As noted in the July 26 front-page article “ ‘And then he decided not to be,’ ” the recent spike in heroin abuse stems from a decade-long epidemic of addiction to prescription opioids. When pills become harder to find and more expensive, addicts often turn to heroin.
To prevent opioid addiction and the shift to heroin, norms around prescribing painkillers must change. State and national medical groups have developed new prescribing guidelines for opioids that recognize their addictive potential: For non-cancer pain, they should be taken in the lowest possible dose and preferably for short periods.
Prescription-drug-monitoring programs, which record data on controlled-substance prescriptions, are key to improving opioid prescribing. Such programs can identify patients who might be doctor shopping or who are being prescribed opioids at high doses or for extended periods. Monitoring programs can notify health departments, medical boards and insurers when data suggest that prescribers might not be following opioid prescribing guidelines. Requiring that prescribers consult the database before prescribing opioids can ensure that this information is considered in clinical practice.
Monitoring program data holds great promise in getting the heroin epidemic under control. By preventing medically induced opioid addiction, we can reduce the demand for heroin and the deaths attributable to its use.
Thomas W. Clark, Somerville, Mass.
The writer studies prescription monitoring and opioid abuse as a research associate at Brandeis University.