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How should U.S. regulate powerful painkillers?

January 6, 2015 at 6:25 PM EDT
Forty-six people die every day in the U.S. after overdosing on prescription painkillers, causing some states to crack down. Are tighter laws creating new problems? Judy Woodruff gets views from Bob Twillman of the American Academy of Pain Management and Dr. Andrew Kolodny of Physicians for Responsible Opioid Prescribing.
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JUDY WOODRUFF: Each day, 46 people die in this country after overdosing on prescription painkillers.  In 2012 alone, the CDC says 259 million prescriptions were written for painkillers, enough to supply every American adult with a bottle of pills.

Now many states are pushing back, including New York, Tennessee, Kentucky, Florida, and Washington State.  Three of those states now require doctors to check a patient database before writing a prescription.  This year, Massachusetts, Rhode Island, Georgia, and Texas are also considering tighter laws.

But some physicians and patient advocates say this crackdown is creating new problems.

We get two views now.

Dr. Andrew Kolodny is the director of Physicians for Responsible Opioid Prescribing.  He’s also chief medical officer for the Phoenix House Foundation.  It’s a national nonprofit addiction agency.  Bob Twillman is the executive director of the American Academy of Pain Management and also a clinical psychologist at the University of Kansas Medical Center.  Mr. Twillman was caught in a traffic jam tonight.  He couldn’t make it to the studio, so he joins us by telephone.

And we welcome both of you.

Dr. Kolodny, I’m going to turn to you first.  You believe that it is important to impose more regulations on the use of painkillers.  Why?

DR. ANDREW KOLODNY, Physicians for Responsible Opioid Prescribing: Well, the United States is in the midst of a severe epidemic of opioid addiction and overdose deaths.  According to the CDC, this is the worst drug epidemic in United States’ history.

And the CDC has been very clear about what’s causing this epidemic.  The CDC has said that, as prescriptions for opioid painkillers began to skyrocket in the late 1990s, that it’s led to parallel increases in rates of addiction and overdose deaths.  And what this is suggesting is that we may not be able to turn this epidemic around until doctors and dentists begin to prescribe more cautiously.

JUDY WOODRUFF: And what — just quickly, what do you mean by that, more cautiously?

DR. ANDREW KOLODNY: Well, the United States, with about 5 percent of the world’s population, is consuming 80 percent of the world’s entire oxycodone supply and 99 percent of the world’s hydrocodone supply.

Opioids are essential medicines for end-of-life care or when used short term for acute pain, but this vast overprescribing of opioids is mainly for conditions where use of opioids are probably not safe or effective, like low back pain with a normal spine, fibromyalgia, chronic headache.

JUDY WOODRUFF: Well, Bob Twillman, let me turn to you now.  And, again, apologies that we’re — you are not able to join us on television, but we can hear you.

You have told us that you believe some regulations of painkillers makes sense, but you think the regulations have gone too far.  Why do you believe that?

BOB TWILLMAN, American Academy of Pain Management: Well, I think what we have seen with regulations in this area has been an attempt to find very simple solutions to what is really two complex problems, those two problems being the problems with prescription drug abuse, but also the problem of chronic pain.

And, you know, just a point on that, if prescription drug abuse is an epidemic, then I think chronic pain may be a pandemic, because the Institute of Medicine tells us that affects over 100 million people in the United States.  So I think what we have to do is to find the kinds of solutions that really address both of these problems and don’t wind up giving us what’s essentially a zero sum game.

JUDY WOODRUFF: Dr. Kolodny, what about his point?  You heard him, that there’s a problem with chronic pain and something has to be done about that.

DR. ANDREW KOLODNY: Chronic pain is a serious problem, and many Americans do suffer with chronic pain.

But, unfortunately, we are harming far more people with chronic pain than we’re helping when we treat them with long-term opioid medications.

When we talk about drugs like oxycodone and hydrocodone, these are drugs that come from opium, in the same way that heroin comes from opium.  And, in fact, the effects that hydrocodone and oxycodone produce are indistinguishable from heroin.  So these drugs are essential.  We should be using them, but we shouldn’t be treating low back pain, fibromyalgia and chronic headaches with long-term opioids.

What we heard from Bob Twillman is really the argument that the industry has been making from the very beginning of this epidemic.  They would like policy-makers to think there are these two distinct populations, millions of pain patients who are helped by these medications and drug abusers.

And what they’re saying is, let’s not penalize the pain patients for the bad behavior of the drug abusers.  The reality is that we don’t have two distinct populations.  There’s a tremendous amount of overlap.  And when you look at who’s dying from painkiller overdose deaths, the majority appear to be patients having these medications prescribed to them for chronic pain.

In fact, there are more Americans dying from painkiller overdoses who are getting these medications from doctors than young people who we now see switching to heroin.

JUDY WOODRUFF: And, Bob Twillman, if that’s the case, why shouldn’t there be much more careful regulation of the prescription of these painkillers?

BOB TWILLMAN: Well, we do think there should be much more careful use of these medications.

We also agree that they are being overprescribed and prescribed for the wrong kinds of pain.  So, I think we have to do, though, is to find the solutions that will allow to us really use these medications for those patients for whom they do provide benefit, and not get into a situation where what we’re doing is saying, let’s just — let’s just lower the supply across the board, because what we have seen is that the policies that we have put in place in the last few years that have actually done that have caused patients who have legitimate pain and need these medications to be fully functional have trouble getting those medications.

JUDY WOODRUFF: How have you seen that?  Where is the evidence for that?

BOB TWILLMAN: Well, you know, it’s hard evidence to collect, because, in essence, what you’re doing is asking people to collect evidence about services that have not been delivered to them, as opposed to services that have been delivered.

But I have talked to patients who call into our offices and tell us they’re having trouble getting their prescriptions filled.  One gentleman I talked to had been to 35 pharmacies trying to get his prescription filled.  And he had been to — going to the same pharmacy year after year, month after month, and one month he shows up and they say, we won’t fill this anymore.  We can’t fill this anymore.

And so he winds up going to 35 pharmacies trying to get his prescription filled.

JUDY WOODRUFF: Well, we are clearly not going to be able to resolve this tonight.

Dr. Kolodny, just very quickly, what is your answer, in brief, to those individuals who can’t get prescriptions who need them?

DR. ANDREW KOLODNY: I think that we do all need to worry about access to opioid medications, and we’re beginning to see pharmacies put signs in the window that say, “No oxycodone here.”

The pharmacists are not doing that because of state or federal interventions or regulations.  They’re doing this because they’re worried about getting robbed or shot.  We have a severe epidemic of opioid addiction.  And if we want to preserve access to opioids so that they’re available for all of us when we need them, we need to bring this epidemic under control.  And that may not happen until doctors and dentists begin to prescribe more cautiously.

JUDY WOODRUFF: Dr. Andrew Kolodny, Bob Twillman, we thank you both.

BOB TWILLMAN: Thank you.

DR. ANDREW KOLODNY: Thank you.

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