BETHESDA, MD 11 Jul 2014—Two public health problems in the United States—prescription drug abuse and heroin use—are inextricably linked, and solutions will require comprehensive efforts, said participants in a June 19 White House policy summit.
"It is impossible to understand our nation's heroin challenge without also understanding our prescription drug abuse challenge," said Michael Boticelli, acting director of the Office of National Drug Control Policy.
The half-day summit was closed to the public but broadcast live via a webcast. Participants included U.S. Attorney General Eric Holder, state and local officials, and professionals in fields related to addiction treatment, education, and prevention.
About 110 Americans died of a drug overdose every day during 2011—more than died from traffic accidents, according to federal data. Boticelli said that prescription opioids were a factor in nearly 17,000 overdose deaths in 2011, and heroin use contributed to more than 4,000 deaths.
Some recent research suggests that people who became addicted to heroin were first hooked on prescription opioids. And policymakers and others have speculated that efforts to restrict the illicit use of prescription opioids may be prompting those who are addicted to switch to heroin.
Among the believers is Vermont Governor Peter Shumlin, who told summit attendees that the oxycodone-abuse problem of a decade ago has been supplanted by a deadly epidemic of heroin use in his state.
"You can buy Oxycontin on the streets of Vermont for 80 bucks a pill. You can buy a bag of heroin on the streets of Vermont for $30 a bag," Shumlin said, adding that heroin is even cheaper in nearby states.
"There's a huge economic incentive to get this drug into my state, and it's happening," he said.
Shumlin in January devoted virtually all of his state-of-the-state address to the problem of opioid addiction and drug-related crime in Vermont.
He said the number of heroin-related deaths more than doubled in the state since 2000, as did the number of Vermonters treated for heroin addiction, with 40% of that increase occurring last year. Shumlin said a "full-blown heroin crisis" exists in the state.
Vermont's response to the problem involves a combination of law enforcement activities and public health initiatives, including increased funding for substance abuse and needle exchange programs.
Perhaps the most obvious pharmacy-related effort to combat opioid abuse in the state involves the Vermont Prescription Monitoring System, which requires pharmacies, before providing any Schedule II, III, or IV controlled substance to a patient, to verify the patient's identity; pharmacists must also submit weekly reports to the state on those dispensing activities.
Holder said that, at the national level, the Drug Enforcement Administration (DEA) and other units of the Department of Justice have also "stepped forward to educate pharmacists, doctors, and other health practitioners in the identification and prevention of controlled substance diversion during the healthcare delivery process."
He said more than 6500 pharmacists and pharmacy technicians have participated in DEA-sponsored diversion awareness conferences to learn about prescription drug abuse trends and the pharmacist's role in preventing diversion.
In addition, DEA has helped sponsor eight drug "take-back" events since 2010 that have removed more than 2100 tons of prescription opioids and other drugs from patients' homes. Holder said DEA is developing regulations to "make it easier to establish permanent drug disposal sites nationwide."
Holder also noted that his department participated in a summit last year on the opioid and heroin epidemic in northern Ohio.
According to a report from the U.S. Attorney's Office for the Northern District of Ohio, the summit participants called for a collaborative effort with pharmacies to inform customers about how to properly dispose of unused prescription drugs and to expand the availability of "drop boxes" for unused medications.
The Ohio summit attendees also called for the development and adoption of uniform guidelines for the management of chronic benign pain, with an emphasis on the use of the guidelines in emergency departments.