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Prescription painkiller abuse cases on the rise in Missouri hospitals

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Missouri hospitals have seen a drastic increase in prescription painkiller abuse over the past decade. According to a study from the Missouri Hospital Association, the rate of hospitalization due to the abuse of prescription opioids has increased by 137 percent since 2005.

The numbers localize a problem usually shown through national statistics. For instance, according to the Center for Disease Control and Prevention, 44 people die every day in the United States from prescription painkiller overdoses.

Missouri Hospital Association spokesman Dave Dillon said his organization compiled the data to jumpstart a conversation among health care providers in Missouri.

“We need to get together identify what is within the realm of possible to reduce this and start developing state policies, if in fact that’s the right answer, that we can implement ourselves or that lawmakers can help us implement,” Dillon  said.

Dillon said caregivers need to be better connected so that they can avoid over-prescribing pain pills. But he stopped short of saying what form that connection should take.

“These are really, really important painkillers within the health care community, and they are most likely not going go to go away. So we have some responsibility as a provider community to do our best to insure that they are used appropriately and don’t get into the wrong hands,” Dillon said.

Missouri remains the only state in the country without a prescription drug monitoring program.

Addressing the problem

Doctor E. P. Barrette sees prescription painkiller abuse on a regular basis as the medical director of the Barnes-Jewish outpatient clinic. Many of the clinic’s 15,000 patients have chronic pain.

According to Barrette, using opioids like oxycodone to manage chronic pain can lead to addiction.

“I’ve been practicing medicine 25 years, and 25 years ago no one with chronic back pain would be on oxycodone or hydrocodone. Ever. And we started giving them out, and I think over time we’ve discovered patients have more problems than benefits,” Barrette said.

“The guidelines have changed somewhat,” he added. “I think doctors need to be a little more reluctant before beginning and first prescribing opioid medications, and trying alternative medications first. Once people get on them they in general become dependent on them and tolerant over time and request higher doses.”

When Barrette became director of the Barnes-Jewish clinic, he implemented new policies and training for the staff. They now recommend less powerful medication first and refer patients to pain management clinics that offer steroids before considering opioids.

He estimates the number of clinic patients prescribed opioids for chronic pain has been cut in half since 2010.

“The unique problem with Missouri is we are now the only state without a prescription drug monitoring program. So to try to take care of patients with chronic pain without that tool really puts us at a disadvantage,” Barrette said, adding that “I know how powerful this tool is because we see patients from Illinois and I can look in the Illinois prescription drug monitoring program.”

Barrette testified before the Missouri General Assembly last year in support of a bill that would have set up a prescription drug monitoring program. Upheaval in the state Senate limited the number of bills that made it out of that legislative House last year, but in previous years Senator Rob Schaaf has been an outspoken opponent, citing privacy concerns.

Prescription painkillers are widely regarded as a gateway drug to heroin. 

An earlier version of this story said the Barnes-Jewish outpatient clinic served 1,500 patients.

Follow Camille Phillips on Twitter: @cmpcamille.