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PREVENTABLE DEATHS ON THE RISE

PREVENTABLE DEATHS ON THE RISE

Hollie Hendrickson 12/1/2013

STATE LEGISLATURES MAGAZINE | december 2013

Growing numbers of overdoses, suicides and brain injuries have lawmakers searching for solutions.

By Hollie Hendrickson

Sharp increases in the number of suicides, prescription drug overdoses and traumatic brain injuries in recent years have caught lawmakers’ attention. In fact, traumatic injuries and violence kill more Americans under age 45 than do cancer, heart disease, hypertension and influenza combined, Centers for Disease Control and Prevention data indicate. Prescription drug overdoses, brain injuries and suicides are “certainly three of our key priorities right now,” says Pam Sagness, substance abuse administrator with the North Dakota Department of Human Services.

Bottle of prescription drugsAdds Senator Ted Lieu (D) of California: “Opioid abuse is now an epidemic in this country—that’s the label the CDC gives it. More Americans now die from prescription drug overdoses than they do from heroin and cocaine combined.”

Lieu is joined by legislators around the nation investigating and trying a number of programs to control these growing public health concerns.

Prescription Painkillers

Deaths from prescription drugs have reached epidemic levels in the past decade. According to the CDC, 105 Americans die from prescription drugs overdoses, mainly painkillers such as oxycodone (Vicodin) and hydrocodone (OxyContin).That’s more than 38,000 deaths annually—up more than threefold since 1990.

In 2010, enough painkillers were prescribed to medicate every American adult for a month. The same year, about 12 million Americans (age 12 or older) reported using prescription painkillers without a medical reason.

Almost all drugs involved in overdoses originally come from legitimate prescriptions, but many make their way to addicts and others seeking the drugs’ euphoric effects. Over time, an abuser may need to take larger doses to get the same high and to reduce withdrawal symptoms. But the danger increases with the size of the dose. Larger doses can slow breathing and ultimately stop it, resulting in death.

This year, lawmakers in 22 states passed at least 30 laws aimed at preventing prescription drug abuse and overdose, many of which beefed up prescription drug monitoring programs. Others established regulations for pain management clinics.

Promising policy options that have not yet been proven effective to prevent overdose deaths, but are accepted by the scientific community as a good step toward prevention, include:

  • Maintaining and strengthening prescription drug monitoring programs by ensuring providers have real-time access to data, and providing unsolicited reports to prescribers, pharmacists, licensing boards and law enforcement agencies.
  • Ensuring that providers follow evidence-based guidelines for safe and effective use of prescription painkillers.
  • Setting regulations to prevent pain management clinics from prescribing inappropriately.
  • Monitoring prescription claims information in state benefits programs such as Medicaid or workers’ compensation for signs of inappropriate prescribing and use of controlled prescription drugs.

Traumatic Brain Injuries

Traumatic brain injuries—alone or in combination with other injuries—resulted in 2.4 million emergency department visits, hospitalizations and deaths in 2009, according to the CDC. (The numbers do not include brain injuries sustained by military members.)

In 2010, the CDC estimates that the direct and indirect medical costs of traumatic brain injuries reached $76.5 billion.

The most common causes of brain injuries are falls (35.2 percent), car accidents (17.3 percent), collisions with objects—common while playing sports (16.5 percent)—and assaults (10 percent).

 In 2012, 12 state legislatures passed laws on sports-related concussions in youth. And at least three states passed laws addressing other aspects of traumatic brain injuries.

Legislation and prevention strategies include:

  •  “Return-to-play” laws, such as Ohio’s, which bans athletes from returning to play on the same day they’ve been removed because of a traumatic brain injury and prohibits coaches from allowing students to return to practice or competition without a doctor’s approval, among other measures;
  •  Policies to help prevent traffic crashes and child or adult falls—both major causes of traumatic brain injuries;
  •  Rehabilitation programs for brain injury survivors, including military veterans;
  • Guidelines for emergency personnel when they transport patients with a suspected traumatic brain injuries.

Suicide

Every 15 minutes an individual dies by suicide in the United States, according to the CDC. In 2010, more than 38,000 people took their own lives, making suicide the 10th leading cause of death for all ages, the second leading cause of death for adults ages 20 to 29, and the third leading cause for those ages 15 to 24. Another 1 million adults attempt suicide each year.

Nine state legislatures enacted 10 suicide prevention laws in 2012, many that:

  • Encourage schools and communities to support people seeking help, promote tolerance, decrease stigma, and teach positive life and coping skills;
  • Require suicide prevention training for teachers;
  • Evaluate existing suicide prevention programs.
  • The statistics paint a grim picture, but the news is not all bad. Lawmakers and other officials in many states are actively seeking effective ways to prevent suicides, overdoses and taumatic brain injuries.

Tighter Controls for Painkillers

The Food and Drug Administration in October recommended tighter controls on how doctors prescribe the most commonly used narcotic painkillers.  Currently, a patient can refill a prescription for hydrocodone-containing drugs five times over a six-month period before needing a new prescription. The new regulations would reduce by half, to 90 days, the supply of the drug a patient could obtain without a new prescription. The changes, which could take place as early as next year, may cut down on the availability of prescription painkillers. At least 35 states have laws on prescribing limits for controlled substances.

Hollie Hendrikson tracks policy related to injury and violence prevention for NCSL.

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