Several members of Congress have urged federal regulators to do more to encourage the use of pain pills that incorporate measures to deter people from abusing the drugs.
Republican U.S. Rep. Hal Rogers of Somerset, whose 5th District in Eastern and southern Kentucky has been savaged by prescription drug abuse, recently raised the issue in a letter to Sylvia Burwell, secretary of the U.S. Department of Health and Human Services.
U.S. Rep. Andy Barr, a Republican who represents the 6th District in Central Kentucky, and 15 other House members also signed the letter.
The letter addressed the use of what are called abuse-deterrent opioids, or ADOs. Opiods are a class of powerful painkillers such as OxyContin.
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Taken as intended, the drugs provide pain relief over several hours. However, drug abusers crush the pills and then snort the powder or mix it with liquid to inject it, getting a large dose of the drug in one rush.
The painkillers have been among the most-abused drugs in the nation for well over a decade.
More than 16,000 people in the United States died as a result of overdoses of prescription opioids in 2013, triple the number from 2001, according to the letter to Burwell.
In Kentucky, overdose deaths in 2014 were up 7.6 percent from 2013, according to the state Office of Drug Control Policy.
An increase in heroin abuse was a key factor in that, but in the counties with the highest overdose-death rates, Floyd and Pike, abuse of prescription drugs remains a more serious problem.
“Pills continue to be overwhelmingly the cause of overdose deaths and hospitalizations” in Eastern Kentucky, said Van Ingram, head of the Kentucky Office of Drug Control Policy.
Some companies, including the maker of OxyContin, have designed versions of painkillers that are harder to abuse.
The measures to do that include hardening pills so they’re more difficult to crush or including a substance in them that counters the effect of the drug if the pill is crushed, said Dr. Bill McCarberg, president of the American Academy of Pain Medicine.
The Food and Drug Administration issued guidance to drug makers this year aimed at getting more abuse-deterrent opioids to market.
The agency said it considers development of such products a high public-health priority.
But in their letter to Burwell, Rogers, Barr and the other House members said the medical community “has been slow to widely embrace the use of those products intended to deter and mitigate abuse” as prescription opioids continue “to take a devastating toll on individuals, families and communities across the nation.”
Rogers helped found and co-chairs the Congressional Caucus on Prescription Drug Abuse.
Working against prescription-drug abuse has been one of his signature issues. Among other things, Rogers set up Operation UNITE in 2003 to provide money for drug investigations, treatment and education in his district.
The House members’ letter urged Burwell to encourage health care providers to consider prescribing abuse-deterrent opioids in appropriate cases.
The Department of Health and Human Services includes the FDA, which approves drugs and drug labeling.
The letter asked Burwell to look into the feasibility of using labeling requirements to inform prescribers about the availability of abuse-deterrent drugs, and perhaps to provide guidance that doctors should prescribe a drug without abuse-deterrent properties only when a version with such protections is not available or not appropriate for the patient.
Such labeling could make a real difference in doctors’ knowledge about options to prescribe abuse-deterrent opioids, especially in treating patients at risk of abusing the medication, the letter said.
Prescribing pills with deterrent features wouldn’t end all abuse. People could swallow a handful of pills at once, for instance.
However, pills designed to discourage abuse are part of a wider strategy to reduce misuse of prescription opioids, according to Rogers, Barr and the other members of Congress.
McCarberg, a primary-care physician, said he doesn’t think doctors are reluctant to prescribe abuse-deterrent opioids.
The real issue is that many doctors — notably primary-care physicians — are not familiar with the availability of the drugs, he said.
Many primary-care physicians prescribe only low levels of opioids, so it’s not an issue they deal with a lot, McCarberg said.
Labeling to address use of abuse-deterrent drugs, and other educational efforts, could help doctors better understand the issue, he said.
Ingram also said more information for doctors would be a good idea.
“Our prescribers need to know these are an option,” Ingram said, particularly for patients who will be taking painkillers for a long time.
There is greater potential for addiction with chronic use of a powerful painkiller, Ingram said.
The requirement by insurance companies and public health plans to prescribe cheaper generic drugs is one roadblock to wider use of abuse-deterrent opioids, McCarberg said.
Prescribing an abuse-deterrent formulation can mean higher co-payments for patients and the hassle of having to get prior authorization from the payor, McCarberg said.
“For us in primary care, that’s a big effort for us to do,” he said.
Most generics do not have an abuse-deterrent version, Ingram said.
The House members’ letter to Burwell noted that Medicare Part D places more restrictions on patient access to abuse-deterrent opioids than on versions without the additional abuse protections.
That could stifle innovation in abuse-deterrent drugs, the letter said.
The letter asked Burwell to make sure payors such as Medicare and Medicaid provide access to abuse-deterrent opiods.
“We need to get these drugs into the hands of patients, so that folks won’t be tempted to crush or snort or inject these dangerous drugs,” Rogers said in a news release. “It’s really a matter of life and death.”