Kelly Ayott (NH AG) on Dope.

AyotteNH AG Kelly Ayotte is demonstrating a common myopia (shared by the nation as a whole) when it comes to dealing with the rising rate of prescription drug abuse.  She wants to create a database to help track stimulants, pain killers, muscle relaxants and other commonly abused prescriptions in the state in an effort to reduce the rising number of deaths associated with this form of abuse.  Some claim the database poses privacy issues, while others contend that there are complex government regulations and a full blown pissing match between physicians and Pharmacists over who should be monitoring for abuse, and who is ultimately responsible when the system fails. 

I contend that all of these things are true to some degree, but we can probably avoid most of them, and prevent the extensive costs to taxpayers of setting up and monitoring such a system, by simply looking at some obvious relationships (at least in New Hampshire) and connecting the dots.  Get the complete dope on the jump.

 

Let’s start with the article from the Union Leaderin which Ms. Ayotte, in response to the rising number of reported deaths from prescription abuse last year states that

New Hampshire is the only state in the region that does not keep a central database. In all, 35 states keep track. In Maine, more than nine out of 10 database checks are by doctor offices. The rest come from pharmacies and police, Ayotte said.

 “It’s a public health issue and a way that will allow pharmacists and physicians to get the information they need, so they are not over prescribing,” Ayotte said.

Well that just begs for further inquiry.

So first up we have this from WBZ TV.com

The States (New Hampshire’s) Medical Examiner reported to WBZ that 57% of the 168 deaths from prescription drug overdose were caused by methadone, a drug typically prescribed to Heroin Addicts to “assist” them in escaping their addiction to Heroin. 

But according to this report in the Concord Monitor it is not addicts under methadone treatment that are dying.

Methadone is prescribed to help addicts overcome heroin addiction and as a painkiller. Officials say it is not the liquid methadone dispensed to addicts at clinics that is causing the overdose deaths but the tablets prescribed by doctors to relieve pain

From which I must conclude that 95 of the 168 deaths in New Hampshire (57%) were related specifically to methadone prescriptions for pain relief.  Looking back to the Union Leader quote Kelly Ayotte ignores the obvious soution and instead points us toward Maine for a remedy.  But what of Maine’s remedy?

From 2003 when Maine implemented the program to 2005 the CDC reports an increase in methadone deaths in Maine from 36 to 61.  New program, more deaths.  If that doesn’t seem to be enough of a non starter look at the dramatic increases in opiate use and abuse in Maine based on increased requests for treatment, and the skyrocketing number of prescriptions in Maine for opiate based pain killers.  Given these increases it would be difficult to see the mortality number going down though I could not find specific details for 2006 or 2007, or for methadone abuse specifically.  But despite the presence of the database and its new limitations, the first two years for which we have data are still showing an increase in deaths, which is exactly the opposite of its intended purpose.

And for the record, at least up to 2005, all the New England states (whom we are to understand have a database similar to Maine) show increasing death rates from methadone use or abuse. (see CDC link and tables for details) 

The real problem is that while as a state and a nation all the data points to significant increases in both the number of prescriptions written for methadone as a pain reliever and increasing deaths from methadone poisoning, no one wants to make that connection.   Most of the research I viewed from the medical community ignores this obvious connection instead referring to the “complex relationships regarding opiate use.”
 
We have this gem from the CDC of all places.
 
 

 

It has been difficult to determine the extent to which increases in opioid-related deaths have been due to specific prescribing practices, improper taking of the medication by patients, diversion of the drug from the patient to someone else, or other means. In July 2007, a SAMHSA-sponsored conference on methadone mortality concluded that all forms of methadone distribution (tablets, diskettes, and solution) continue to rise, with the greatest rise in distribution coming from tablets distributed through pharmacies;…

So we are to believe that if any other prescription med started killing several thousand Americans annually, we’d what, let them keep selling it, and doctors keep prescribing it, or would someone sue them while the FDA pulled the product off the market?

 

Kelly thinks a database will help.  Yes, more intrusive and complex government regulations and oversight is certainly a far better coarse of action than halting the administration of a medicine that can be directly linked to 95 deaths in 2007, in the State of New Hampshire alone. 

Where’s the outrage?

We can argue about the complex nature of the relationship between opiates and their users but dead is dead.

 

-Methadone deaths are the leading cause of increased drug poisonings in America, with all overdose poisonings ranking number two behind automobile deaths for causes of accidental death in the US.

-Methadone is more difficult to dose as a pain reliever because of its half life in our systems relative to its pain relieving capacity.

-Users cannot simply take more of it if the prescribed dose does not do the job because it could simply kill them.

-We know that prescriptions for methadone as a pain reliever account for the largest increase in the drugs use.

-Abuse is increasing as are deaths.

And finally, 57% of the 168 overdose deaths in NH have been linked directly to abuse or misuse of a methadone pain relief tablet.   You want a database?  How about the one that shows us how many people will die as a result of ignoring the actual problem?

Or is that realtionship just too complex?

 

 

 

 

 

 

 

 

About Steve Mac Donald

Husband, Dad, Dog Lover, Blogger, (sometimes) Radio Co-Host, Free Speech Facilitator, Climate Denier, Gun Owner, info-junkie, ...
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6 Responses to Kelly Ayott (NH AG) on Dope.

  1. I love the logic and the way that you brought the obviousness of the situation to the front. Everyone wants the government to “save them” from everything these days, and they have no idea what they are giving up in the process. Soon we will be completely without free will and privacy–how about this other easy answer? When you take a new medication RESEARCH IT, TAKE IT AS PRESCRIBED and UNDERSTAND HOW IT WORKS.

    Maines methadone overdoses have actually DECREASED in the past two years according to our Medical Examiners office. The reason? It’s not the database, of this I am sure. What is it then? Education and FEAR. People fear methadone and it’s users are becoming more knowlegdeable-because of a massive education campaign about methadone in Maine.

    HERE is another wonderful “HUH”? . There are groups forming all over the country trying to “regulate” methadone’s use. It’s been proven time and time again that this rash of overdoses comes NOT FROM CLINICS for the treatment of addiction, but pain relief prescriptions from doctors offices. HOWEVER, where do these groups point to first for MORE regulation-the clinics! The clinics which are already THE MOST REGULATED FORM OF MEDICAL TREATMENT THERE IS-including chemotherapy and radiation clinics. Yet, no one says a word about how to help pain patients stop overdosing. We KNOW that the problem isn’t the methadone coming from clinics, yet clinic’s continually get targeted by groups trying to save lives!

    ANOTHER wonderful tidbit on this subject? People entering methadone treatment for opiate addiction reap great rewards to their health. RARELY do people in treatment overdose on methadone OR any other drugs. In fact, the mortality rate for an active addict is signifigantly poor-yet when methadone treatment enters the picture, an addicts morbitiy returns to almost the same as a “non-addicts”. How can that NOT be seen as a HUGE SUCCESS?

    So what are the dots connecting here? People want to know how to save people from overdosing on methadone and it seems fairly clear to me-if your trying to save an opiate addict from overdose, get them into treatment-don’t make it HARDER for them……and if you want to save pain patients lives, EDUCATE DOCTORS on how to prescribe methadone OR just don’t give it to pain patients. Pain patients have NUMEROUS other options for their treatment.

  2. elcabra says:

    Thanks for the reply. I appreciate your input.
    Is the data on Maine’s decresaing overdoses readily available? I’d love to add it in as an update.

  3. KRISTAN HILCHEY says:

    Here is a link to an article regarding overdose deaths in Maine. I have paper copies of the report for 200, however I can’t find a link on-line to the report.

    “Cocaine deaths seen increasing across Maine
    By Meg Haskell
    Saturday, January 05, 2008 – Bangor Daily News

    Methadone-related deaths in Maine have decreased for the second year in a row, but cocaine-related deaths are on the rise, according to a new report from the Margaret Chase Smith Center on Public Policy at the University of Maine. ………..”

    http://bangornews.com/news/t/news.aspx?articleid=158552&zoneid=500

    Also FYI: patients on methadone for addiction are NOT entered into Maines drug database because of confidentiality law regarding substance abuse treatment.

  4. elcabra says:

    The CDC data I referenced is different from that in the Bangor News Link you provided. They may be using different reporting or metrics.

    The CDC shows 55 Confirmed deaths from Methadone pain relievers in Maine in 2004, while the number in the article “implicates” 76 deaths in the same year. “Implicates” makes me wonder if that includes combinations of drugs in which methadone was mentioned. It’s always something with data like this. The numbers for 2000 are different as well.

    The article also indicates 67 deaths ‘
    “implicte” in 2006 which is higher than the 61 from CDC in 2005, but again, that may not mean anything.

    Looks like I’ll need to look around some more.

    Thanks for the link though. If you come across anything else send it along.

  5. Everything you want to know about the ME PMP can be found here: http://www.maine.gov/dhhs/osa/data/pmp/index.htm. I also attached the link to their evaluation report.

    I work in prevention in NH and came from ME where I did the same. I applaud AG Ayotte for trying to address this problem. It’s not just the methadone use that is a problem in NH, it’s the non-medical use of prescription drugs. Youth are using at alarming rates, stealing from adults, elders are selling their meds to pay their bills, grandparents don’t even realize their grandchildren are stealing from them, and ADHD medications are being abused by youth in elementary and middle schools. Ask a treatment facility what their recent admissions were for or your law enforcement what their drug related crime is about…it all comes back to Rx abuse. SAP’s at schools and youth themselves will tell you the same thing. Alcohol is still the number one drug of choice but Rx abuse is increasing in alarming percentages across the country and NH is no different.

    No state has a perfect system and CADCA (Community Anti- Drug Coalitions of America) has recommendations on how communities can deal effectively with this- it is through coalition collaboration with law enforcement, pharmacies, health care professionals, older adults, parents, educators–everyone has a role to play. Until a group of all the stakeholders sits down to have a serious conversation about doing a comprehensive educational strategy in NH, the problem will continue to be ignored.

    AG Ayotte has a starting point and she isn’t in denial. Doctor shopping is very common to the opiate addict and prescription monitoring is a very effective strategy to helping physicians when an addict is doing just that. However, pharmacies need to do their part too and the NH Pharmacy Board needs to get on board with educational material on each and every addictive prescription that is dispensed so the risks are known and so consumers know where to go for help. How about more education for prescribing physicians on addiction? How about educational material for doctors offices on how to discard old medication? How about a safe place to discard the old meds?

    Instead of being critical of AG Ayotte, let’s offer solutions so that NH statistics of overdoses decrease instead of rise. Isn’t that the goal?

  6. elcabra says:

    Thanks for your input Cyndi.
    I have checked that link in the past, but not found everything I’m looking for.

    You make many of the points I have seen elsewhere, cogent, detailed and organized, but they ignore an important question. If opiate pain relief (particularly methadone tablets) have such a high rate of fatality, because they are so prone to abuse, why do we still use them?

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