Pills intended to ease pain have become agents of death at an alarming rate.
The United States currently faces a growing epidemic in the form of prescription drug abuse, according to President Bill Clinton and an expert panel who gathered on May 13 at the Johns Hopkins Bloomberg School of Public Health for a town hall discussion co-hosted by the school and the Clinton Foundation's Health Matters Initiative.
The town hall, "Prescription Drug Abuse: Evidence Informing Action," was held on the one-year anniversary of the Clinton Foundation's announcement of its intent to address prescription drug misuse.
The numbers are disquieting. One person dies every 19 minutes in the United States from a drug overdose, now the leading cause of death among those ages 25-44, according to numbers provided by the Clinton Health Matters Initiative. Prescription drug overdoses now kill more Americans than heroin and cocaine-related deaths combined, and the death rates have more than tripled since 1990.
Clinton, who gave the keynote address, spoke passionately about his personal connection to drug-related tragedy. He detailed the deaths of two men, ages 30 and 32, who took OxyContin after a night of "five or six beers." One of the men worked for his wife, Hillary Clinton, in the State Department. The other was the son of an Albanian immigrant who lived across the street from the Clintons.
"Both of them were given these pills by their lady friends who were totally ignorant of the biochemistry that was going on. It was just about, this will give you a buzz," Clinton said. "And it did, after which they fell asleep and never woke up. Neither of them were addicted to prescription drugs. And neither of them were trained enough in human biology to have any clue that they were about to deaden the portion of the brain that told them to breathe while asleep."
Clinton admitted his ignorance to the prescription drug abuse epidemic prior to these events.
"I wondered how many other people are dying, whether from addiction or ignorance," Clinton said, "and we began to do what we could."
Specifically, the Clinton Foundation worked with the pharmaceutical industry and others to improve the supply and affordability of naloxone, a drug used to counter the effects of opiate overdose. Last month, the FDA approved Evzio, a prescription treatment that can be used by family members or caregivers to treat a person known or suspected to have had an opioid overdose. Evzio rapidly delivers a single dose of naloxone via a hand-held auto-injector.
Clinton said that more can be done to drive down the cost of such life-saving drugs and distribute them more efficiently. The Clinton Health Matters Initiative aims to save over 10,000 lives over the next three years by cutting in half the number of young people who misuse prescription drugs.
"There are a lot of lives riding on this," Clinton said. "And if the trends in what we're seeing in heroin continue, there could be more [deaths]. I'm assuming we've got this problem. I'm assuming we have a life-saving answer. And I know we don't really have a clue to how to get that life-saving answer to all the problems in time to save all of these lives. That's what I'm obsessed with, so if you can help us in that specific way, I would be very, very grateful."
In earlier remarks, School of Nursing Dean Patricia Davidson called the prescription drug abuse issue a public health crisis.
"We continue to abuse prescription medications at an alarming rate," Davidson said. "As the research into the whys, the hows, and the what-to-dos continues, we steadfastly move forward to keep up. But there is still much work to do. Across the street, right here at the Johns Hopkins School of Nursing, we have put together a dynamic team of nurse leaders, teachers, and researchers who are at work now tackling this urgent problem. The Bloomberg School of Public Health has likewise put its greatest minds to the task, and together we will solve this problem. Johns Hopkins is uniquely positioned to meet this crisis, and we embrace a moral obligation to help lead the way."
Bloomberg School Dean Michael Klag, who introduced Clinton and thanked him for his leadership and vision in helping to convene this discussion, said there are no easy answers.
"As a physician who practiced internal medicine for 28 years, I know well the risks and the benefits of opioid analgesics and other prescription medications," he said. "I also understand that our current situation, where more Americans die from prescription drug overdoses than from motor vehicle injuries, is a complex problem that requires a systems approach to solutions."
Klag said physicians and nurses manage a difficult balancing act in meeting legitimate needs for pain relief and creating a dependency.
"But some providers are part of the problem, as are some patients," Klag said. "We recognize the inherent challenges in making a coordinated, thoughtful, and effective public health response. It's in the area of research that Johns Hopkins can make the most impact. Through our Center for Drug Safety and Effectiveness and our Center for Injury Research and Policy, we are working to amass and disseminate the scientific knowledge and data that will help us create new approaches to this problem."
The event was the first of an ongoing collaboration between the School of Public Health and the Clinton Health Matters Initiative to explore public health issues and solutions. The town hall meeting brought thought leaders from around the country to share ideas and energy as they apply evidence to inform action.The event included a panel discussion moderated by _Today Show_ correspondent Gail Saltz, a psychiatrist, best-selling author, and the sister of Johns Hopkins astrophysicist and Nobel laureate Adam Riess. The panel of experts included Amy Klobuchar, U.S. senator from Minnesota; Margaret A. Hamburg, commissioner of the U.S. Food and Drug Administration; former U.S. congressman Patrick Kennedy; and Douglas Hough, a Johns Hopkins behavioral economist. What's driven this rash of overdoses, the panelists said, has been the exponential growth of prescription painkiller and stimulant sales. Between 1991 and 2010, consumption of opioid analgesics like OxyContin and Percocet increased from 75 million pills to 209 million pills. With so many of these addictive pills in circulation, the potential for misuse and abuse has skyrocketed. Studies have shown that most teens obtain the pills from family members or friends for free—sometimes taking them from the home medicine cabinet.
Klobuchar offered several solutions that are working in her home state of Minnesota, which she described as "not only the the land of 10,000 lakes, but also the land of 10,000 treatment centers—and proud of it." She used her own father—a recovering alcoholic who at 87 is still climbing mountains—as an example of the power of good treatment. Klobuchar is also a big believer in drug courts and an advocate of prescription drug take-back programs.
"We have very limited disposal opportunities for prescription drugs in this country," she said, adding that the prevalence of kids addicted to prescription drugs demonstrates the importance of ridding family medicine cabinets of them.
Kennedy addressed the all-important mental health component of addiction and spoke compellingly about systemic fixes based on his own experience recovering from opiate addiction: "I would propose a 'check-up from the neck up.'" If physicians aren't paying at least as much attention to their patients' mental health issues as they are to asthma and cholesterol, he said, then the real cost-drivers in health care today are not being addressed.
While acknowledging the enormous toll of this problem, Hamburg spoke of promising scientific and technological approaches on the horizon, deterrents that will reduce the opportunities for abuse of these drugs.
"Importantly, we need to recognize that opiates are ... probably most often not the treatment strategy of first choice," she said. "But it may be the option a provider knows best. We need to actively engage with the scientific research community and industry to try to develop new non-opiate, non-addictive pain strategies for ... important pain syndromes."