Will a new nationwide database reduce an 'epidemic' of prescription drug abuse?

The Omnibus Appropriations Act of 2009 included funding for The National All Schedules Prescription Reporting (NASPER) law, which passed in 2005 and was intended to coordinate prescription drug monitoring in all 50 states.

There will likely be many welcome -- and perhaps some unwelcome -- side-effects that result from the creation of this new database. Patients, doctors, as well as the pharmaceutical industry should take notice now that the law is being implemented.

One of the prime movers in the bill's passage was the American Society of Interventional Pain Physicians. I recently had the opportunity to interview Dr. Laxmaiah Manchikanti, CEO and chairman of that group.

We spoke about the growing problem of prescription drug abuse and how this legislation will help in the fight against it.

"Illegally obtained prescription medicine, compounded with physical, psychological, and emotional elements, is of epidemic proportions," Manchikanit told me. "Americans, constituting only 4.6% of the world's population, consumed 80% of the global supply of opioids, 99% of the global supply of hydrocodone and two-thirds of the world's illegal drugs."

He added that patients suffering with chronic pain frequently end up abusing the same drugs given to them to alleviate this pain, while around 22 percent also add illicit drugs.

"Controlled prescription drugs like hydrocodone, OxyContin, Ritalin and Valium now constitute the fourth-most-abused category of substances in America, only behind marijuana, alcohol and tobacco," he said. "Between 1999 and 2002, the number of opioid analgesic poisonings on death certificates increased 91.2%, while heroin and cocaine poisonings increased 12.4 and 22.8% respectively."

Manchikanti pointed out that 60% of patients who abuse drugs receive them from one doctor. Another 15 to 20% come from "doctor shopping," in which they visit more than one doctor without disclosing that fact to the other physicians. He sees NASPER as a major weapon in the fight against such abuses, by better allowing doctors to track prescription histories and the activities of other caregivers.

The funding of NASPER will allow more states to create and maintain centralized databases of prescriptions, which Manchikanti estimates could eventually reduce prescription drug abuse by 30 to 50%. With continued funding, he believes this could be accomplished within the next five to six years.

In my lifetime, we've made major strides in understanding the consequences of pain and how to alleviate it. The fear of those who've benefited from these advances has been that steps to curb abuse would limit legitimate access to the drugs. NASPER should make it easier for doctors to prescribe with confidence that these medications will be used as they were intended.


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