Best practices for responding to prescription drug abuse: A haddon matrix approach

Background/Purpose. Driven by rising prescription opioid overdoses, poisoning has passed road crash as the leading cause of injury deaths. The Federal government, alarmed, has declared prescription drug abuse a public health crisis. This paper summarizes and classifies how communities are responding to this crisis. Methods. To identify evidence-based and promising programs, we supplemented searches of pubmed, conference programs, and the internet with interviews with Federal, interest group, and program staff. We used the Haddon matrix as an organizing tool to classify crisis responses. We defined the event as the period when someone is misusing prescription drugs but has not yet been detected. We defined the agent as either the prescription drug or the script needed to get it. Results. The problem is tri-partite with different responses needed to therapeutic use of abusable medications, recreational use, and addiction. Strong evidence exists for co-prescribing naloxone antidote, especially when coupled with prescriber education and prescription controls. Effectiveness evidence also is mounting for comprehensive Prescription Monitoring Programs. Several programs build on evidence-based substance abuse prevention and recovery strategies including three prescription drug education programs evaluated in randomized trials. Theft reduction and take-back strategies seem sensible but lack evaluation. Strategies for controlling pain of people who are known to be addicted to painkillers are especially challenging. No interventions exist addressing the facilitative role of cell phones and the internet. Conclusions. We have a garden full of ideas. A few flowers are blooming. We need to determine which of the thousand sprouts are weeds.