street.
Prescription drug abuse may now be a prime cause of accidental death in the United States, according to a recent tally of preliminary data from the U.S. Centers for Disease Control and Prevention. One 2010 survey, funded by the National Institute on Drug Abuse, found that 16 million Americans aged 12 and older had used a prescription painkiller, sedative, tranquilizer or stimulant for purposes other than their medical care at least once in the prior year.
One of the ACP's 10 recommendations highlighted the need to educate doctors, patients and the public about the dangers of prescription drug abuse. The guidelines also suggested that doctors consider the full range of available treatments before prescribing painkillers.
Among the other recommendations:
Evidence-based, nonbinding guidelines should be developed to help guide doctors' treatment decisions.A national prescription-drug-monitoring program should be created, so doctors and pharmacists can check similar programs in their own and neighboring states before writing and filling prescriptions for substances with high abuse potential.
Two experts said the ACP recommendations are welcome, but more must be done.
"[The new guidelines] are spot on and can be effective, but in order to have any real impact on prescription drug abuse, the most important strategy they need to recommend would be proper addiction curriculum and education programs for all medical schools," said Janina Kean, president and CEO of High Watch Recovery Center, a drug rehab facility in Kent, Conn.
"There is a fundamental lack of education about addiction medicine and treating patients with substance-use disorders provided in medical school, as well as internships and residency programs," Kean said.
"For example, psychiatrists -- the very person whose specialty is behavioral health -- in many instances do not appropriately treat patients who have co-occurring addiction disorder," Kean said. "At High Watch, in case after case we have been confronted with patients who have achieved sobriety, then see a psychiatrist for an anxiety disorder and relapse after being prescribed a [drug] that is an addictive controlled substance."
Dr. Stephen Dewey researches addiction and the brain at the Feinstein Institute for Medical Research in Manhasset, N.Y. He called the ACP guidelines "excellent and perhaps long overdue," and said they are based on extensive and rigorous science.
"The ACP has acknowledged the roles played by physicians in this growing problem and is now offering suitable, effective and well-conceived strategies to address it," Dewey said. "The human and financial costs associated with prescription drug abuse cannot be overstated. If fully implemented, [the guidelines] will have a direct and positive impact on the human condition."
The guidelines were published Dec. 9 in the journal Annals of Internal Medicine.
-- Robert Preidt
