State Must Address Prescription Drug Abuse

Inspector General Patrick Maley's job is too look for waste in state government and look for ways to improve state government.

He says one way to do both – and to save lives – is to change the way South Carolina fights prescription drug abuse.

“In this country we have more overdose deaths from prescription drugs than all other illegal drugs combined,” Maley said. “You've got to stop the new addicts. You've got to stop the new addicts and bring attention to the costs of this problem.”

Maley spoke at a recent meeting of the Prescription Drug Abuse Alliance. 

“I need your help,” he told the group. “It's a difficult problem to address.”

It's also a problem Maley is familiar with, from his previous work in position as an FBI Special Agent.

He worked in Kentucky, “ground zero” for prescription pill abuse problem, he said.

“The addiction in Eastern Kentucky was so pervasive in such a short amount of time,” Maley said.

He said a number of foreign doctors in Eastern Kentucky were handing out opiate prescriptions “left and right.”

“They created such an addictive population,” Maley said, that soon Kentucky was seeing 1,000 deaths a real from prescription drug overdoses. “In Pike County, Kentucky, the people there think it's a god-given right to go in and get Oxycontin. That's the culture now.”

But now Kentucky is “leading the country” in addressing this problem, he said.

States have tried to address the abuse by prosecuting pill mills, often unsuccessfully, as those cases are difficult to prosecute.

“They have plenty of plausible deniability,” Maley said. “We've been relying on law enforcement inappropriately for decades to solve this problem. You ain't going to solve it by arresting people.”

Pills mills “are definitely a problem,” but equally troubling is doctors who prescribed drugs in high numbers, he said.

“There's lots of reasons along the curve as to why doctors are over-prescribing,” Maley said. “A small percentage of doctors have caused this problem. So let's find those doctors and let's address those doctors.”

A number of state agencies have joined the fight, identifying prescribers and auditing them, applying Medical Board standards.

“These guys are practicing outside the standards,” Maley said. “They'll write a report and give it to the Medical Board. I think in the past this issue has not been given the attention it should have been given. The Medical Board is ready to address this problem.”

DHEC is also helping fight the problem, but “they feel helpless,” Maley said.

Educating doctors is crucial.

“It has shown time and time again that it has driven down the curve on prescribing,” Maley said.

Some people need more education than others.”

Other states have seen great success with the Prescription Monitoring Program.

“It is such an intelligence tool to target our efforts,” Maley said. “It's used by doctors to look at patients. It's used by narcotics officers to look at shoppers.”

South Carolina has to utilize that program more, he said.

“It is not used by state government to find the pill mills, and it's not used by state government to target the doctors who need the most education,” Maley said. “Everyone around us is doing it … because the problem has become so pervasive.”

The program can be used to find out why those pills are being prescribed and if action needs to be taken.

“You can use those analytical tools to find those high-end doctors,” Maley said. “You can find those who are prescribing within medical guidelines and those who are not. Those who are not, go to the medical board.”

Other states have abandoned the “soft, passive approach” to combating prescription drug abuse, Maley said.

“There is none of that. It is – you will use PMP, you will do this,” Maley said. “A lot of people need pain meds, they do. They give them great latitude in prescribing (patients) up to three months. When you cross that three month threshold, the burden on the doctor to articulate why they're using painkillers goes up.”

PMP will also help address pill mills.

“If you're a pill mill doctor and you were told you have to use PMP for every patient, what do you think the effect on that pill mill is?” Maley asked. “I think you're out of business. That gives you legal liability, that gives you civil liability.”

PMP use in mandatory in other states.

“PMP in this state is voluntary, ” Maley said. “22 percent of doctors in this state have signed up and a whole lot less than that actually use it.”

Maley agreed with alliance members that the system needs to be more user-friendly.

South Carolina is tenth in the country in use per opiates per capita and nineteenth in overdose deaths.

“We're spending billions and billions on the war on illegal dreams, and that's not as big a problem, in some respects, as this is,” Maley said.

There's not just a financial cost associated with opiate abuse and addiction – there are social costs as well.

“You've got family disintegration, you've got unemployment,” Maley said.

He says an analytical, incremental approach can work wonders.

“If we shine a bright light on these guys, I am confident they will wind down their efforts,” he said. “And if they don't, there are more extreme efforts.”