Pharmageddon: a statutory solution to curb Ohio's prescription abuse problem.

AuthorWoodworth, Ed
  1. INTRODUCTION II. BACKGROUND A. Dangers of Prescription Drug Abuse 1. Opioids 2. Tranquilizers 3. Stimulants B. Costs of Prescription Abuse C. Reasons for Prescription Drug Abuse D. Sources of Prescription Drugs Used for Abuse 1. Pill Mills 2. Doctor Shopping 3. The Home E. Current State of Federal Law: Controlled Substances Act F. Current State of Ohio Law vis-a-vis Prescription Reporting III. ARGUMENT A Core Competencies of House Bill 93 and Medical Rule 4731-11-11 1. House Bill 93 Makes It Difficult to Operate Pill Mills in Ohio 2. The Recent changes Also Enable Easier Access to oARRS B. Shortcomings of H.B. 93 and Rule 4731-11-11 1. Technical Issues with Ohio's Current Law 2. Reactive C. Proposed Solution 1. Mandatory OARRS Monitoring 2. Interstate OARRS Connectivity 3. Unused Prescription Collections 4. Anti-Doctor Shopper Statute D Debunking the Criticism of OARRS by Practitioners and Patients IV. CONCLUSION I. INTRODUCTION

    Portsmouth, Ohio is a small steel town with a big city problem. (1) This city has been particularly hard hit by the prescription drug abuse epidemic. (2) Nationally, the prescription abuse epidemic has killed more people than the crack cocaine epidemic of the 1980's and the heroin epidemic of the 1970's combined (3) In 2010, "9.7 million doses of prescription painkillers were dispensed in Scioto County[, Ohio, or] 123 doses for each of the 79,000 men, women and children in the county." (4) Portsmouth counts its dead by lining the front window of a vacant department store with pictures of those who died due to overdosing. (5) The city is essentially raising third and fourth generation prescription drug addicts. (6) In one particularly disheartening instance, a local family could name eleven houses on their street that sold drugs. (7) The majority of people who abuse these medications either get their drugs from dealers on the street or from someone who has access to these drugs. (8) The drug of choice--Oxycontin--is legal, and can be obtained from a local pharmacy with a prescription. (9) Drug abuse there is so pervasive that, despite the high unemployment rate, (10) some businesses have difficulty finding job candidates who can pass a drug test. (11)

    While some parts of Ohio are affected more so than others by this prescription abuse epidemic, (12) current legislation allows a situation, like that of Portsmouth, to happen anywhere in Ohio. This is in large part due to Ohio's statutory scheme that focuses more on punishment than prevention, despite recent encouraging changes that have been made. (13) Despite the changes already in place, the legislature should enact a consequential solution that prevents prescription abuse by removing these drugs from the streets.

    Ohio has a system in place with the capability to curb prescription drug abuse, but it is far underutilized. (14) The Ohio Automated Rx Reporting System ("OARRS") currently tracks all controlled prescription medications dispensed by an Ohio-licensed pharmacy. (15) OARRS is "designed to allow physicians and pharmacists to cross-check prescriptions with each other and identify individuals who may be doctor shopping." (16) When using OARRS, physicians can more effectively serve as the gatekeepers to dangerous prescription medications because they have access to more information to make the best decisions regarding prescription choices for patients. (17) But, currently, reporting from the system is not required in all situations, and before the recent changes of 2011, only a minority of practitioners were registered to use it. (18) In response to the growing prescription drug abuse epidemic, the Ohio legislature enacted House Bill 93 on May 20, 2011 (19) to eliminate "pill mills," (20) or a physician's office that sells prescriptions under the table to anyone with cash. (21)

    Regardless of the positive effects with the enactment of H.B. 93, Ohio needs to take more action to prevent prescription abuse. Ohio was at the cusp of tackling the prescription abuse epidemic, but fell short of the results it was capable of attaining. (22) Specifically, H.B. 93 falls short because it does not focus on prevention. (23) Instead, H.B. 93 only gives OARRS the capability to identify clinics that supply patients with unnecessary quantities of medication. (24) While this prevents some prescription abuse, it does not go far enough. For instance, most physicians may use Ohio's Prescription Monitoring Program (PMP), also known as OARRS, but only few physicians are required to do so. (25) However, used to its full potential, OARRS can provide physicians with more information to identify drug-seeking behaviors of patients. (26)

    Also, H.B. 93 does not address other issues that facilitate drug abuse. (27) One reason why prescriptions are so easily abused is because there are so many of them in the house. (28) Another reason is that patients are not effectively held accountable for doctor shopping. (29) Thus, Ohio should mandate OARRS reporting and monitoring by all prescribers, promote OARRS interconnectivity with other states, mandate prescription return programs, and create stronger anti-doctor shopping statutes to effectively curb prescription abuse.

    Prescription abuse in Ohio continues to be a serious and complex issue that should be addressed. Accordingly, Part II of this Note examines the background of prescription drug abuse generally. It identifies the dangers of prescription drug abuse, the cost drug abuse places on society, some reasons for prescription drug abuse, sources of prescription drugs, and discusses the current state and federal laws regarding prescription drug abuse and prescription reporting. Part III discusses the positive and negative aspects of H.B. 93 and Medical Rule 4731-11-11 and then offers proposals to more effectively prevent prescription drug abuse. Part IV discusses various criticisms of the current OARRS system and demonstrates why these concerns are either unfounded or do not outweigh the benefits of having such a system.

  2. BACKGROUND

    Prescription drug abuse is a complicated topic with many facets. To help understand the topic, it is necessary to discuss the dangers, costs, causes, and sources of prescription abuse, and to look at the relevant federal and Ohio statutes that pertain to prescription abuse. Thus, Part A identifies the dangers of abusing opioids, tranquilizers, and stimulants--three of the most commonly abused classes of prescriptions. Part B discusses the costs that prescription abuse places on society. Part C proffers various reasons for prescription drug abuse. Part D identifies pill mills, doctor shopping, and the home as major sources of prescription drugs. A brief description of the Controlled Substances Act, which regulates drugs at the federal level, can be found in Part E. Finally, Part F provides an overview of the statutory scheme surrounding prescription drug abuse in Ohio.

    1. Dangers of Prescription Drug Abuse

      The dangers of prescription drug abuse are well documented. Prescription drug abuse is "the intentional use of a medication without a prescription; in a way other than as prescribed; or for the experience or feeling it causes." (30) The most commonly abused medications are pain relievers, (31) tranquilizers, (32) and stimulants. (33) As will be discussed in more detail, the abuse of opioids, tranquilizers, and stimulants can have devastating effects on the human body.

      1. Opioids

        "The term opiates refers to naturally occurring alkaloids, such as morphine, codeine, and thebaine ... that are derived from the opium poppy plant." (34) Abusing opioids can be very harmful to the body. (35) Opioid chemicals bind to the opioid receptors in the central nervous system (36) and provide an analgesic effect because they decrease and alter the sensation of pain. (37) Opioid abuse may lead to drowsiness, and may dangerously decrease the rate of breathing. (38) Furthermore, "if combined with other medications that cause drowsiness or with alcohol, heart rate and respiration can slow down dangerously." (39) In addition, a person's prolonged use of opioids can dull the effects of the drug because the body becomes tolerant of the drugs' effects. (40) consequently, a person taking the drugs may increase their dosage. (41) Finally, opioid addiction is most common in those who abuse these drugs recreationally, and the unpleasant withdrawal effects tend to reinforce the addiction. (42) Ironically, the Ancient Sumerians referred to the opium plant as "hu gil" or "plant of joy," (43) perhaps alluding to its propensity for abuse. (44)

        Opioids also have indirect effects on the health of patients with a history of prescription drug abuse. (45) For example, healthcare "providers tend to undertreat pain in this population due to biases, misconceptions, and systems issues." (46) Thus, when patients with a substance abuse history are actually in pain and need medicine, physicians fear that the patient is "crying wolf" in an attempt to secure more medication. (47) This undertreatment results in "increased length of stay [at a hospital], frequent readmissions, and increased outpatient and emergency visits." (48)

        Opioid abuse is so pervasive that it impacted nearly an entire generation of people living in southern Ohio. (49) The most popular drug abused in Scioto County, Ohio, is an opioid by the name of Oxycontin. (50) "Nearly 1 in 10 babies born last year in this Appalachian county tested positive for drugs." (51) The situation in Scioto County has been compared to the drug abuse epidemics of the 1970's and 1980's: "a generation of young people ... were raised by their grandparents because their parents were addicts, and now they are addicts themselves." (52) The addiction to opioids creates such desperation that in some instances people will kill and commit other crimes to get access to Oxycontin. (53) For instance, a local elderly man had access to Oxycontin prescriptions, and a burglar broke into his...

To continue reading

Request your trial

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT