Download Health and Aging Commitrtee CHAIR: Anne Gonzales Cindy

Health and Aging Commitrtee
CHAIR: Anne Gonzales
Cindy Koumoutzis, State Director, Ohio CAN
I would first like to introduce myself, my name is Cindy and I am a Co-Founder of the
National non-profit organization, Change Addiction Now (C.A.N.) and the State Director for
Ohio C.A.N. It is our mission to bring the family voice to addiction and recovery by speaking
out for evidence based practices, harm reduction and reaching out to families who continue
to hide in shame and stigma. Throughout Ohio we continue to Embrace, Educate and
Empower those whose lives have been impacted by substance use disorder.
Numerous people in the United States struggle each and every day with chronic pain. Pain
affects more patients than diabetes, heart disease and cancer combined. Yet while the
amount of pain reported by Americans has not changed since 2000, we now see four times
the amount of opioids prescribed. The burden of pain is high, both for the individual patient
and society, and the combined annual cost of health care and decreased work productivity
due to pain is $635 billion in the United States. More importantly, the result is a quadrupling
of deaths, many preventable as we face an ongoing opioid overdose epidemic. This is a nondiscriminatory crisis facing the largest of cities to the smallest of towns. We are not only
losing our parents, friends and neighbors, but also our children, siblings and co-workers.
And we can prevent this devastation by safer prescribing.

Doctors dispensed more than 750,630,661 doses of opioids in 2014. Abuse of opioids
is considered by many to be a precursor to heroin use.

Ohio patients who were prescribed opioids received on average 143 doses of the
drug for a three-month period.
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Opioids are being dispensed at such a rate in Ohio that if spread out across the state
each Ohioan would have been prescribed about 5 pills every month this year.
Every day, more than 40 Americans lose their lives to prescription opioids. We know of no
other medication routinely used for a nonfatal condition that kills patients so frequently.
Chronic pain is a public health concern in the United States and patients with chronic pain
deserve safe and effective pain management. Prescription opioids have a role in pain
management and can manage some types of pain. We also know that abusers of
prescription opioids may shift to heroin use, as it becomes more difficult to obtain or misuse
newer opioid pain medications, thus adding to the complexity of the opioid abuse issue. In
order to tackle opioid abuse, a multifaceted approach needs to be taken. HB 248 gives
proper direction and suggests best practices the prescribing of opioid medication.
Given the complexity, it is clear that innovation in the area of abuse-deterrent formulations
alone will not be able to solve the issue in full. However, it does play a vital role and can
contribute to reaching the overall aim of reducing the abuse of prescription medicines. We
need to set limits on amounts prescribed, monitor their usage and make abuse deterrent
medications a priority with all patients. We also need to adhere to prior authorization
requirements making certain these requirements are no more restrictive than those not
abuse-deterrent.
Many Americans mistakenly believe that prescription drugs are less dangerous when abused
than illicit drugs because they are approved by the U.S. Food and Drug Administration.
Many well-meaning individuals are unaware of the risk associated with sharing their
prescription medications with a friend or family member, and although parents often
remember to lock the liquor cabinet, many do not think to lock the medicine cabinet,
leaving unused medication accessible to teens.
Abuse-deterrent medications protect the community against prescription drug abuse by
deterring or reducing certain forms of abuse. The FDA approved abuse-deterrent labeling for
a reformulated ER oxycodone product, indicating “that the product has physical and
chemical properties that are expected to make abuse via injection difficult and to reduce
abuse via the intranasal route (snorting).” The FDA granted such labeling because well
controlled clinical studies demonstrated significant reduction, up to 60%, in various abuserelated parameters and indicators following the reformulated medication’s introduction into
the market in April 2010.
Abuse-deterrent medications and prescribing guidelines stated in HB 248 have the potential
to reduce the public health burden of prescription opioid abuse. Currently available ADFs
can reduce the likelihood of the following:

Patients progressing to abuse via nonoral administration routes.

Individuals with established substance use disorders developing new complications
related to their disorder.

Misuse due to the unknown risks associated with product manipulation, which can
result in overdose-related mortality
By reducing the likelihood of abuse, ADFs reduce the likelihood of civil and criminal liability
that physicians and pharmacists face as a result of overdose-related deaths caused by
patient abuse. Physicians may be more willing to prescribe and pharmacies may be more
willing to dispense abuse-deterrent controlled substances to patients with legitimate needs,
thereby reducing barriers to access for patients with chronic pain.
This increase in abuse of controlled substances and resulting overdose deaths is correlated
with significant increases in the supply of such medications, including opioids, central
nervous system depressants including barbiturates and benzodiazepines. Alprazolam, a
benzodiazepine, was the mostly commonly prescribed psychiatric medications.
Benzodiazepines are also commonly abused and are particularly dangerous when taken in
combination with alcohol or other medications. Benzodiazepines were involved in 30.6% of
prescription drug-related overdose deaths [CDC, 2014c]. There are currently no
benzodiazepines with FDA-approved abuse-deterrent labeling on the market. It is
imperative that those being prescribed medication for chronic pain show just cause for
prescribing of benzodiazepines.
The decision to prescribe or take an opioid is a serious one. It is my hope that providers and
patients will use the recommendations in H. B. No. 248 to make an informed decision about
the best way to manage pain and set clear expectations. We have an obligation to act now
to reverse the trends of opioid overdoses and deaths. With these guideline as one tool, we
can change the course of the opioid epidemic in this country.