Opioid Prescriptions Are Down, So Why Are They Still Killing Americans?
Between 2006 and 2017, U.S. retail pharmacies filled 233.7 million prescriptions for opioids. In 2006, opioid prescriptions in 14 states met or exceeded a medically determined high dosage level. That number doubled by 2010 to 28 states, before dropping to just six states in 2017.
Those numbers track pretty closely with the efforts of Purdue Pharma, one of the most hated companies in America, to market its opioid painkiller OxyContin. The Connecticut-based pharmaceutical maker received U.S. Food and Drug Administration (FDA) approval for OxyContin in 1995 and launched sales of the drug in the following year. The company paid $600 million in fines and other charges in 2007 after pleading guilty in federal court to charges of misleading regulators, doctors and patients regarding the risk of abuse and addiction to OxyContin.
According to a report Monday in The New York Times, Purdue marketed the drug as a less-addictive, longer-acting painkiller than competing drugs like Percocet or Vicodin in an effort to persuade reluctant doctors to prescribe the drug. The Times examined recent lawsuits filed by the state of New York against Purdue, its controlling Sackler family and other pharmaceuticals makers and distributors seeking massive damages related to all defendants committing fraud in their applications to do business in New York.
In a new study published Tuesday on the Journal of the American Medical Association’s Network website (JAMA Network Open), researchers looked at the annual amounts of opioids prescribed per person, the length of the prescriptions, and four different prescribing rates — prescriptions with durations of three or fewer day; prescriptions for 30 days or more; high dosage prescriptions above 90 MME and extended-release, long-acting (ER/LA) prescriptions — looking for long-term trends over a 12-year period and in different states over that time.
Based on the 233.7 million prescriptions reviewed in the study, the mean amount of opioids prescribed per person dropped from 628.4 morphine milligram equivalents (MME) to 543.4 MME between 2006 and 2017. The rate of high dosages dropped from 12.3 per 100 population to 5.6; short-term prescription durations dropped from 18.0 per 100 people to 10.0; ER/LA formulations dropped from 7.2 to 6.0 per 100 people.
The researchers found, however, that the prescription duration rose from 13.0 to 17.9 days and that prescriptions for durations greater than 30 days rose from 18.3 to 24.9 per 100 population. On the first measure, every state showed a statistically significant increase; on the second, the increase was statistically significant in 39 states.
In 2006, the mean duration of an opioid prescription was 14 days or less in all but eight states, and in only one state, West Virginia, did prescriptions run as long as 16 days. By 2010 the mean duration fell below 14 days in only nine states, and by 2017, no state’s mean prescription duration fell below 14 days, and in 22 states the prescription duration exceeded 18 days.
The U.S. mean prescription duration in 2006 was 17.6 days per 100 persons. That rose to 24.7 days in 2017, with a high of 47.7 days in Alabama, 47.4 days in Tennessee, 46.1 days in Kentucky, and 45.3 days in Arkansas (nearly double the state’s duration in 2006).
The national ER/LA prescription rate dropped from 6.4 per 100 persons in 2006 to 5.4 days in 2017 but rose in four states: Arkansas’s rate rose from 6.8 to 7.2; Delaware rose from 10.2 to 11.0; Idaho, up from 7.0 to 7.6; Oklahoma’s rate rose from 8.9 to 9.0; Vermont rose from 7.7 to 8.3. Tennessee joined Delaware and Oklahoma as the only three states with ER/LA prescription rates greater than 8.6 per 100 persons.
The authors note, “Because duration of use is the factor most often associated with opioid use disorder and overdose, the increase in mean duration per prescription and prescribing rate for 30 or more days is notable and worth further investigation.” The drop in short-duration prescriptions indicates that doctors are seeking alternatives to opioids for short-term pain relief.
And what about the overall impact of opioid use? Increased use of cheaper and more potent opioid analogs like fentanyl continue to cause Americans’ deaths. More than a third of all opioid-related deaths in 2017 involved doctor-prescribed opioids. The authors said: “Accordingly, both illicit street drugs and prescription opioids must become less available. This highlights the complexity of solving the current epidemic. Closing the path to opioid use disorder will require addressing overprescription of legal opioids, reducing the availability of illicit opioids, and getting patients with opioid use disorder into treatment.” Next read about several effective pain treatments that aren’t opioids, according to doctors.