The Centers for Disease Control and Prevention reported earlier today that the number of prescriptions written for painkillers decreased from 2012-2015, reflecting the first drop in opioid prescribing since the onset of the epidemic. The CDC stated that prescriptions for opioids declined 13.1% over these three years.
However, the CDC’s acting director Anne Schuchat appeared only cautiously optimistic in an interview. She noted that the prescription rate was still three times the level from 1999, and as much as four times as European countries. Yes, the rate is down, but there were still enough opioids administered in 2015 to ensure every American could receive medication around-the-clock for three weeks.
“It looks a little bit better, but you really have to put that in context. We’re still seeing too many people get too much for too long.”
“It’s still too high. We are heading in the right direction, but we have a long way to go.”
The mass availability of prescription opioids has, without a doubt, fueled the addiction crisis, but those who can no longer obtain their drug of choice may switch to street heroin, which is cheaper and easier to allocate.
The CDC estimates that up to 4 in 5 new heroin users initiated their habit after first becoming dependent on prescription painkillers.
Schuchat thus noted that fewer prescriptions for opioids may result in fewer initial addictions and that the improvement should be considered “prevention.”
“The fewer we get started, the fewer we get addicted to opioids.”
She is correct about initiating addiction with new prescriptions for opioids. However, physicians should be very cautious about denying medication to patients who are already dependent. They may need long-term weaning or opioid replacement therapy, such as methadone, in addition to counseling, detox, and other assistance for addiction treatment.
The epidemic has affected nearly every community in the U.S. According to the new report, from the turn of the century to 2015, prescription painkillers are responsible for the deaths of nearly 180,000 people, and the annual “economic burden” is an estimated $75.5 billion.
In 2015 alone, the CDC reports that more than 33,000 people died from overdoses related to prescription painkillers or illegal street opioids/opiates such as heroin and fentanyl.
An estimated two million people are dependent. Recent data compiled by the New York Times suggest those figures will continue to rise in 2016.
In 2014, another agency reported there were 1.27 million emergency room visits or hospital admissions for health problems related to opioids. And the shortage of treatment options for the addicted has caused Trump and his administration to rethink the repeal of The Affordable Care Act.
For example, states with significant drug addiction problems are resisting proposals by the federal government to roll back Medicaid expansion, an action that is allowing more people to receive treatment.
The are some suggestions from insurers and other data collectors that opioid prescriptions have also been on the decline since 2015.
The report also confirmed that there are significant disparities in opioid prescribing practices across the U.S.
To analyze data, researchers use a measurement called morphine milligram equivalents – this is the most efficient method of describing the potency of different opioid drugs and different doses. The CDC surveyed painkiller prescriptions and broke them down county.
For example, physicians in some hard-hit areas of Appalachia, New England, and the Southwest prescribed the equivalent of up to 5,543 milligrams of morphine per 100,000 in 2015, yet in other locales, prescribers didn’t prescribe any at all.
Additionally, painkillers are more often prescribed in small towns, “white” counties, areas of higher unemployment, lower income levels, higher levels of Medicaid enrollment and a greater incidence of arthritis, diabetes, disability, and suicide.
And the more physicians and dentists there are per capita, the greater chance that people are to get prescriptions for painkillers.
A Sustainable Trend?
In recent years, public health officials such as the CDC have been encouraging physicians to reduce the number of opioid pills they prescribe, the dosage and the duration of treatment. Guidelines released by the agency last year asked doctors to limit prescriptions to seven days for acute pain and to only prescribe opioid long-term for the treatment of cancer or palliative care.
Data reveals that these tactics are working. The prescribing of opioids was at its highest in 2010, equating to 782 milligrams of morphine per person, an amount that declined to 640 milligrams per person in 2015.
However, the study also revealed a sustained increase in the long-term prescribing of painkillers, and the average length rose from 13 in 2006 to 18 in 2015. The CDC has stressed that there is no evidence that opioids are effective in the long-term for the treatment of chronic pain, and urges patients to seek alternative and complimentary therapies.
From the report:
“Previously, opioids had primarily been reserved for severe acute pain, postsurgical pain, and end-of-life care.”
“This change…increased the amount of opioids prescribed…First, opioid use for chronic non-cancer pain increased the number of opioid prescriptions. Second, the use of opioids to treat ongoing chronic conditions increased the average lengths of time for which opioids were prescribed.”