Editorial: The pill problem

Statewide in Maine during the seven-year period from 2006 to 2012, nearly 398 million prescription hydrocodone and oxycodone pills were distributed, according to Drug Enforcement Agency data compiled by the Washington Post.

Hannaford in Ellsworth sold more than 4.2 million of the pills. Carroll Drug in Southwest Harbor, seventh in volume among the distributors listed, sold 1.1 million. In Hancock County overall, 15.8 million prescription painkillers were sold during that seven-year period.

The numbers of any individual pharmacy should be considered in context. Hannaford in Ellsworth, for example, serves customers from all over the region as well as visitors passing through. Another important caveat: pharmacies fill prescriptions, they don’t write them. Still, the number of pain pills that flowed through small-town pharmacies in Hancock and Washington counties during those seven years is staggering, especially considering what we know about opioid addiction today.

For Gordon Smith, the state’s recently appointed director of opioid response, the numbers, while “very alarming,” are old news. At the time Maine was a high prescriber, he said, and the state has since taking steps to stem the tide.

Since 2013, the percentage of opioid pain pills prescribed in Maine has gone down 41.5 percent. A 2016 law limited the number of milligrams a medical provider can prescribe per day and requires patients receiving more than 100 milligrams per day to be tapered off to that level or below. (There are need-based exceptions.) There’s also greater awareness today and better education for providers prescribing these powerful, potentially addictive medications.

Nonetheless, we will feel the ripple effects of those high-prescribing days for years, if not generations. For someone recovering from major surgery or suffering a debilitating illness, painkillers offer physical relief. But for others, they can be an instrument of great suffering. Many users don’t know there’s a problem until it’s too late.

The National Institute on Drug Abuse, a federal scientific research institute under the National Institutes of Health, U.S. Department of Health and Human Services, identifies prescription opioid use as a risk factor for heroin use. It cites a study of young, urban injection drug users interviewed in 2008 and 2009, which found that 86 percent had used opioid pain relievers non-medically prior to using heroin. The three main ways they were introduced to pain pills was through family, friends, or personal prescriptions. In a study of people who began abusing opioids in the 2000s, 75 percent reported that their first opioid was a prescription drug. For many people struggling with addiction, the problem didn’t start on the street or at a party, but in a doctor’s office or the family medicine cabinet.

Considering those figures, and the fact that childhood trauma and mental illness put people at greater risk for substance-use disorders, provides a more nuanced view of addicts: victims as opposed to criminals. We need to take a good, hard look at the system that allowed millions of opioid pills to pour into our communities so that when the next big pharmaceutical drug comes along, it won’t precipitate the addiction crisis of the next generation.

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