Painkiller abuse can be stopped

Thursday, November 5, 2009

By Dr. JAMES CANFIELD

For the past two years a serial killer has run loose in New Hampshire, taking the lives of more New Hampshire residents than are dying in automobile crashes on our highways – more than 200 each year. This killer is the intentional ingestion and occasional fatal overdose of prescription opiate drugs such as Oxycontin, Vicodin and Percocet.

Dozens of state sheriff’s departments and Highway Patrol officers and hundreds of town police officers patrol our roads and highways to control reckless driving and resultant highway fatalities. To maintain a degree of driver safety we have a system of driver education, child-seatbelt restraint laws and vehicle operator licensure (though we license drivers under 18 years of age, unlike any other country). We also have an effective statewide system of hospital trauma centers, trained EMT personnel, air and surface medical emergency transportation, resulting in New Hampshire’s low highway fatality rates.

Trying to curtail the now larger current mortality of opiate drug ingestion fatalities, however, we have only a handful of DEA agents, Board of Pharmacy personnel and a few dozen police narcotics officers. Their inability to stem this new wave of death is tragically clear. What can we do?

Well, what not to do is to continue wasting money on “feel good” public school education programs like DARE, which has never been proven effective in lowering teen substance abuse in any controlled scientific analysis, anywhere in the country. School parking lot video surveillance costs less and works.

What needs to be done is for the manufacturers of all controlled drugs approved for sale in the U.S. to label each and every capsule or tablet with a micro-scannable bar code identifying the drug, manufacturer, dose and lot number, day of manufacture and most importantly, the unique serial number for each pill or capsule produced that day.

Just as important, manufacturers will enclose an indigestible, fluorescent-light identifiable and scannable bar code wafer in each tablet or capsule with the same data as placed on its surface, so recovery of gastric and intestinal contents from those dying by fatal overdose can be analyzed to identify the specific drug, source and pill. We then can thus identify drugs found in plumbing systems and trash, despite attempts to destroy them by persons illegally selling, transporting or using controlled prescription drugs. For the first time, authorities will be able to trace an individual pill or capsule’s point of diversion and path of distribution.

What needs to be done is to achieve real-time integration of data-sharing between police departments, DEA agents, county forensic medical officers, the New Hampshire Board of Pharmacy, hospital emergency rooms, the New Hampshire Board of Medicine and all New Hampshire pharmacies.

What needs to be done is to establish a statewide, real-time 24/7 accessible registry of all controlled substance prescriptions, utilizing the expanded pill-specific data format, microscanning, and a single data-sharing program using secure electronic data transmission.

What needs to be done is for all pharmacists and prescribers of controlled substances to inventory and track all purchases, sales and prescription of controlled substances using the micro-scannable bar code format and identify prescription recipients not just by name and address and date of birth, but also their Social Security number. We can thus achieve individual pill/prescriber/patient matching.

It is a tragic shame that a few addictive narcotic products produced by our highly profitable drug industry are not better prohibited from illicit diversion by currently involved personnel and agencies working with pharmacies and physicians. We don’t just need better interagency communication and more and better trained and utilized people – we clearly need more of both – but we need to get smarter – and fast – and get currently available micro-label technology in use by the pharmaceutical manufacturers, so that along with better communication between more good guys, we can start tracking down and jailing more bad guys.

Dr. James Canfield is a pediatrician in Amherst.