Introduction
Chairman Souder, Ranking Member Cummings, and distinguished members of the Subcommittee. I appreciate the opportunity to appear before you today to discuss the Federal response to Prescription Drug Abuse.
Abuse or non-medical use of prescription drugs can be defined as use of drugs not prescribed for an individual, use of drugs solely for the experience or feelings they cause, or use of drugs by a person who has made false or inaccurate claims to obtain the drugs. Several classes of controlled prescription drugs, prescribed by physicians for legitimate medical purposes, have abuse and addiction potential: narcotic opioid analgesics (for management of pain, cough and other indications), stimulant drugs (to treat attentional disorders, narcolepsy and, less frequently, depression), tranquilizing drugs (to treat anxiety) and sedative drugs (to promote sleep) are of particular concern. These drugs are safe, effective and necessary when used according to doctors’ prescriptions and advice.
Last year, the National Survey on Drug Use and Health (NSDUH) uncovered a higher number of new initiates into non-medical prescription drug use than initiates into marijuana use. Data described below (Sec. II) indicate that misuse and abuse of controlled and certain over-the counter prescription drugs is a significant national problem. Notwithstanding the abuse of a range of controlled and over-the-counter prescription drugs, more attention has focused on opioid analgesic drugs, because of the higher absolute number of users, escalating rates of abuse, high addictive potential, and the potential to induce overdose crises or death due to respiratory failure.
Potential causes. Among the factors postulated to fuel increased diversion of legitimate prescription drugs are: 1) public perception that prescription drugs are safer than illicit street drugs; 2) easier availability via web-based sources or theft of legitimate prescriptions; 3) increased direct-to-consumer advertising, which fosters the view that prescription drugs are integral to our lives; 4) increased prescriptions for chronic pain, sleeping and attentional
problems, with increased potential for diversion; 5). inadequate public perception on guarding prescription medications; 6) increased web-based sources on how to tamper with medications; and 7) the aging of the US population, which requires an increased level of medications to sustain good health.
Potential profiles of abusers and sources of drugs. Different cohorts of users require different strategies to prevent non-medical use of prescription drugs. Intended populations include patients who suffer pain, but misuse drugs, or are co-morbid for opioid abuse, or opioid abusers who acquire prescription drugs by doctor shopping, pill mills, or by other means. Unintended populations of users include children, teens, adults and high risk populations who can become abusers by acquiring prescription medications by forgery, internet purchases, robberies, buying from patients, stealing from home medical sources, and access to illegal drug rings.
Response of various sectors: ONDCP, FDA, DEA, DOJ, SAMHSA, NIDA, pharmaceutical companies, medical associations, pain management specialists, medical schools and communities, are developing strategies in response to this mounting problem, with the ultimate goal of attenuating diversion of effective medications with abuse potential, while not compromising the health, comfort and well-being of intended patient populations. The core problem—misuse and abuse of legitimate medications by unintended
populations—is complex. This emerging challenge requires surveillance, distribution chain integrity, interventions, and more research by private and public sectors. Coordinated responses that include federal, medical partners, public health administrators, state legislators (e.g. Alliance of States with Prescription Monitoring), and international organizations are needed to implement educational outreach and other strategies targeted to a wide swath of distinct populations, including physicians, pharmacists, intended patient populations, educators, unintended populations, parents, high school and college students, high risk adults, the elderly, and many others. Effective risk management plans developed by pharmaceutical companies in collaboration with the FDA, as well as outreach to physicians and their patients and pharmacists, need to be complemented by education, screening, intervention and treatment for those misusing or abusing prescription drugs. ONDCP is a key contributor to devising policies and funding demonstration programs that can survey, detect, intervene and treat unintended populations that use prescription drugs.
