Prescriptions for painkillers have reached completely outsized proportions in the nation and in Missouri. According to the Centers for Disease Control and Prevention, “enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for a month.” As every anesthesiologist knows, these drugs are potent respiratory depressants, so overdoses – intentional or not – can and do lead to death.
These deaths have more than quadrupled in Missouri during the past 10 years. The latest figures from the Missouri Department of Health & Senior Services show nearly 900 deaths annually, compared to the low 200's of a decade ago.
From a public health standpoint, a 50 percent reduction in these deaths would save 450 lives, nearly six times more than are estimated to be saved by primary enforcement of seat belt laws. Missouri’s rural counties have nearly twice the overdose rate of their urban counterparts.
While the Missouri Society of Anesthesiologists believes painkillers are indispensable for the management of pain when properly prescribed and used, much more can be done to reduce the improper prescription and use of these agents.
A recent article in the Wall Street Journal also highlights the impact “pill mills” and prescription drug abuse can have on neighboring states. The top recommendation of the CDC to reduce the abuse of painkillers is for every state to have a robust prescription drug monitoring program.
These programs electronically track information about who is prescribed what drugs and at what location. State and federal laws already require this information to be provided in the prescription and dispensing processes.
Missouri is currently the only state in the country that has not passed legislation to enable a functioning monitoring program.
“Doctor shoppers” – those who claim to have a condition amenable to treatment by prescription painkillers and who go from one doctor’s office to the next seeking these drugs – are numerous in Missouri. They are so common that a fellow physician told me that he expects more than half of the patients of any new physician’s office to be drug-seekers.
Having researched the signs and symptoms of their alleged conditions online, these drug-seekers tell very convincing stories to the doctor. At present, there is no way for a physician to know if his or her patient already has painkiller prescriptions.
A key component to a robust monitoring program is the ability of a doctor to see, in real time, if his patients have painkiller prescriptions from other doctors. In other states, this ability has been shown to significantly reduce painkiller prescription abuse.
Like it or not, the lack of any monitoring program has helped Missouri gain a national reputation as a place that makes painkiller prescriptions readily available to abusers.
As an active member of the Missouri Prescription Drug Monitoring Program NOW Coalition, the Missouri Society of Anesthesiologists strongly urges the Missouri House of Representatives and Missouri Senate to pass an effective prescription drug monitoring program early in the 2013 legislative session.
Without it, many Missouri residents will continue to die needlessly.
Joseph Forand, M.D., is past president of the Missouri Society of Anesthesiologists.