HAZARD – Better utilization of the state’s prescription drug monitoring program, increasing education about the disease of addiction, and providing greater collaboration and communication on available resources were all short-term priorities identified by medical professionals attending an Operation UNITE symposium held Saturday, March 6, 2010.
The symposium brought together more than 300 physicians, nurses, pharmacists, dentists, social workers, substance abuse counselors, adult care providers, coalition representatives and other professionals to address prescription drug abuse and workplace safety.
Sponsors included the University of Kentucky Center on Drug and Alcohol Research, the Kentucky Medical Association, the University of Kentucky College of Pharmacy and the Center for Lawful Access and Abuse Deterrence.
In addition to learning about current abuse trends, pending legislation, and treatment models, the symposium offered an opportunity to discuss issues and viewpoints related to substance abuse and workplace safety.
While these issues are not new, interest and concerns were heightened following the murder of Dr. Dennis Sandlin at his Perry County clinic last December.
“This is a complex, ugly problem,” said Karen Engle, director of UNITE, told those assembled at The Forum in Hazard.
Nearly 7 million people are using prescription drugs for non-medical purposes, said Fifth District Congressman Harold “Hal” Rogers. “Our region is crying out for ways to break free from the chains of addiction.”
Addiction comes at a heavy price, Engle said. “Young people are dying almost every day. We can account for over 100 overdose deaths since January alone” in 22 of the 29 counties of the Fifth District.
“These numbers show only a snapshot of what we’re up against,” Engle said. “We do not pretend to have all of the answers, but working together we can find real solutions that give guidance and direction to medical professionals everywhere.”
To that end, Engle announced the formation of a Medical Professional Advisory Council to provide input to UNITE’s Board of Directors.
“We need your help and your partnership,” Engle said. “Our goal is to reach out to you, get to know you, learn from you and ask you to lend us your expertise.”
The symposium began with an emotional call to action by Dr. Sandlin’s daughter, Denise.
“My father’s patients were his love and joy,” Denise Sandlin stated. “How do you help people who seemingly don’t want to help themselves? I truly hope you leave here asking more questions and seeking more answers.”
One of the most important short-term solutions is to better utilize the Kentucky All-Schedule Electronic Reporting (KASPER) system, considered as the best in the nation.
Currently 33 states operate some type of prescription monitoring program, but noted there is not currently a way to easily share information.
That law enforcement component, said Dave Hopkins with the Kentucky Cabinet for Health and Family Services, is critical to identifying and stopping abuse.
“We’ve asked for legislation to allow states to share information,” Rogers said, but stressed he opposes a proposed national program because it “locks out” the law enforcement use.
Another recurring theme during the morning presentations was the need to better educate all providers about addiction.
“Addiction is a chronic and relapsing disorder,” said Dr. Sharon Walsh, director of the UK Center on Drug and Alcohol Research. “The longer treatment is provided the greater success. Sometimes it is a lifetime.”
“Drug abuse is a preventable behavior (and) drug addiction is a treatable disease,” agreed Bob Neri, senior vice president and chief clinical officer for WestCare, which operates a treatment facility in Pike County.
But, Neri noted, most of the power to change behavior is lost before the teenage years. And once addicted, the most successful rehabilitation is through a “10-month dose” of treatment – both residential and clinical. The problem is it takes funding to provide this level of service, and currently that money is not available.
Drug diversion is also a critical concern.
“Substance abuse is still being treated as a subculture, but it’s permeating our culture. It has affected every family – including my own,” said Daniel Mongiardo, Kentucky’s lieutenant governor and a Perry County physician. “Most of the drugs that are on the street are coming from us, the providers.”
While most of the narcotics are dispensed legally, an unacceptable amount reaches the streets through illegal activity or ignorance, Mongiardo said.
“There are things you may be doing that unknowingly leads to this type of behavior,” Walsh said, noting it is important to enact practices that “reduce the risk” while maintaining appropriate levels of care to patients.
Dr. Lynn Webster, of the Utah-based Lifetree Clinical Research and Pain Clinic, called it a “pain paradox.”
“We are part of the problem,” Webster said. “Diversion is not acceptable and needs criminal intervention. Misuse, abuse and addiction must be addressed by the medical community.”
“It is a public health commitment to balance prescription drug prescribing and meeting needs,” said Dr. Marsha Stanton, a registered nurse and volunteer for the Center for Lawful Access and Abuse Deterrence. “The patient does have a responsibility” to realize the potential for abuse.”
“You work in the most violent procession in America,” said Bill Abney, who conducts risk management assessments. “It’s a frightening issue for which there are no easy answers. We need to draw the line on unacceptable behavior.”
Substance abuse is not just an Eastern Kentucky problem, but a national epidemic, the presenters stressed. There are, however, regional differences in the drugs of choice and how they are used.
“The rural folks and the urban folks really aren’t so different … but they are,” said Dr. Carl Leukefeld, chair of the UK Department of Behavioral Science.
Leukefeld cited a recent study that found nine different ways drugs are used. Rural users tend to start younger, are mostly white, have no religious preference and tend to crush and snort pills.
Other recommendations, gleaned from a series of four town hall-style forums held leading up to the symposium, include:
• Address aggressive behavior by establishing a written agreement explaining what is to be expected from both patients and providers. After three incidents the relationship could be terminated and reported to a network to alert other physicians.
• Create a “Prescriber’s Bill of Rights” through collaboration between physicians and the legal profession.
• Expand education for individuals and professionals on such issues as Casey’s Law, the UNITE Treatment Voucher program, the disease of addiction and treatment options.
• Increase training and awareness of KASPER and give physicians access to Kentucky CourtNet, which lists a person’s criminal history.