EDITORIAL: Hope in the success of prescription monitoring

Salem News - 8/27/2018

Aug. 27--One of the most insidious aspects of the opioid scourge is that for many it all started in a place of healing -- the doctor's office. Alleviating pain is a fundamental part of modern medicine, yet pain pills have set far too many on the path to addiction.

That's why data released Friday by the state Department of Public Health are so encouraging. A digitized system of tracking opioid prescriptions seems to have seriously dampened the number of drugs available, at least from pharmacies.

It is no panacea and by no means the only factor in reducing the number of opioid prescriptions. Still, the somewhat straightforward task of tracking and counting drugs known to have a high potential for addiction appears to be helping rein in this problem.

On Friday, the Department of Public Health reported 568,000 prescriptions of Schedule II opioids (such as morphine, codeine and oxycodone) were written from April through June of this year. That represented only a slight decline from the first three months of the year. But it is a stark contrast to the beginning of the monitoring program, from January through March 2015, when nearly 842,000 prescriptions were written statewide. From that period, prescriptions have declined by nearly one-third.

The North Shore and Merrimack Valley regions accounted for some 12 percent of prescriptions written during the second quarter of this year -- in line with the region's share of the state's overall population.

The state's monitoring system allows doctors, dentists and nurse practitioners to research a patient's drug history. Indeed, it is now legally required before writing a prescription for potentially addictive drugs -- which likely explains its frequent use. The system was consulted 1.7 million times this spring, according to the data released Friday, or nearly 13 times every minute of every day.

Joanne Peterson, founder and director of the group Learn to Cope, which supports family members of addicts, remarked last fall that "doctors are getting educated."

"Many of the people who get addicted to prescription opioids are people who didn't need them in the first place," she said.

The prescription monitoring program is only part of the effort. The state medical society has launched campaigns to train prescribers on managing pain and screening for substance abuse. The state has also limited, by law, initial opioid prescriptions to a seven-day supply.

There are still areas for improvement. Three-dozen other states have similar monitoring programs, and a federal opioid commission has called for more work to ensure all communicate with each another.

Also, some reports suggest these programs have the opposite of their desired effect in some cases, prompting prescribers to up dosages to ensure patients an adequate supply. It's a potential consequence that needs more study. It also underscores the fact that these drugs, while susceptible to abuse, are in many cases necessary. Their benefit to people recovering from surgery or serious injury, or who are beset with painful illness, cannot be overstated.

Last week's data also suggest the opioid problem is far from contained. On Friday, the state reported 657 confirmed deaths from opioid-related overdoses during the first six months of the year, with another 322 to 396 likely to be added, for as many as 1,053. That's somewhat higher than the first six months of last year, when there were 975 deaths. The positive news is that the number of opioid-related deaths seems to be falling, even if just gradually, from one quarter to the next.

Perhaps more concerning is the prevalence of the drug fentanyl, which is far more powerful than heroin and was present in nearly 9 of 10 cases of deadly overdoses for which a toxicology report was available. Fentanyl, and the similar though far more dangerous carfentanil, substantially raise the likelihood of overdose.

This scourge and its tragic, far-reaching effects are far from solved. But there's hope in the success of programs like prescription monitoring that it can be brought under control.

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