National Institute on Drug Abuse director, in Ky., offers solutions to stop over-prescription of painkillers, opposes pot legalization

By Melissa Patrick
Kentucky Health News

The director of the National Institute on Drug Abuse, Dr. Nora Volkow, told a group of Kentucky journalists and others at the Foundation for a Healthy Kentucky Health Journalism Workshop Sept. 21 that it is possible to decrease the over-prescription of opioids, which she says is driving the heroin epidemic, but the solutions aren’t “sexy.”

Prescriptions in the U.S. for opioids have increased from 76 million in 1991 to nearly 207 million in 2013.

The increase began in 2000 when The Joint Commission (on Accreditation of Health Care Organizations, then part of its name) began to require health-care providers to assess pain as a fifth vital sign and treat it as necessary, noting that addiction training is often not part of the medical curriculum, Volkow said.

Chronic pain is rampant in the U.S., with more than 100 million Americans suffering from moderate to severe pain, she said. And because there are few alternative treatments, it has led to the over-reliance on, and over-prescription of, opioids.

Kentucky saw a surge in heroin overdoses after the legislature cracked down on so-called pill mills, but the over-prescribing of opioids is what is driving heroin addiction, not the laws that have made legal opioids harder to access, said Volkow, a neurocscientist.

Volkow said there was a “horrific escalation” of babies born physically dependent on drugs and suffering withdrawal. She said she could not predict if these children would grow up to be addicts, she did know that addiction hurts babies’ ability to bond with mothers, which puts them at a higher risk for increased anxiety later on.

Volkow said education and implementing solutions that we know will work is the way to combat this problem, and “It is solvable.” She offered these suggestions:

  • creating a shift in America’s cultural attitude that says there is a pill for everything;
  • educating patients about the abusive potential of opioids when they are prescribed;
  • decreasing obesity rates, because obesity is a major cause of joint pain;
  • exploring non-medication avenues for managing pain, such as real-time brain imaging that shows how cognitive processes influences brain activity;
  • better educating health-care providers on how to recognize and treat addiction;
  • making sure providers are following recommended guidelines when prescribing opioids; and
  • creating new pain relievers with reduced abuse, tolerance and dependence risk.

Kentucky tied for fourth in prescription of opioids in the nation in 2012, at 128 prescriptions per 100 people, according to the IMS National Prescription Audit. Kentucky has the third highest overdose death rate in the nation, with more than 1,000 people dying each year. In 2014, 233 people died from a heroin overdose in Kentucky.

Nationwide in 2013, there were 16,000 plus deaths from opioid-prescription overdoses and 8,000 from heroin, says the Centers for Disease Control and Prevention.

The number of deaths from prescription drugs and heroin have become so dramatic that no one could ignore them, Volkow said.

She also noted that the increase in opioid use among young people was “alarming,” citing that 10.5 percent of 12th graders said that they had abused Vicodin in the previous year and 5 percent of them had abused Oxycontin.

Dr. Nora Volkow

Volkow spoke at length on the importance of utilizing medications in treating opioid addicts, saying that it is proven that when drugs containing methadone and buprenorphine are part of an ongoing addiction treatment program, addicts have the most success of recovery. She noted that only 30 percent of providers prescribe such medications, and fewer than half of addicts get them.

Removing a person from the drug “is not treatment,” she said, noting that this mode of “treatment” creates an almost 100 percent chance of relapse, and the best chance of success is with the use of medications like suboxone.

Volkow doesn’t like the idea of legalizing marijuana. She said her view isn’t driven by whether it is more or less harmful than alcohol or nicotine, but by the societal cost of legalizing another drug. She said that once a drug becomes legal, that increases exposure and addiction to it, increases the likelihood that it will be used regularly and increases the adverse effects from the drug; and marijuana is proven to have negative effects on adolescents.

She said the medical and mortality cost related to drugs comes mostly from legal drugs, noting that 400,000 people die a year from tobacco and 24,000 die from opioids, and asked, “Why do we want to expose ourselves to a third legal drug?”

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