Debate Over Prescription Drug Addiction as Governor Declares Public Health Emergency

BOSTON, Mass.—On Thursday, 27 March 2014, Governor Deval Patrick declared a public health emergency in Massachusetts in response to the growing rate of opioid addiction. The declaration provides Department of Public Health Commissioner Cheryl Bartlett with emergency powers. She will work with the Public Health Council to take several actions to combat addiction and improve treatment.

For example, it will permit first responders to carry and administer Naloxone (Narcan), an opioid antagonist that can reverse an overdose and save a life. The emergency powers will also make Naloxone widely available through standing-order prescription in pharmacies. The state will also impose a mandate for prescription monitoring to better safeguard against abuse or misuse. Four out of five heroin addicts were reportedly addicted to prescription painkillers first, which has put doctors under scrutiny and raised awareness about over prescription.

The declaration also includes a ban on the hydrocodone-based painkiller Zohydro, which Governor Patrick banned without contacting its maker, Zogenix, Inc. “I think, frankly, the governor is out of line on this,” said U.S. District Court Judge Rya W. Zobel, who is poised to strike down the ban.

“It shouldn’t be a governor saying what drugs we can or can’t use,” says Judy Foreman, health columnist with the Boston Globe and author of the book A Nation in Pain. “That’s the FDA’s job.”

The FDA has approved Zohydro, though the drug is not yet available in Massachusetts.  Foreman worries that all the actions taken against opioid addiction could hurt those who need medication the most.

“There are 100 million Americans in chronic pain, and an estimated 10 to 30 percent of those are in severe to disabling pain, and they need those drugs,” she says, adding that she has no ties to any pharmaceutical companies. “I worry that too much monitoring may make access to opioids for legitimate pain patients harder.”

Chronic pain is very difference from acute pain that lasts a few weeks or months. “It is a disease of the nervous system in its own right … a revving up of the pain signals in a way that becomes self-perpetuating to the point that the initial cause is often no longer discernible,” Foreman explains.

While federal data shows 80 percent of heroin addicts are first addicted to prescription painkillers, according to Foreman, many were using the pills without a prescription or recreationally. “Legitimate pain patients typically use the drugs only to relieve pain, not to get high,” she says.

However, she does believe there are cases of over prescription, like after minor dental or dermatological surgery, and she applauds Blue Cross Blue Shield’s recent initiative to limit the use of short-acting pain relievers.

Foreman believes one way to address this is to spend more time with patients and use questionnaires like Brigham and Women’s SOAPP questionnaire for chronic pain to determine personal or family history of substance abuse. Patients with severe chronic pain and no such history “are at a very low risk of running into addiction problems,” says Foreman.

According to Patrick’s statement, at least 140 people have died from suspected heroin overdoses in communities across the Commonwealth over the last several months. It also said that the number of unintentional opiate overdoses increased by 90 percent from 2000 to 2012.

Massachusetts is not the only New England state worried about an opiate addiction. Vermont has become the face of the so-called “heroin epidemic.” The state’s governor, Peter Shumlin, devoted his most recent state-of-the-state address to the issue, citing an eightfold increase in treatment for opiate addictions from 2000 to 2012.