Featured in the May/June 2013 Colorado Medicine.
CMS joins coalition to combat prescription drug abuse
Kate Alfano, CMS contributing writer
On March 8, nearly 90 stakeholders from around the state met at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences in Aurora to pose strategies for reducing prescription drug misuse in Colorado. These experts included a dozen CMS leaders and members, many from the CMS Workers Compensation and Personal Injury Committee, who provided the physicians’ perspective.
The day started in a large group session as several top state officials described their agencies’ work on prescription drug misuse. The key message from each speaker was collaboration: that all participants in the meeting, and others invested in the issue not attending that day, must work together to meet a lofty goal of reducing the number of Coloradans who misuse these medications.
Colorado Attorney General John Suthers framed the issue by talking about the huge direct and indirect costs of prescription drug misuse that translate to increased health care costs, law enforcement costs, social services and loss of workplace productivity. He then described his role and explained how a successful collaboration between law enforcement and pharmacists brought down an oxycodone trafficking ring in January. “The fact is partnership is key in combating this measure and that’s why we’ll work closely with all our law enforcement partners and with our key partners in this room,” Suthers said.
“Those of us in law enforcement know that our critics will say you can’t successfully fight drug abuse from a law enforcement context,” he continued. “We know we can’t be successful with law enforcement efforts alone, but I can tell you that we have seen dramatic examples of success in reducing drug abuse when prevention, treatment and law enforcement work together. That’s what we need to do now. Together we can turn this around.”
Barbara Gabella, MSPH, epidemiologist for the Colorado Department of Public
Health and Environment, said the state’s focus falls on opioids because in 2011 36 percent of the state’s drug poisoning deaths in Colorado and 6.4 percent of admissions to substance abuse centers involved these drugs, the highest rate in 10 years. Opioid misuse disproportionately affects younger people; 61.5 percent of clients admitted in 2011 to substance abuse centers for these drugs were between the ages of 18 and 34.
“We have an interest in Colorado for setting a prevention goal for opioid misuse,” Gabella told the audience, standing before a presentation slide illustrating the goal for 2016. “If currently 6 percent of Coloradans are misusing prescription pain relievers, that represents about 255,000 people. If we set our goal to reduce misuse to 3.5 percent, that means that we want no more than 163,000 Coloradans age 12 and older misusing opioids. We would need to prevent 92,000 Coloradans age 12 and older from misusing.”
She continued: “Studies show that if we prevent opioid misuse, we’ll prevent misuse of other drugs like anti-depressants and benzodiazepines. We all have a role in creating this future and we’re starting today.”
Chris Urbina, MD, CDPHE executive director, presented his agency’s strategies. He said they will look closely at the prescription drug monitoring program and use it to continue to identify and monitor trends, work with partners to implement a permanent drug disposal program, encourage open dialogue about mental health and substance abuse, and encourage the continued effort to educate physicians and other providers.
“Those are our four key strategies going forward,” he said. “I hope you’ll believe this is truly a winnable battle and we can really make a difference.”
Participants then moved into roundtable discussion groups focusing on five topics: the Prescription Drug Monitoring Program (PDMP), safe disposal of prescription drugs, data and analysis, public awareness, and provider and prescriber education. Attendees discussed current action in these areas as it pertained to their specific expertise, and each group worked together to develop prevention strategies.
By the end of the day, each roundtable submitted at least one recommendation.
- The PDMP group recommended requiring education about the existence and utilization of the PDMP as part of the licensing process for prescribers and pharmacists, and they recommended improving the usability of the PDMP system through the use of information technology and increased access.
- The disposal group recommended expanding the existing prescription drug reclamation program and establishing permanent dropoff locations.
- The data and analysis group recommended mapping out all sources of data related to prescription drug use, misuse, and overdose in Colorado, then standardizing data collection tools across agencies for continued analysis.
- The public awareness group recommended multiple education campaigns that target different audiences and address common misperceptions.
- The provider and prescriber education group recommended requiring all DORA-licensed prescribers (with exemptions) to undergo education that reflects best practices in controlled substance prescribing and addresses pain management and patient safety.
These recommendations have been forwarded on to be further developed at the Governor’s Prescription Drug Abuse Reduction Policy Academy meeting and will influence Colorado’s full strategic plan and timeline on the prevention of prescription drug misuse, which will be presented at the National Governors Association meeting in May.
Over the past few months, the CMS Workers Compensation and Personal Injury Committee has studied this issue and the Colorado Medical Society’s role in it. The group drafted a report containing their proposed long-term goal and strategies for CMS in preventing prescription drug abuse, and the CMS Board of Directors approved the report at its March 15 meeting.
Look for action on this issue as CMS works to fulfill this goal: “To assure access to compassionate, evidence-based care for patients who suffer from acute and chronic pain, while significantly reducing the potential for medically inappropriate use or diversion and the resulting range of medical, psychological and social consequences, including addiction, overdose and death.”