That's the question vexing public health directors - and anyone with a loved one who's experienced one - everywhere. That includes Rhode Island, where health department chief Dr. Michael Fine named combating prescription drug overdose deaths one of his top priorities.
The Trust for America's Health, a nonpartisan think tank focused on preventing disease, has just ranked all 50 states by the number of policies and strategies each has in place to prevent deaths from prescription drug overdose. We report on how Rhode Island fared in the report here. But here's some more detail on those strategies and how Rhode Island measures up.
(Source: Trust for America's Health, "Prescription Drug Abuse: Strategies to Stop the Epidemic," October 2013 report)
Some key Rhode Island findings from the report include:
No.Indicator Number of States Receiving PointsA "Y" means the state received a point for that indicator1Existence of Prescription Drug Monitoring Program (PDMP): Has an active program
2PDMP: Requires mandatory utilization by prescribers
3Doctor Shopping Laws: Has a law specifying that patients are prohibited from withholding information about prior prescriptions from their healthcare provider
50 and Washington, D.C.
4Support for Substance Abuse Treatment Services: Participating in Medicaid Expansion, which helps expand coverage of substance abuse services and treatment
24 and Washington, D.C.
5Prescriber Education Required or Recommended
6Good Samaritan Laws: Has a law to provide a degree of immunity or mitigation of sentencing for individuals seeking to help themselves or others experiencing an overdose
17 and Washington, D.C.
7Rescue Drug Laws: Has a law to expand access to, and use of naloxone, a prescription drug that can help counteract an overdose, by laypeople
17 and Washington, D.C.
8Physical Exam Requirement: Has a law requiring healthcare providers to physically examine patients or have a bona fide patient-physician relationship before prescribing a controlled substance
44 and Washington, D.C.
9ID Requirement: Has a law requiring or permitting a pharmacist to require an ID prior to dispensing a controlled substance
10Lock-In Programs: Has a pharmacy lock-in program under the state's Medicaid plan where individuals suspected of misusing controlled substances must use a single prescriber and pharmacy
46 and Washington, D.C.
Rhode Island does not have a law requiring pharmacies to ask for ID before they'll fill a prescription for a controlled substance. When I asked the head of pharmacy regulation why not, and whether such a requirement is a possibility for the future, she told me, basically, that she preferred not to mandate such behavior but to encourage pharmacists to do the right thing. Some individual pharmacies may already have implemented such a policy.
Rhode Island also does not have a law requiring access to naloxone (or Narcan), which, if administered in time, can counteract a suspected overdose. The state's department of health, however, recommended earlier this year that doctors prescribe naloxone to patients considered at risk of overdosing. And there's a relatively new pharmacy program in the state that will dispense naloxone to people at risk of an overdose.
What else could be done? Making substance abuse treatment not only more accessible but more affordable might help. A recent brief from the Health Care Cost Institute found that out-of-pocket costs for substance abuse treatment for people with employer-sponsored insurance have increased faster than other mental health and medical costs. For some, treatment seems too expensive, and low-cost or free programs often have a waiting list.