Over 1,000 people are treated in emergency departments for misusing prescription opioids every day, reports the Center for Disease Control and Prevention.
Pharmacists like John Worden believe that today’s opioid epidemic offers an opportunity to dramatically improve how these medications are used.
Worden is the director of pharmacy at McPherson Hospital, and he’s served as the president of the Kansas Board of Pharmacy for a year and has been on the board for 5 years. He explained that more often than not, doctors mean well and take steps to reduce their patient’s pain, yet a number of factors can develop standard treatments into an addiction.
“Pain management treatment is a very difficult thing. It’s 100 percent subjective; you can’t measure it like you can blood pressure or weight,” Worden explained. “Because of that, we’re dependent on each person’s perception of pain. There are options other than drugs like massage therapy or acupuncture, but when it comes to medication, there’s limited options. The predominant one available for over the past 50 years is opioids.”
The first part of the problem is abuse — people develop addictions or want to sell prescription pain medication on the street. The second issue is keeping track of the prescriptions written and to whom.
“We needed a way to better identify bad actors.That’s when K-TRACS came into play,” Worden said.
The Kansas Tracking and Reporting of Controlled Substances program, or K-TRACS, is authorized by the Kansas Legislature that monitors all controlled prescription medication. Other states have similar programs, though the implementation of K-TRACS put Kansas ahead of the game.
“Kansas is one of the early adopters and leads the nation in a lot of the organization and controls that go around prescription or opioid monitoring,” Worden said. “There’s a committee of physicians, pharmacists and other healthcare modalities that forms a task force that oversees K-TRACS. Those individuals review the data and looks for high-risk patients: those are patients that see greater than 5 to 7 doctors and go to a dozen pharmacies. Letters of notification go to that patient’s providers to say ‘Hey, you might not be aware but your patient is going to a dozen pharmacies and five other providers.’ It’s meant to be a tool to help providers.”
Established at the end of 2010, this tool is demonstrating some success.
“It’s absolutely working. It’s becoming more and more adopted and we can see that providers are doing more checking before they pull out the pad and write the prescription,” Worden said.
K-TRACS is meant to seek out drug-seeking behavior, which is signaled when a patient has received too many prescriptions.
“When you ask if they’re aware that this patient is doing this, a lot of times they don’t know. Then, their family doctor can coach that patient and get them to a treatment program,” Worden said. “There are treatment programs and we have medications that give people just enough to get through it without the big high effect. They have a tapering process.”
Though K-TRACS seems like the magic pill to fix the epidemic, it still has its faults.
“Kansas does not require providers to check before they prescribe. Some states have gone so far to mandate that before a physician can prescribe, they have to check,” Worden explained, pointing out that the Legislature is having conversations on requiring the use of K-TRACS.
Because physicians handle busy work days, the board is adopting changes to make using K-TRACS simpler to encourage its use.
“You have so many you do in a day, it can be a hassle. There’s a really big effort to make the information available in the electronic medical records on a physician’s computer while they’re in the patient’s chart, rather than having to log in to another system with another password — it has to be easy,” Worden said. “Kansas has received some grants from the CDC and other organizations to make those connections are in electronic medical records, but that’s all new in the past year. We’re hopefully setting that up now to get more providers to adopt it into their workflow.”
Though K-TRACS can monitor the number of prescriptions, it’s up to providers to prevent drug interactions that can be fatal.
“For the U.S. on the whole, drug overdose is the leading cause of death for people under the age of 50. Almost all of those overdoses are unintentional and that happens though mixing,” Worden said. “They’ve been taking this chronic pain medication and they might get another medication thrown on top that interacts with it, or a patient has too much alcohol and they run into a problem.”
The root of this problem lies in the fact that healthcare is spread out among different types of doctors.
“If you have a broken hip, you’ll see an orthopedic doctor who’s treating you for that pain, but you’re also on a chronic sleep medication from your family doctor. That primary care doctor is meant to manage it all, but it’s hard for specialist to manage all the details, so some of those issues can come up,” Worden said. “The biggest issues is when people shop around at a lot of different pharmacies. If you continue with the same pharmacy, that pharmacist will absolutely intervene if they see a problem, but if someone shops all over and tries to skirt the system intentionally, that’s when issues happen.”
Instead, Worden recommends sticking with the same pharmacy because that pharmacist can be the gatekeeper to ensure these interactions don’t happen.
Once susceptible patients are identified, providers can integrate treatment options into their care, but withdrawal is a tough road to travel.
“A patient might have high addiction potential — people with underlying mental health problems or addictions to alcohol. They might have an accident and they require opioids and get hooked. Some people have a very low addiction threshold and that’s when problems arise. Their body may become dependent on it in a week and it’s harder for them to withdraw,” Worden said. “When those people run out, they fall into that huge market of people buying leftover prescription drugs or heroin.”
Now, the state is looking for more treatment options and withdrawal specialists to assist in the tapering process.
“People trying to detox from opioids can’t die from it, but their body’s receptors is craving that drug so badly that your body feels like it wants to die,” Worden said. “In the opioid world, people will go through a program and be off for 4 to 6 weeks and the temptation will be so great that they go back to doing it at their previous amount, and that’s when overdoses happen.”
As K-TRACS is still a young program, providers are hopeful that increased use in the future will prevent addictions and save lives.
Contact Cheyenne Derksen Schroeder by email at firstname.lastname@example.org or follow her on Twitter at @MacSentinel.