The Unintended Side Effects of Fighting Prescription Drug Abuse
By Twinkle VanFleet
A workplace accident in 2001 changed my life forever. While working as a part-time grocery checker and cashier, I suffered an incident that led to the tendons being torn from the bones of my right foot. After an initial misdiagnosis, I ultimately discovered that I had a rare central nervous system disorder that subsequently altered my skin, blood vessels, muscles, bones, and caused atrophy and other issues to my body. Since my accident, pain has become an unbearable, unmanageable, and near-constant presence in my life.
Through painful trial and error, my physicians and I have finally found the appropriate combination of medications to provide some relief from my debilitating symptoms. The prescription medications that I take allow me to do things that most people take for granted. Now, I celebrate small triumphs such as cooking a meal, occasionally attending a function, and watching my grandson grow.
Some of the medications that helped give me my life back were prescription opioids, which have recently come under increased scrutiny due to heavy abuse by some.
Those who abuse prescription opioids often change the original pill form by chewing, grinding, melting or snorting the drug to get a faster high. In an effort to help address the problem of abuse, some regulators have put in place restrictions on access to these medications. Unfortunately, people who use prescription medications as intended can become unfortunate casualties of efforts to regulate opioid abuse, as we end up getting lumped in with those who misuse treatments. It is difficult to obtain refills without scheduling multiple doctor visits, and, in some cases, doctors are not allowed to call in prescriptions.
Fortunately, there are new weapons available to help combat prescription opioid abuse which do not sacrifice the many patients who legitimately use the medications to fight pain. New "abuse deterrent formulations" (ADF) for opioids have properties that make it difficult or undesirable for someone to tamper with them. These medications are made with physical and chemical barriers, such as a special kind of coating or hardness to the pill itself, that won’t allow them to be chewed, crushed, cut, grated, ground up, or melted with water or alcohol. ADF formulations can even eliminate the "drug" effect if the product’s form is altered.
California policymakers must enact policies to help develop a strong, lasting solution to the health crisis of prescription opioid abuse. There are several major actions that will help reduce opioid abuse while making sure there is continued access to necessary care for the millions of pain patients who need the medications and use them responsibly.
First, advocates must push for legislation that prevents substitution of ADF products for non-ADF products at a patient’s pharmacy, unless that switch is approved by the prescribing health professional. Legislative attempts to curb abuse should advance patient safety while placing a high priority ADF treatment options. Additionally, non-opioid therapies should be offered as a first line of treatment for pain while reducing the opportunity for opioid abuse. Pharmaceutical companies should be encouraged to create abuse-deterrent options for treating pain patients. Finally, states should define what constitutes an "abuse-deterrent" medication based on FDA guidance.
We must find a balance that separates patients who truly need opioid medication to live productive lives and those who are abusing them. Responsible patients should not be punished in an attempt to crack down on prescription drugs and opioid abuse. Legislators, health care professionals and pharmaceutical companies must work together to stop opioid abuse while keeping the needs of chronic pain patients front-of-mind.
Twinkle VanFleet is a Sacramento resident and executive board member and advocacy director for the Power of Pain Foundation.