Friday, February 22, 2013

The Drug Debate Headed in Right Direction

The WorkCompCentral news this morning has two stories on prescription drug issues.

In one, the International Association of Industrial Accident Boards & Commissions (IAIABC) announced to the criticism of many that it was not going to publish a model law that seeks a standard for controlling narcotics.

In another a representative of the federal government's Drug Enforcement Administration (DEA) told attendees at the California Medical and Pharmacy Board's forum in San Francisco that it is working to put together a national prescription drug monitoring program.

In a press release, IAIABC said, "After thoughtful review by the Executive Committee, it was determined that adopting model legislation and regulation on opioid use could be interpreted as too narrow and restrictive for jurisdictions.

“The Executive Committee was concerned the models could unintentionally create conflict in jurisdictions that may be already taking steps to initiate regulations for appropriate guidelines.

“However, they contain valuable information, and as such the Executive Committee is asking that the issues addressed in the drafts be re-framed to offer policy considerations rather than a single policy response,” the IAIABC said.

Joseph Rannazzisi, deputy assistant administrator in the Drug Enforcement Administration's Office of Diversion of Control, told attendees at the San Francisco forum that a national prescription drug monitoring program that links together all the states is one of the things that officials in Washington, D.C., believe can help clamp down on excessive prescriptions, and that there are "a lot of proponents to get funding" for a national prescription drug database in Congress.

The IAIABC has received criticism for its position, and while perhaps disappointing the organization's announcement on the model law is consistent with its longer-term position on the topic.

In a press release in March, 2012, IAIABC said that, "This is a complex solution that will not be solved by passing a law or learning about one successful program; it can only be resolved by sustained initiatives at every level of the workers’ compensation system."

What may be more significant, in this era of the Affordable Care Act (ACA) and approaching deadlines for state compliance with its provisions, is that the federal government is taking another step towards nationalization of health care with its drug database.

It's a difficult balance between state rights and independence, and control over a national problem.

While some states have implemented successful controls over their narcotics problem (e.g. Ohio and Texas) there are other states that have not done so (e.g. Georgia) so the market shifts across borders to those states that fail to implement effective programs.

In federal terms this is called "interstate commerce" over which the federal government has some Constitutional authority.

Michael Botticelli, deputy director for the National Drug Control Policy, said at the San Francisco forum that since Florida passed legislation implementing a prescription drug monitoring program and prohibiting physicians from dispensing Schedule II and Schedule III drugs from their offices, officials have seen a spike in prescription drug shopping and overdose deaths in Georgia. A national drug monitoring program would help prevent that, he said.

Botticelli's observations are supported by federal statistics.

On Wednesday, the Centers for Disease Control and Prevention (CDC) published findings in the Journal of the American Medical Association showing drug overdose deaths increased for the 11th consecutive year in 2010.

CDC's analysis shows that 38,329 people died from a drug overdose in the United States in 2010, up from 37,004 deaths in 2009.

Overdose deaths involving opioid analgesics increased from to 15,597 in 2009 to 16,651 in 2010.

In 2010, nearly 60% of the drug overdose deaths (22,134) involved pharmaceutical drugs. Opioid analgesics, such as oxycodone, hydrocodone, and methadone, were involved “in about three of every four pharmaceutical overdose deaths (16,651), confirming the predominant role opioid analgesics play in drug overdose deaths,” the CDC said.

A federal drug control database would help to control that market in states that can't get their own issues under control. The danger of course is further independent state loss of control over the medicine that is practiced within state borders.

It's a delicate balance, but is something that is inherent in the friction between the federal and state governments. When states don't do things that the federal government sees as necessary or priority then a shift occurs in the power to govern.

IAIABC said that it will still issue some recommendations for states to be published, it hopes, as policy recommendations rather than a single model law at the IAIABC Forum in Des Moines, Iowa, April 29 to May 3. So I don't really see IAIABC's decision not to publish a model law as necessarily withdrawing from the debate, only that they are stepping back in recognition that there are several different paths to the same outcome.

Maybe there isn't any disconnect between state action and federal initiatives - maybe they go hand in hand so that states which do have effective drug policies can participate in large scale data systems that will assist in controlling drug abuse and, presumably, provide economic benefits within state borders.

And the states that don't have a policy will be able to see through IAIABC's efforts what works, what doesn't, or come up with some other novel solution.

One thing is certain - there is quite a bit of interest and activity in both state and federal governments to come to terms with effective, responsible, prescription drug policies.

It's all headed in the right direction.

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