Prevention of prescription drug abuse can start with education about the risk of overdose death

Clark

Photo: Nextgov

On January 16, the ATTC Network hosted a free webinar, “SAMHSA’s Opioid Overdose Prevention Toolkit & Prescription Drug Abuse,” led by the Director of the Center for Substance Abuse Treatment at SAMHSA, Dr. H. Westley Clark.

In addition to an overview of the toolkit itself, Clark’s presentation included epidemiological details about the current overdose epidemic, federal-level efforts to address overdose, and the importance of access to evidence-based treatment (including medications).

The recorded webinar is available online for on-demand viewing.  You can also download the slides for an overview of the talk.

Here are two salient points:

  1. The exchange of prescription pain relievers is happening at a person-to-person level.  
  2. Prevention of prescription drug abuse can start with education about the risk of overdose death .

To expand a bit on each point:

The exchange of prescription pain relievers is happening at a person-to-person level.  Most people get painkillers for free from friends and family members.  Most friends and family members get those same painkillers from just one doctor.

Take a look at this revealing graph to get a sense of the numbers:

SAMHSA 2012

Source: 2012 National Survey on Drug Use and Health, SAMHSA

That is to say, prescription drugs are generally not distributed by a sinister network of dealers; they mostly come from someone you know with a (perhaps entirely legitimate) prescription from a doctor.

In fact, a well-designed study last year estimated that only 0.7% of opioid purchasers fit into the category of  a “doctor-shopper,” someone who obtains drugs from multiple doctors for purposes of abuse or distribution.

Prevention of prescription drug abuse can start with education about the risk of overdose death.  Prescription drug users tend to operate in a gift economy and many consider themselves to be good people, regular people.  Many don’t recognize the risks of sharing pills.

The risk of death from an overdose, said Clark, is a good jumping off place for a larger conversation about substance use.  Not only is pill-popping not harmless, it can actually kill you or someone you love.

“We can use overdose as a starting point to get people to be aware of some of the consequences of the misuse of prescription opioids or heroin, for that matter,” he said. “We’ve got friends and relatives who are handing people very powerful drugs with the assumption that if they can take it, then anybody can take it.  And that is not the case.”

We can use overdose as a starting point to get people to be aware of some of the consequences of the misuse of prescription opioids.

Emphasizing the long-term consequences of a behavior–like the possibility of becoming addicted as a result of recreational painkiller use–doesn’t always get through to people.  But the possibility of dying from a drug overdose today or tomorrow?  No kindly neighbor wants to bear responsibility for that.

As the presentation concluded, Clark echoed many public health officials, academics, and community members by saying that the overdose problem is complex and should be tackled on many fronts.  It’s not something that will go away in one fell swoop and prevention approaches will  need to continue to evolve.

“It’s an incremental strategy; you can’t expect everything to occur at one time,” he said.

Clark ran through currently available and forthcoming resources to help individuals and communities prevent prescription drug abuse and overdose.  Some of them are listed below.

What do we have now?

SAMHSA’s Opioid Overdose Prevention Toolkit, which Clark reported has been downloaded over 26,000 times

POATS, by the ATTC Network, a package of tools and resources for SUD treatment providers on prescription drug abuse and the effectiveness of buprenorphine treatment

The Association of State and Territorial Health Associations 2013-15 Prescription Drug Strategic Map

What will we have soon?

SAMHSA is currently building guidelines on the use of opioids for pregnant women

SAMHSA is currently building guidelines on the use of extended release injectable naltrexone (brand name Vivitrol)

More

Dr. H. Westley Clark’s testimony before the Energy and Commerce Subcommittee on Health on Prescription Drug Abuse (June 14, 2013)

Related

JAMA Forum: The Public Health Problem of Drug Overdose