Drug overdose deaths in the United States have tripled since 1990, primarily due to increasing rates of prescription opioid painkiller abuse and misuse. In 2011, prescription painkillers were involved in more deaths than heroin and cocaine combined.
Prescription painkiller overdose deaths are just the tip of the iceberg. In 2011, for every one death caused by a prescription painkiller, 25 emergency room visits for misusing or abusing opioid painkillers occurred, 105 people met the clinical criteria for opioid painkiller abuse or dependence, and 659 people used such drugs without a medical reason.
Nationally, four times more prescription painkillers were sold to pharmacies, hospitals, and doctors’ offices in 2010 than in 1999. Once painkillers are prescribed and dispensed, many of these drugs are diverted to non-prescribed users.
This document intends to inform state lawmakers about effective and promising policy strategies to reduce and prevent the occurrence of overdose deaths. It lists several policies that states may consider to reduce this epidemic. While many of these interventions have a promising evidence base, more evaluation is needed to ensure that policies have their intended impact. As such, policymakers and implementers can consider including evaluation as part of the implementation process.
Prescription Drug Abuse Legislation
For examples of legislative action related to preventing prescription drug overdose misuse, abuse and overdose from 2015 through the current session, visit NCSL’s Injury and Violence Prevention Database
For older legislation from the 2009-2014 sessions, visit the prescription drug abuse webpage.
Prescription Drug Monitoring Programs
Statewide Prescription Drug Monitoring Programs (PMDPs) electronically track prescriptions for controlled substances using data submitted by pharmacies. When suspicious prescribing behavior is detected, these programs can notify certain entities or agencies of possible abuse. These programs can curb inappropriate prescribing behavior and prevent patients from obtaining controlled substances from multiple providers. Legislatures in 49 states enacted laws to create PDMPs, and each state’s program operates differently. Promising strategies legislators may want to consider to strengthen PDMPs follow.
- Encourage interstate exchange of PDMP data by developing interoperability standards with neighboring states.
- Require real-time data reporting to make prescription information, including details on the patient and the provider, available to providers immediately after a drug has been dispensed.
- Require prescribers of controlled substances to participate in the PDMP.
- Allow programs to generate and distribute routine reports to prescribers that track usage and prescribing rates.
- Encourage PDMP data sharing among clinicians, licensure boards, law enforcement, Medicaid Program Integrity offices, researchers, etc., in appropriate circumstances.
- Ensure that providers are knowledgeable about the state’s PDMP and other overdose prevention tools to increase participation.
Pain Management Clinics or “Pill Mills”
Pain management clinics, or “pill mills,” are facilities primarily engaged in treating pain by prescribing or dispensing controlled substance medications for profit. At least 10 states have laws that require some type of state oversight of pain management clinic operations. Promising strategies that legislators may want to consider to prevent harmful prescribing practices in pain management clinics follow.
- Set regulations to prevent pain management clinics from prescribing inappropriately.
- Evaluate existing policies that create specific registration, licensure or ownership requirements for pain management clinics.
- Encourage partnerships among health departments, law enforcement agencies and other state or community stakeholders.
Balancing the risk of under-treatment and over-treatment is an enormous challenge providers face when prescribing painkillers. Ohio, Indiana, New Mexico, New York City, Oklahoma, Washington and Utah have created state opioid prescribing guidelines for providers who prescribe and monitor patients receiving prescription painkillers. Some strategies to support safe and appropriate prescribing of prescription painkillers follow.
- Ensure that providers follow evidence-based guidelines for safe and effective use of prescription painkillers.
- Encourage the evaluation of evidence-based guidelines for different professions or disciplines by professional boards.
- Assess the different prescribing practices for different levels of care to avoid oversimplification of guidelines.
Drug Overdose Immunity or “Good Samaritan” Laws
To encourage people who are experiencing a drug overdose to seek help, some states have passed drug overdose immunity or “Good Samaritan” laws. These laws fall into two primary categories: The first encourages calling 911 to seek medical assistance for oneself or someone experiencing an overdose by providing criminal immunity for both the person in need and the person who seeks help. The second provides varying levels of criminal or civil immunity for those who prescribe, possess or administer an emergency dose of the opioid antidote naloxone to reverse the effects of the overdose. Some strategies that legislators may want to consider to prevent drug overdose death by encouraging medical treatment for overdose follow.
- Improve access to opioid “antagonists” (drugs that counter the effects of an overdose), such as naloxone, to medically treat painkiller overdoses in emergencies.
- Allow qualified emergency medical responders to possess and administer naloxone or other opioid antagonists.
Patient Review and Restrictions Programs
Some state benefit programs, such as Medicaid and workers’ compensation, have implemented interventions to reduce inappropriate use of medical and pharmacy services. These programs limit beneficiaries suspected of misusing prescription painkillers to a single prescriber or pharmacy. This practice may help avoid the costly and potentially harmful effects of overlapping prescriptions from multiple sources, while maintaining appropriate pain care. Some promising strategies for state policymakers to consider follow.
- Require state benefit program beneficiaries suspected of misusing controlled substances to use a single prescriber or pharmacy.
- Improve coordination of care among state benefit program beneficiaries to ensure appropriate access to medical care and prescription drugs.
- Evaluate existing patient review and restriction programs to identify gaps and best practices within the state.
Public Education and Awareness
Educating the public about the fatal effects of consuming too many prescription painkillers can be an important tool for preventing accidental overdoses. Kentucky and Utah have statewide awareness campaigns to educate teens, their parents, middle-aged adults, and others that prescription painkillers can be just as dangerous as illicit drugs. Some promising strategies to consider follow.
- Create and fund statewide public awareness campaigns.
- Encourage widespread participation in public awareness campaigns on the appropriate use of prescription drugs.
- Promote partnerships among schools, law enforcement agencies and public health departments to ensure diverse messages and widespread broadcasting.