Wednesday, October 16, 2013

Dying to me don't sound like all that much fun

John Mellencamp had a hit years ago, called "the authority song." I heard a DJ once say that this was from his "rebelious period," which I thought really did not narrow it down much with Mellencamp. One of his lyrics in this song struck me when I read a recent report on opioids: 

He said , "You don't need no strength, you need to grow up son."

I said, "Growing up leads to growing old and then to dying"

"OO and dying to me don't sound like all that much fun."

Indeed, dying to me also does not sound all that appealing. Certainly, we are all headed that way. Death and taxes, I get it. That does not mean that because it is inevitable it is necessarily inevitable on any given day. Death can still be senseless and needless in specific instances. 

The "Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority." They recently released a report on prescription drug abuse. The death rates and issues with drugs are not "news," but their findings are staggering.

Taken alone, their findings would be staggering. Taken in context, they are even worse. Context? In 2012, the Center for Disease Control reported that "drug overdose" is a more likely cause of death in this country than "automobile accident." That conclusion should have resulted in some serious soul-searching and some serious action across this country. Certainly, there have been some efforts made. There are many officials who take this situation with appropriate concern. However, the deaths continue and more must be done. 

The Report notes the scientific advances of the past twenty years and all that has meant to pharmacology, but notes 

"there has been a striking increase in the misuse and abuse of these medications — where individuals take a drug in a higher quantity, in another manner or for another purpose than prescribed, or take a medication that has been prescribed for another individual." 

In short, these medications are not being used appropriately in some instances, and they are getting into the wrong hands. There is a particular issue with pain medication. The Report notes "Overdose deaths involving prescription painkillers have quadrupled since 1999 and now outnumber those from heroin and cocaine combined." 

About 50 Americans die each day from prescription pain killers in the United States. This country takes heroin and cocaine very seriously. Legislatures and law enforcement have pursued these with zeal. Will the same effort be directed at the pill problem? The Report says that the annual cost of prescription drug abuse is about $53.4 Billion. Dividing this by the 314 (approx) million people in this country, this epidemic is costing us about $170.00 each annually. 

There is evidence cited in the Report that supports people are engaged in "abusive purchases of controlled substances." Examining the Medicaid population led the Government Accounting Office to conclude that 65,000 Medicaid patients in five states "acquired the same type of controlled substances from six or more different medical practitioners during fiscal years 2006 and 2007 through “doctor shopping.” Are these people using multiple doctors to obtain the pain medication they need for their medical conditions? 

Vast volumes of pain relief medication is in our marketplace. The volume of prescribed pain medication quadrupled in America between 1999 and 2010. In an odd coincidence, the volume of "fatal poisonings" related to pain medication also quadrupled. An incredible set of statistics. Emergency room visits for medication misuse have increased. Many such visits involve minors. They are often taking medication that belongs to some adult. Is this possible because of the sheer volume of pills out there? The volume of minors who seek treatment for medication poisoning is double the volume who seek such treatment for household product poisoning. 

States are taking action. The Federal Government is focusing attention on this pandemic. Tools such as prescription drug databases are being deployed, allowing physicians and pharmacists to look for patterns in prescriptions. Few jurisdictions require doctors to consult such databases before prescribing medications. When I have asked why they are not required, the response I get is that the physicians do not want to be regulated or restricted, so they are not. Interesting answer. 

Physicians and clinics referred to as "pill mills" are being examined, and some are being closed. Some physicians are being prosecuted for their prescription practices. Just Google "physician pill mill prosecution" to learn about those instances. It is not as though America is sitting on its collective hands, but the deaths and illness continues. Some feel that the death rate has not crested yet, that is that the rate continues to increase. The numbers take some time to compile. Therefore the results of the various efforts are hard to measure in real time. 

The workers' compensation system serves a vast array of people with a great diversity of medical issues and complaints. It is a self-executing system, which involves injured workers, employers, and insurance professionals. There are also physicians, therapists, nurses, case managers, and more. With this community, is there any reason that medication should be an obstacle or danger for injured workers' or their families? 

Everyone in this community should be focused to "assure the quick and efficient delivery of disability and medical benefits to an injured worker and to facilitate the worker’s return to gainful reemployment at a reasonable cost to the employer." Fla. Stat. 440.015. This community has to understand the potential for these medications, appreciate the benefits that they represent in the appropriate circumstances, and yet remain cautious of the harm that they might cause if misused or overused or poorly monitored.

While the workers' compensation community cannot change the world, it might change one corner of it. Our marketplace should be conscious of this epidemic and must commit to assuring that workers' compensation patients and those who live with them are not part of the statistics. Dying to me don't sound like all that much fun. 

UPDATE 10.17.13

The National Safety Council declared prescription drug overdose a "national epidemic" this week. Their report cites some similar statistics as those above. They have graded the state's efforts on this problem, and concluded that three states (Kentucky, Washington and Vermont) meet the NSC's four rating standards. Twenty three states partially meet the standards, and 14 simply do not (Arizona, New Hampshire, Idaho, Kansas, Missouri, Delaware, Iowa, Maine, South Carolina, Wyoming, Hawaii, Nebraska, Pennsylvania and South Dakota). The NSC suggests some actions to make changes in the drug overdose arena. 

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