Hawaii’s alarming increase in fatal prescription-drug overdoses reflects a national trend that the U.S. Centers for Disease Control has described as an epidemic. The dispensing of powerful narcotic painkillers has skyrocketed over the past decade or so, and misuse of these drugs has likewise grown.
Opioid analgesic painkillers such as fentanyl, oxycodone and hydrocodone have an important place in the management of chronic pain. But as the rising death rate illustrates, some legitimate patients misuse the drugs, which also are abused by recreational users who have no medical reason to be taking them. Factor in the reality that some doctors overprescribe the painkillers and that young people in particular consider prescription drugs less dangerous than illegal ones and you’ve got the recipe for our current public health crisis — one that demands a multi-faceted approach to solve.
Nationally, consumption of opioid analgesics jumped 300 percent between 1999 and 2010, and associated death rates more than tripled between 2000 and 2010, according to the CDC.
In Hawaii, as in the U.S. overall, prescription-drug overdoses have overtaken car crashes as the leading cause of fatal injuries. From 2009-2013, 773 people in Hawaii died of prescription-drug poisoning, up from 585 deaths in the previous five-year period.
Research cited by the U.S. Department of Health and Human Services shows that teenagers and young adults perceive prescription drugs as safer and less addictive than illegal drugs, and that drugs obtained from their parents’ or grandparents’ medicine cabinets or from the neighborhood pharmacy are less risky than those bought from a drug dealer on the street.
This marks the need for stronger awareness campaigns highlighting the risks of prescription painkillers, to counteract misperceptions that fuel abuse. Detailed information must be delivered by doctors to their patients and by families, schools, law enforcement agencies, churches and nonprofit organizations to children and others who are learning how to lead healthy, productive lives. Evidence supporting methodical patient and public education campaigns is limited but promising, according to HHS, proving that teaching people about the safe use, storage and disposal of narcotic painkillers helps reduce overdose deaths.
Prescription Drug Monitoring Programs, which operate in 47 U.S. states, including Hawaii, also are powerful tools that merit technological refinements to foster fuller use. Launched only two years ago, Hawaii’s PDMP is credited with reducing the amount of "doctor shopping" some patients do to obtain painkillers. The program allows physicians and pharmacists to check patients’ medication histories online, and lets the state readily monitor doctors’ prescribing patterns.
These are vital aspects of the multi-pronged approach, given that an analysis of opiate-related fatalities in Honolulu from 2004-2008 found that nearly half of the 270 deaths were linked to narcotics prescribed to the victims by their doctors. Illegally purchased opiates accounted for only 4 percent of the deaths, indicating that painkillers obtained from family members — pilfered from tutu’s medicine cabinet, for example — were to blame in a large percentage of deaths, although the study could not quantify the number exactly.
Education campaigns, online monitoring and other efforts to combat prescription-drug abuse must acknowledge that many patients need powerful painkillers to relieve suffering caused by their medical conditions. Ensuring access for those legitimate needs while curbing illicit use demands that doctors, patients and their families recognize the risk of abuse — and keep a lid on it.
