Reducing the Burden of Prescription Opioid Abuse in Eastern Kentucky by Improving Florida's Prescription Drug Monitoring Program
Creators: name: Quillen, Deane
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2015

description: In 1996, Purdue Pharma released the powerful slow-release opioid OxyContin, and for the nearly two decades that have followed, the United States has battled a prescription drug abuse problem of epidemic proportion (Center for Disease Control and Prevention, 2011). Central Appalachian states like Kentucky, with low income, rural populations economically dependent on manual labor, are particularly susceptible to the addictive potential of the drug and others like it. In response to the marked rise in opioid diversion, addiction, and overdose, Kentucky established its prescription drug monitoring program (PDMP) Kentucky All Schedule Prescription Electronic Reporting (KASPER) in 1999 as a tool for medical professionals to monitor, store, and reference data related to patients' prescription history (Kentucky Cabinet for Health and Family Services, 2006). Presently, 49 states plus Washington D.C. have some form of prescription drug monitoring program in place in order to identify trends indicative of "doctor shopping" and prevent the over-prescription of scheduled narcotics (Prescription Drug Monitoring Program Center of Excellence, 2013). Kentucky's model garnered significant praise and in 2013, KASPER was labeled "a gold standard" PDMP (Substance Abuse and Mental Health Services Administration, 2013). Still, Kentucky's drug overdose mortality rate more than quadrupled between 1999 and 2013. Approximately three quarters of these overdose deaths involved prescription drugs (Trust for America's Health, 2013). Evidence suggests that access to pills from states with less robust prescription drug monitoring legislation was to blame. The United States Drug Enforcement Administration reported that in 2010, of the top 100 oxycodone purchasing physicians nationwide, 90 were located in Florida (Rannazzisi, 2012). In his testimony on prescription drug diversion in March of 2012, Kentucky Attorney General Jack Conway stated that law enforcement officials estimated 60 percent of pills sold illegally in Kentucky originated in Florida (Prescription Drug Diversion, 2012). Florida failed to enact a PDMP until 2011 and is one of just three states whose program does not share data with authorized users in any other state. This paper will use peer-reviewed literature, state law archives, raw data from a 2008-2014 longitudinal study of more than 500 prescription opioid users in rural southeastern Kentucky, and drug use and overdose statistics from state and federal agencies such as the Kentucky Office of Inspector General, Drug Enforcement Administration, and Centers for Disease Control and Prevention to identify key stakeholders and motives, establish temporal relationships between illicit opioid use trends and changes to prescription drug monitoring policies, explore barriers to implementation of stricter regulations in Florida, and outline next steps toward achieving a more transparent and effective PDMP there. The purpose of this paper is to make the ethical public health case for Florida to strengthen its PDMP in order to significantly reduce the burden of diverted prescription opioids in Kentucky.