by Naomi Creason The Sentinel
In the mid ‘90s, a new drug sat on the horizon being billed with the ability to combat pain safely.
Jack Carroll, executive director of the Cumberland-Perry Drug and Alcohol Commission, remembers what some of the promises were for that new type of drug.
“They were marketed as being less addictive alternatives to drugs like codeine and morphine,” he said. “We believed it to be less addictive. We always want to believe that there’s a silver bullet out there, an easy solution, chemical solution that has no downside to it.
“It fell well short of the promises,” he added.
What the country got was OxyContin … and a prescription drug abuse epidemic that has changed the face of addiction.
Dr. Carrie DeLone, medical director of Holy Spirit Hospital, said the development and release of the drug was the first step in a push to treat chronic pain.
“There was a total gamechanger in 1995 when Oxycontin hit the market,” she said. “(Before) we thought it was too dangerous to treat chronic pain, that it was addictive and there wasn’t good evidence that it was helpful. That’s still the case.”
She noted that, at the time, there were none of the options and methods available today to treat chronic pain. Pain was not even a consideration for treatment until The Joint Commission later pushed for hospitals and physicians to focus on pain and to be accredited based on their pain treatment.
All of that combined created an atmosphere where highly addictive medication was fairly easily accessible.
“It’s an epidemic that was started by the pharmaceutical companies and propagated by the health care industry,” DeLone said. “There was hardly anyone admitted to rehab for prescription drug problems before the ‘90s.”
“The U.S. makes up just a little less than 5 percent of the world’s population, but consumes 80 percent of the worldwide supply of prescription painkillers,” Carroll said. “Between 1999 and 2010, the sale of prescription drugs increased by 300 percent.
“The opioid epidemic in the health care community is of our own making,” he added. “We allowed it in with overprescribing painkillers.”
It’s an issue facing much of the country and very visible in the Midstate, even at locally-owned pharmacies.
Shawn Hopper is the pharmacy manager at Holly Pharmacy in Mount Holly Springs, where he’s worked since 2013. He said the pharmacy receives quite a bit of prescriptions from a local pain clinic, so Oxycodone and other opioid painkillers are very familiar to the pharmacy staff.
“We get those prescriptions pretty frequently. We’ll open up, and a lot of the mornings, the first six people in a row are just trying to get that,” he said.
Though Holly Pharmacy tends to get many of its narcotic prescriptions from the pain clinic, it also gets some from family physicians — which is where problems can arise.
Fake prescriptions are a concern for pharmacists, especially since there are not many available tools for them to fully determine the legitimacy of a prescription or if the customer is shopping around for drugs. Because of that, pharmacists often don’t have a choice but to fill the prescription.
“We keep an eye on them, especially patients without insurance, or patients with insurance who ask us not to file it with the insurance company,” said Shelly King, pharmacist at SmartMed Prescription Center in Carlisle, who said they check with the insurance anyway to make sure there aren’t other prescriptions for the drug already filled.
King noted that they watch to see if a patient fills other medications or just the painkillers, and to see if the customer and physician is from York but they are filling a prescription in Carlisle. Those can be red flags, but if a physician confirms the prescription, King said there aren’t many options.
“It puts the pharmacist in a tough position because the doctor prescribed it,” she said. “Sometimes we know that something is not right.”
King said she believes there are some physicians who over-prescribe painkillers, which doesn’t help the opioid addiction problem in the area.
“I think doctors need to pull back,” she said. “I really think they’re kind of bullied into a corner. Patients push and push for it, and doctors just say, ‘Whatever.’”
For Carroll, a part of the problem is that family physicians are often not trained to handle prescribing this type of medication.
“Despite the many years it takes to become a doctor, there is no training for addiction or prescription medication or pharmaceuticals,” he said. “The physician ends up relying on the pharmaceutical sales rep or on reference materials.”
There are some fail-safes built into the system, with emergency room or urgent care doctors only writing prescriptions for a small number of pills or insurance providers regulating prescriptions be filled after 35 percent of the opioid prescription is used — something King said pharmacists additionally regulate by not allowing prescriptions to be refilled until two days before the drug runs out.
Solutions and problems
Many medical professionals believe more must be done in the health care end of the spectrum to affect the results of addiction on the street.
Carroll said Pennsylvania has issued a list of best practice guidelines for family physicians, dentists and oral surgeons — the three most likely areas of medicine that will prescribe opiate painkillers.
But the guidelines are still voluntary, and Carroll said there are still routines where a prescription after a tooth is pulled can be for 30 Vicodin instead of only 12 pills, and an offer for the patient to return for more if needed.
That type of availability, especially when that Vicodin bottle can sit unused in a medicine cabinet, is especially disconcerting when it comes to children and teenagers, according to DeLone, who speaks at community events. She said teenagers have a number of reasons how they started using the medication recreationally, one of which is because they can reach into virtually any medicine cabinet and retrieve a pill.
“Also, they say they’re not going to get in as much trouble as they would taking a street drug. Others say the medicine looked safe because it was in a bottle that said CVS or Rite Aid,” she said. “There’s a mentality that just because they’re prescriptions that they’re safe. It’s misused in every age group.”
Carroll said he would also like to see addiction training for physicians.
“If (a doctor) identifies someone who has tried to con you out of prescription medication, instead of showing them the door, you attempt a brief intervention with them and refer them to a substance abuse program,” he said. “As a medical professional, that’s your job, but physicians aren’t trained for that.”
The drug and alcohol commission, as well as law enforcement, also joined forces with Cumberland County to form the Community Opiate Overdose Prevention coalition that aims to educate the public about the ongoing opioid and heroin abuse problems in the county. COOP has already held two town hall meetings, with a third on the way in April in Newville.
Carroll said education is important to show the public what is going on and how people can become addicted.
Hampden Township Police Chief Steve Junkin said he believes people are beginning to understand how the epidemic can affect anyone in their community.
“There’s no community that is not affected by it,” he said. “People are becoming more aware of it. They understand now how they’re next door neighbor’s son is an addict. These drugs grab a hold of you.”