Oklahoma Health Commissioner Describes Efforts of States to Curb Prescription Drug Abuse

October 27, 2014|1:34 p.m.| John Skendall

Prescription drug abuse is a serious and rapidly growing threat to the U.S. population. Since 2009, more people have died each year from drug poisonings than from motor vehicle crashes. A large proportion of these deaths involved an opioid analgesic such as oxycodone, methadone, or hydrocodone.

For many, this deadly addiction doesn't begin in a back alley, a party, a club, or on a street corner. It starts in a hospital or doctor's office, with a physician whose intent is not to cause pain, but rather alleviate it.

In response to the growing problem of prescription drug abuse and misuse, ASTHO, under the leadership of Oklahoma Commissioner of Health Terry Cline, challenged the health agencies of each U.S. state and territory over this past year to make a strong and concerted effort to stem the rampant rate of abuse and deaths associated with prescription drugs. Of particular concern are opioids, which can be as dangerous and addictive as heroin. In fact, the vast majority of heroin users reported using prescription drugs earlier in their addictions.

Cline and ASTHO's work in this area are already gaining traction. At the time this article was published, 46 states and two U.S. territories had pledged to meet the 2014 ASTHO President's Challenge: To reduce the rate of prescription drug abuse and the number of resulting deaths in their state 15 percent by 2015.

I recently interviewed Cline about the ASTHO "15 by 15" challenge that he as ASTHO's president posed to states.

Terry, thank you for having this conversation with us today. Why this challenge, and why now?

We've seen an exponential rise in prescription drug abuse and misuse in this country, and I certainly wasn't the first to raise the issue to larger attention. But, as president of ASTHO this year, I felt it was really time to see what we can do to change this deeply troubling trend. I think my background in health, particularly with matters of the brain and the psychology of addiction, helped me to, I hope, frame this more clearly and allow us to put a human face on the problem. Prescription drugs do not discriminate against anyone and you can see a wide range of people, from adolescents to older adults, across socioeconomic categories, and all various ethnic groups succumb to the power of this particular addiction. Prescription drugs do not discriminate against anyone and you can see a wide range of people, from adolescents to older adults, across socioeconomic categories, and all various ethnic groups succumb to the power of this particular addiction.

You mention your background in psychology. What have you seen in your career that helps you now where you sit as Oklahoma's health commissioner and with the 15 by 15 challenge in particular?

Well, I can tell you I've seen firsthand families that have been ripped apart by addiction, and I've seen people, even children, with amazing inner strength and resilience who withstood the deep pains of being the family member of an addict, but who still always walked away with lasting scars. We must do a better job of mitigating these harms before they consume people and the ones they love.

You also mentioned stigma. There is a subtle, sometimes unspoken belief shared by many that addicts are weak, lazy, or unwilling to "get clean." Do you agree?

You are correct that some do believe that. And they are mistaken. There is a point in addiction where it is no longer a conscious choice. People do not want to become addicts; often they want nothing more than to quit. But addiction is powerful, and it takes a lot of strength and courage to overcome. People who face down and overcome addiction, be it to narcotics or prescription drugs or another substance, are to me the furthest thing from weak. Many of the same struggles we see in managing chronic diseases, such as diabetes, are present in finding the road to recovery; however, most other chronic diseases do not carry the same hostility and stigma that most addicts experience.Many of the same struggles we see in managing chronic diseases, such as diabetes, are present in finding the road to recovery; however, most other chronic diseases do not carry the same hostility and stigma that most addicts experience.

To that end, what can be done at the state level to make inroads with the problem of prescription drug abuse?

The 15 by 15 challenge is really a multi-pronged approach. There is no one front to fight the war. It needs to be tackled from all directions—from educating the physicians who write the prescriptions to educating patients themselves, and providing access to evidence-based, effective addiction treatment at the local community level for people suffering. And many points in between. These are outlined in the plans and comprehensive strategies we've shared with states to achieve the 15 percent reduction by 2015 goal.

The results will start coming in next year from states as they track the effects of their work to curb prescription drug abuse misuse and deaths. How do you define success for the challenge?

If we helped one person, it was worth it. But I feel strongly we're helping states and territories in the U.S. to be set up for long-term success. I anticipate we'll see noticeable results of the effort this year. I'm excited to find out.

Speaking of the longer term, what would you love to see happen as the result of this challenge, say 10 years from now?

I look forward to the day when we can prevent things like prescription drug abuse and addiction from happening in the first place.I look forward to the day when we can prevent things like prescription drug abuse and addiction from happening in the first place. And that will happen through education and by spreading awareness. We're already seeing promising points of intervention, where right in a doctor's office or hospital, patients can be screened for potential prescription drug misuse or abuse. We're going to get better at assessing people who are at risk, even at moderate to low risk. And we've already come a long way in understanding the impact of these drugs on the brain and its contributions to addiction. We have seen public health successfully overcome and eradicate some of the biggest challenges immagineable to the wellbeing of our planet, so I am confident that we can similarly overcome the rising rate of prescription drug misuse that is killing thousands in the United States.

Terry Cline

Terry L. Cline, PhD, is commissioner of the Oklahoma State Department of Health, and served as ASTHO's president from 2013 to 2014. Learn more about ASTHO's 2014 President's Challenge at www.astho.org/Rx.