Finding Balance Amid the Opioid Abuse Crisis

I have been around long enough to say that the pendulum swings back and forth regarding the feelings of “experts” on prescribing and dispensing drugs. In the 1990s, it was discovered that Americans were being undertreated for pain, something that I think was valid then and is still valid today.

The pharmaceutical companies initially produced more powerful and longer-acting opioids, morphine and oxycodone. The most successful and most abused was OxyContin, a product that has been used widely by legitimate patients and, unfortunately, illegitimately by others. Purdue Pharma went on to spend millions to not only develop an abuse-deterrent formulation but also assist law enforcement and others in reducing the abuse of its own medication.

The new, reformulated OxyContin found its way to retail pharmacies in August 2010. However, the already-stocked old drug remained on the shelves and did not become almost entirely unavailable until late 2010 or early 2011.

That was the first abuse-resistant prescription drug, and the diversion of this product quickly took a nosedive in the United States. Plenty of data are available on the reduction in OxyContin diversion, but some still refuse to acknowledge this fact. These people are calling for the removal of most opioids, especially long-acting medications such as OxyContin.

The truth is that most prescription drug diversion in the United States involves immediate-acting generic opioids, primarily hydrocodone and oxycodone. These drugs have been around for decades and provide great relief for patients who have acute or chronic pain or need a “breakthrough” medication.

In a past article, I discussed the fact that governmental entities are suing several manufacturers of opioid medications. Law firms are salivating over the deep pockets of Big Pharma, and politicians hoping to be reelected want to appear willing to take on Goliath. Only those people know their true motives, but I remain skeptical whenever money and reelections are involved.

The CDC came out with recommendations for prescribing opioids. Although some applauded those recommendations, others later condemned the stricter recommendations as counterproductive. It became commonplace among organizations to blame overprescribing pharmaceuticals for the opioid problem.

There is no question that scores of criminal prescribers have helped fuel our citizens’ addictions. I know because police agencies I oversaw arrested and prosecuted many offenders, as did other law enforcement entities in the United States.

About the same time that reformulated OxyContin hit pharmacy shelves, Mexican drug cartels began to flood the United States with heroin. This plague, which rages still, includes clandestine fentanyl and carfentanil, fueling the overdose death rate that is creating a health care emergency in this country.

In the meantime, most recently, CVS said that it is limiting the dispensation of pain medications. That announcement garnered praise by some and disdain from others, who worry about being able to get their legitimate medications when they need them.

Lost amid the rhetoric and lawsuits are patients being treated for pain. Whenever anyone in authority talks about the prescription opioid problem, they should at least mention these patients and how we need to make sure that knee-jerk actions do not negatively affect this important group. After all, these medications are most often prescribed and needed by patients with pain.

The media need to take a step back when anyone is condemning pharmaceuticals and put the criticism in context.

There is plenty of blame to go around on this issue, but instead of leveling criticism, wouldn’t it be great if everyone worked together to find solutions to opioid addiction and, at the same time, protect those who are in pain?

Cmdr John Burke is a 40-year veteran of law enforcement, the past president of the National Association of Drug Diversion Investigators, and the president and cofounder of the International Health Facility Diversion Association. He can be reached by e-mail at burke@rxdiversion.com or via rxdiversion.com.