The public health issue of our time: prescription drug abuse

The North Carolina Medical Society, dedicated to protecting the health and welfare of North Carolinians, is faced with a public health emergency – opioid abuse.

North Carolina is not alone. According to the National Institute for Drug Abuse, in 2012 an estimated 2.1 million people in the United States suffered from substance-use disorders related to prescription opioid pain relievers. This number includes people with chronic pain who may abuse their prescriptions as well as addicts who may buy them on the street or shop around until they find a new doctor who will prescribe the drugs.

The number of unintentional overdose deaths from prescription pain relievers has soared in the United States, more than quadrupling since 1999. The U.S. Centers for Disease Control and Prevention reports more Americans die each year from prescription drug overdoses than motor vehicle wrecks. Data from the N.C. Division of Public Health reveal more than 1,000 people in our state die of prescription drug abuse annually.

This staggering number of impaired people takes its toll on our workforce, our hospitals and our economy, and exacts a high emotional and personal price on individuals, their families and friends. The problem is complicated by the fact that more than 100 million people in this country suffer from chronic pain, according to the National Institute of Drug Abuse, and for some opioid therapy may be the only option for relief. Physicians often walk a thin line in our desire to confront the public health emergency while upholding our oath to reduce the suffering of our patients.

We, as physicians and physician assistants, have a responsibility to stop the abuse of opioids, as it saps the human and economic resources of our state and country. Over the past decade, the NCMS has convened a task force, regularly communicates with our members and offers educational sessions on opioid abuse issues.

Thankfully, we do have a powerful tool to help us: the Controlled Substance Reporting System, an online registry to track prescriptions for controlled substances and to help ensure patients are getting the medications they need while not abusing them. The system provides valuable information to help us make educated decisions about the needs of our patients.

Unfortunately, a woefully small number of licensed practitioners in North Carolina use CSRS. According to the state’s Division of Mental Health, Developmental Disability and Substance Abuse Services, as of April 2014, approximately 18,700 dispensers and practitioners were registered to use the system. At the end of 2014, approximately 43,000 physicians and PAs were licensed to practice in the state by the North Carolina Medical Board.

I implore my colleagues to join me in doing our part to combat opioid abuse by registering to use the CSRS and then checking it every time an opioid prescription is contemplated, even if that means a bit of inconvenience or a frustrating few minutes with a computer amid an overburdened office schedule.

Understanding physicians are short on time with a growing list of administrative demands, the NCMS successfully lobbied for legislative changes in 2013 to allow doctors to delegate their authority to use the CSRS to anyone under their supervision, subject to DHHS approval. Since then, the state also has upgraded the system technology making it easier to access and use. Yet there has been no rush to register.

Lawmakers are growing frustrated with the lack of compliance. This year they introduced legislation that would make it a felony for a doctor not to be registered and use the CSRS. We do not support such draconian measures. But I understand the frustration of legislators faced with such a public health emergency, and I appeal to doctors to use the system to protect the public and our patients.

This story was originally published August 3, 2015 at 4:50 PM with the headline "The public health issue of our time: prescription drug abuse."