Source: Washington Post
Date: 01 March 2004

White House Targets Prescription Drug Abuse

By Marc Kaufman Washington Post Staff Writer

The Bush administration today unveiled a coordinated effort to combat what it called the growing new menace of prescription drug abuse, which it said now touches and harms more than 6 million Americans.

As part of its new strategy, top administration officials said they would increase state monitoring programs that detect "suspicious" prescriptions and patients suspected of "doctor shopping." The program would also implement new technologies to identify and prosecute Internet "pill mills" that sell controlled drugs with little or no oversight and would increase education to doctors about how to detect potential abusers of prescription drugs.

In addition, the officials said the proposed 2005 budget for prescription drug diversion control will increase by $20 million to $138 million. Most of the funds will be directed at reducing the use of opium and morphine-based painkillers, which are among the most widely prescribed medications in the nation.

"The non-medical use of prescription drugs has become an increasingly widespread and serious problem in this country," said John P. Walters, director of the White House Office of National Drug Control Policy, when he announced the first-ever comprehensive plan to attack prescription drug diversion. "The federal government is embarking on a comprehensive effort to ensure that potentially addictive medications are dispensed and used safety and effectively."

The issue of how painkillers such as OxyContin, Lortab and Vicodin are prescribed and used has become an increasingly contentious one, as some pain doctors and law enforcement officials struggle over how widely and readily they should be available.

The Drug Enforcement Administration and Justice Department have become more aggressive in targeting and prosecuting doctors and pharmacists who they say are improperly prescribing and distributing prescription narcotics, and a dozen health practitioners have been charged in recent years for their prescribing practices and several are in prison. But pain doctors and some advocates for patients with chronic pain say the government has become overzealous and has created a "chilling effect" that keeps many doctors from prescribing painkillers that patients need. The most pressing problem involving painkillers, they say, is that so many Americans in pain remain untreated.

The Drug Enforcement Administration has also initiated an effort to reschedule hydrocodones with aspirin or other analgesics, a very popular class of painkillers that includes some of the most widely used drugs in the nation. A rescheduling under the Controlled Substances Act would make it more difficult for doctors to prescribe them and for patients to receive them.

DEA Administrator Karen Tandy confirmed at today's press conference that the DEA was looking into the hydrocodone issue, and Food and Drug Administration Commissioner Mark McClellan said there had been discussions between the DEA and his agency on the possible rescheduling. Both officials said, however, that any changes could take months or years to enact.

A major focus of the new prescription drug control initiative will be on the burgeoning use of the Internet to purchase controlled drugs. Tandy said there are thousands of Web sites that pop up regularly offering narcotic medications, often without a prescription or a doctor visit. She said it has been very difficult to move against them because they shut down as soon as they are identified, and then re-open under a different name.

A new study by the National Center on Addiction and Substance Abuse at Columbia University identified 495 Web sites advertising controlled prescription drugs during a one-week analysis. Of those, 157 were anchor sites that sold opioid-based drugs such as OxyContin, Percocet and Darvon. Only 6 percent of the sites selling drugs, the study found, required a prescription to complete the sale and none of the sites placed any restrictions on the sale of drugs to children.

In an effort to more aggressively combat the Web sites, the DEA said it would use more Web crawler and data mining technology to identify, and then prosecute, the businessmen behind the Web sites. Walters, director of the White House Office of National Drug Control Policy, said that the administration also planned to pressure both credit card companies and mail delivery services to deal more seriously with the illicit sale of these prescription narcotics, stimulants and depressants.

In addition, Walters said the federal government wants to increase the number of states that have "prescription monitoring programs." These plans can detect individuals who are redeeming prescriptions for controlled drugs from multiple doctors, and can highlight suspicious prescriptions.

Rep. Tom Davis (R-Va.), chair of the House Government Reform Committee, said during today's press conference that his committee was putting together a bipartisan bill that would make it easier to attack the problem of rogue Internet sites.

"The Internet creates an easy environment for illegitimate pharmacy sites to bypass traditional regulations and established safeguards," Davis said.

In describing why the administration will be focusing more on the diversion of prescription drugs, officials today presented statistics that they said showed illicit drug use has increasingly involved prescription drugs.

According to a 2003 University of Michigan study, for instance, the painkiller Vicodin ranked second only to marijuana in terms of illicit drugs used by 12th graders. Other federal statistics estimated that 6.2 million Americans misused prescription drugs in 2002, compared with 2 million who used illegal cocaine and 700,000 who used ecstasy.

The federal officials said that while prescription drug abuse was going up, the overall use of illicit drugs is going down nationwide.

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