Prescription Drug Abuse

LFDA Editor

In Brief:

  • Prescription drug abuse, particularly of prescription opioids, is a growing problem in NH.
  • Improper use of prescription opioids can lead to addiction, and has been linked to increased risk of heroin abuse.
  • New Hampshire has a prescription drug monitoring program and laws that discourage “doctor shopping”.
  • There are many other potential policy responses to rising rates of opioid abuse.
  • Pro: Stricter regulation will help curb prescription opioid abuse, reducing fatalities and the risk of addiction.
  • Con: Stricter regulation may inhibit the ability of medical professionals to effectively treat patients experiencing acute or chronic pain.

Issue Facts:

Prescription drug abuse is a growing problem, both in New Hampshire and in the United States. Three categories of prescription drugs are those most likely to be abused:

  • Stimulants
  • Central nervous system depressants (tranquilizers)
  • Painkillers

Of late, there has been particular concern over the abuse of opioid painkillers. The remainder of this article focuses on facts and policies related to opioid abuse.

What are opioids?

Opioids are drugs that work by attaching themselves to special receptors in the  brain and other areas of the nervous system, causing a reduction in the perception of pain and a feeling of well-being or euphoria. Opioid drugs include oxycodone (OxyContin, Percocet), hydrocodone (Vicodin), meperidine (Demerol), and fentanyl.

It's generally agreed that these drugs can be a safe and effective means of treating acute pain, or pain related to cancer or end-of-life.

However, use of opioids to treat other forms of chronic pain, such as back pain or arthritis, is more controversial.  Long-term use of opioids can result in a patient’s body becoming desensitized to the effect of the drugs, an effect called ‘tolerance’. This may lead to long-term patients being given higher and higher doses. Additionally, long-term use can inhibit the production of natural opioids in the body, which contributes to negative symptoms (withdrawal) when the patient tries to stop.

Risks of addiction

Opioid drugs target the same areas of the brain as heroin and morphine, both highly addictive drugs, but there is some debate over the addictiveness of prescription opioids. The risk of addiction certainly increases when the drugs are used improperly: for example, when they are crushed and snorted, or combined with other substances. Taking opioids in larger or more frequent doses than prescribed also increases risk.

There is also a growing body of evidence connecting opioid abuse with increased risk of heroin abuse. Some users report turning to heroin after developing tolerance for their prescription painkillers, or when they can no longer afford or acquire prescriptions. Heroin is both cheaper and, in many areas, easier to acquire than black market prescription drugs.

The abuse of prescription opioids has been rising across the United States in recent years, as has the rate of deaths related to these drugs. Some experts argue that the rapid increase in the rate of prescribing opioids in recent years has made them more readily available, and point to surveys that reveal that a majority of those using painkillers for nonmedical reasons acquire them from a friend or relative. 

Other potential contributing factors include the greater social acceptability of taking opioids and aggressive marketing campaigns by pharmaceutical companies. 

Prescription opioid abuse in NH

Prescription drug abuse is an increasing problem in NH. 

  • Drug related deaths have been rising, with an estimated 470 deaths in 2016, up from 439 in 2015. A total of 404 of those deaths involved opioids, including heroin and/or fentanyl. 
  • The number of fatal overdoses from prescription painkillers more than tripled between 1999 and 2012. 
  • In 2010, oxycodone abuse was the second-most common reason (behind alcohol abuse) for patients entering state-funded substance abuse treatment programs. 
  • NH ranks 3rd in the nation for per-capita prescriptions of long-acting opioid drugs, such as OxyContin or fentanyl. The state ranked 7th for high-dose opioid drugs, but 39th for overall opioid prescriptions. 
  • 10.46% of NH adults aged 18-25 reported nonmedical use of painkillers in 2012-2013, ranking the state 14th in the nation. The national average was 9.47%. 

Current policies in NH

The following are policies that have been enacted in New Hampshire to combat prescription drug abuse:

  • Pharmacies and other licensed dispensers of prescription drugs are required to submit weekly reports to the state's prescription monitoring program, and medical professionals are required to access data for their patients before writing a prescription. 
  • State law forbids someone from knowingly attempting to acquire a controlled drug through “doctor shopping”: consulting with multiple physicians for the same ailment as a way of getting larger quantities of medication.
  • Doctors and nurses have to do an addiction risk assessment and create a written pain treatment agreement with patients before issuing a prescription.
  • Prescriptions written in an emergency room, urgent care or walk-in clinic can only be for seven days or less. 
  • Patients using prescription opioids for chronic pain for more than 90 days are subject to random urine tests to check for unexpected drug use (except for patients in long-term care homes or who have very low-dose prescriptions).

Additional potential policy responses

  • Limiting the quantity of opioids a doctor can prescribe at a given time in regular practice.
  • Requiring medical professionals who prescribe opioids to take part in training and education programs.
  • Restricting Medicaid reimbursement for opioid prescriptions.
  • Laws regulating pain management clinics by specifying personnel requirements, inspections, license procedures, standards of care, or other practices.  

Related Issues:

Heroin Abuse

Prescription Monitoring Program 

PROS & CONS

"For" Position

By LFDA Editor

“NH should more closely regulate prescription drugs.”

  • Increasing rates of abuse, addiction, and death caused by prescription opioids make these drugs a public health crisis, justifying state intervention.
  • Nonmedical or excessive use of painkillers has a significant economic cost, burdening state health programs.
  • Abuse of prescription painkillers has been linked to increased risk of heroin addiction, which fuels criminal activity and entails greater risk of overdose and death.
  • Opioid prescription drugs are not appropriate for long-term use by chronic pain patients who are not seeking treatment for cancer or end-of-life care. 

"Against" Position

By LFDA Editor

“NH should be cautious of overregulating prescription drugs.”

  • Doctors know better than state officials what medications will best answer the needs of their patients, and their ability to do so should not be inhibited by overregulation.
  • Stringent policies regarding prescription painkillers could result in legitimate pain patients being denied access to needed medication.
  • Making it more difficult for chronic pain patients to access legal medication may turn them to the black market and more dangerous substances.
  • Legitimate pain patients who take prescription opioids in the manner prescribed by their doctors have little to no risk of addiction. 

LEGISLATIVE HISTORY

Killed in the House

Establishes a seven-member controlled drug review board to adopt rules related to scheduling controlled substances, investigative trials of scheduled substances, shipping of such substances in-state, investigations and hearings, and communications with federal regulatory authorities.

Signed by Governor

Declares that if substance use disorder services are a covered under a health benefit plan, prior authorization for prescribed medications for a substance use disorder is only required once a year.

Signed by Governor

Only allows opioid prescriptions via telemedicine if the patient already has an in-person relationship with the prescriber. The Senate amended the bill to also add some rulemaking authority for the pharmacy board and insurance department.

Killed in the House

Authorizes pharmacists to fill a prescription for certain controlled drugs for a 34-day supply or 100 dosage units, whichever is less.

Interim Study

Requires individuals who have access to controlled drugs to report suspected or attempted drug diversion to the drug diversion unit of the Division of State Police. The bill also permits non-licensed individuals who suspect drug diversion to make such a report, provides immunity for persons who make such reports based on a good faith belief, and authorizes the drug diversion unit to investigate such reports.

Killed in the House

Gives law enforcement more access to the Prescription Drug Monitoring Program database.

Signed by Governor

Originally written to make various changes to the Prescription Drug Monitoring Program. The Senate amended the bill to instead create a commission to study the overdose-reversing drug Narcan.

Signed by Governor

Requires the Board of Medicine, the Board of Dental examiners, the Board of Nursing, the Board of Registration in Optometry, the Board of Podiatry, the Naturopathic Board of Examiners, and the Board of Veterinary Medicine to adopt rules for prescribing controlled drugs, and requires the use of the Prescription Drug Monitoring Program database.

Signed by Governor

Establishes the statewide drug court grant program.

Signed by Governor

This bill includes many regulations aimed at combating heroin and prescription drug abuse. For example, this bill increases the penalties for abusing fentanyl and provides funding for an upgrade to the Prescription Drug Monitoring Program.

Signed by Governor

Appropriates $130,000 for technology upgrades to the controlled drug prescription health and safety program to support mandatory use and enhanced reporting and information gathering. The House amended the bill to also limit the ability of law enforcement to seize assets in criminal cases.

Signed by Governor

Establishes a commission to study requiring controlled drugs and controlled drug analogs to be provided in abuse-deterrent formulation. Also adds naturopaths to the list of practitioners for the purpose of the prescription drug monitoring program.

Signed by Governor

As originally written, this bill included various measures related to drug addiction, such as adding fentanyl to drug laws. The Senate amended the bill to instead revise the Governor's Commission on Alcohol and Drug Abuse Prevention, Treatment, and Recovery and make additional appropriations for drug abuse prevention and treatment.

Killed in the House

Repeals the ability of registered nurses to dispense noncontrolled prescription drugs in clinics that have a contract with the Department of Health and Human Services (such as Planned Parenthood).

Signed by Governor

Makes some changes to the prescription monitoring program, for example to include veterinarians.

Killed in the House

Establishes a committee to study opioid misuse.

Killed in the House

Requires pharmacies, hospitals, and prescribers to accept unused prescription drugs.

Should NH take regulatory action to combat prescription drug abuse?

Add a comment

Log in or register to post comments

Issue Status

The New Hampshire attorney general's office is involved in an ongoing lawsuit, contending that the makers of prescription painkillers used deceptive marketing practices that downplayed the risks of addiction. 

CONTACT ELECTED OFFICIALS » 

Here in NH, your opinion counts. We make it easy to find and reach out to your elected officials about the issues that matter most to you. Click to search and contact your elected officials!

Join CCNH-LFDA

Join our constantly growing community. Membership is free and supports our efforts to help NH citizens become informed and engaged. 

JOIN TODAY ▸

©2017 Live Free or Die Alliance | The Live Free or Die Alliance is a 501(c)3 nonprofit organization.