Upstate New York sinks in flood of legal opioids

Some states have passed regulations limiting the amount or length of opioid prescriptions. Across the country, municipalities, law enforcement agencies, nonprofits and grassroots citizens' groups have organized countless meetings and forums in an effort to come to grips with the scope of the opioid crisis.

Yet the supply side of the problem is growing.

"There's been this recognition of the problem of an increase in prescribing — that the addiction problem doesn't start with kids getting into grandma's medicine chest, it's that every grandma has opioids in her medicine chest," said Andrew Kolodny, a medical doctor, research professor and executive director of Physicians for Responsible Opioid Prescribing.

Kolodny and others who advocate for controlling the amount of legal opioids in circulation suggest the timing between the rise in prescriptions and the rise in addiction is no coincidence. Prescription opioids have a legitimate but highly restricted medical use, he said, as part of a doctor’s arsenal in treating severe pain after major surgery, and for end-of-life care and for some cancer patients.

Pharmacists are trained to apply that level of caution, according to Karl Fiebelkorn, senior associate dean for Student, Professional, and Community Affairs of the School of Pharmacy and Pharmaceutical Sciences at the University at Buffalo.

A conscientious pharmacist will take care to counsel patients and to watch for potential problems with prescriptions, said Fiebelkorn, who in addition to his academic credentials has been a practicing pharmacist for nearly four decades.

"With acute pain, we have to be careful," he said. "If, for example, a dentist orders you 36 hydrocodone pills, that’s going to get you addicted, period. A pharmacist will call up and say, 'This person only needs six.'"

Despite that, the DEA's Automation of Reports and Consolidated Orders System (ARCOS) data show nearly across-the-board increases in scheduled opioids, which means more prescriptions are being written and filled.

A pharmacy is a business like any other, Fiebelkorn said. A pharmacist does not want to carry excess inventory — he or she orders opioids based on history and expectations of future demand, orders that are tagged and reported in ARCOS.

Those who develop an addiction then end up acquiring more pills if they can, or going to the street in search of pills or heroin. Some die in the process.

Fiebelkorn has twofold advice for people who are prescribed opioids: Talk to your physician and pharmacist, and don't hang onto old prescriptions. Bring them to the takeback events held periodically by local law enforcement agencies.

On the supply side, he said, pharmacy programs are focusing on educating the next generation of doctors.

At the UB School of Pharmacy and Pharmaceutical Sciences, "we train our students intensely in pain management and abuse, and we also have them volunteer on prescription takebacks, and they go on rotations where they interview and counsel patients," he said. "They’re well-aware when they come into the program — they know it’s a very important issue."