Although there has been a gradual drop in prescriptions for opioids in the United States since 2010, the number of prescriptions written for painkillers is three times as high as it was in 1999, according to a new government report.
Indeed, in 2015 the amount of opioids prescribed was enough for every American to be medicated around the clock for three weeks, according to the new Vital Signs report from the Centers for Disease Control and Prevention that looked at opioid prescribing in the United States from 2006 to 2015.
However, prescribing practices are widely inconsistent and patients receive different care depending on where they live. Some counties prescribe six times as much as others. Researchers found the hardest-hit areas were in nonurban counties with high unemployment, a higher percentage of white residents and a high number of patients who had diabetes and arthritis.
“While some variation in opioid prescribing is expected and linked to factors such as the prevalence of painful conditions, differences in these characteristics explain only a fraction of the wide variation in opioid prescribing across the United States,” Deborah Dowell, M.D., chief medical officer in the Division of Unintentional Injury Prevention at CDC’s National Center for Injury Prevention and Control, said in an announcement about the findings. “This variation highlights the need for healthcare providers to consider evidence-based guidance when prescribing opioids.”
Among the findings:
- The amount of opioids prescribed peaked in 2010 at 782 morphine milligram equivalents (MME) per person and decreased to 640 MME in 2015.
- Daily MME per prescription remained stable from 2006 to 2010 and then decreased 17% from 2010 to 2015 (from 58 MME to 48).
- The average days’ supply per prescription increased 33% from 13 days in 2006 to almost 18 days in 2015.
- The amount of opioids prescribed per capita in 2015 was still approximately three times as high as in 1999.
The maps below highlight the amounts of MMEs prescribed throughout the country in 2015 and change in MMEs per capita during 2010–2015.
The root cause of the epidemic
The root of the problem began in the late 1990s when healthcare providers used opioids to treat chronic pain for conditions, such as back pain and arthritis. But as providers wrote more prescriptions for more days in higher doses, it helped fuel the risk of addiction, overdose and death. Even at low doses, a person who takes an opioid for more than three months is 15 times more likely to become addicted to the painkillers.
The issue has reached epidemic proportions. Drug overdoses accounted for more than 52,400 deaths in the United States in 2015 and 63% of those involved an opioid, according to the CDC. Approximately 15,000 of opioid-related deaths involved a prescription opioid. The agency estimates that 2 million Americans had an addiction to prescription opioids in 2015.
Despite the focus on opioid addiction, some advocates say that the government isn’t putting enough money behind the effort to prevent it. The Republican healthcare bill adds $45 billion for states to spend on opioid addiction treatment, but addiction specialists told The New York Times it isn’t enough to make up for the proposed cuts to Medicaid, which provides treatment for hundreds of thousands of people.
In response to the CDC’s findings, the American Medical Association said in a statement that the country must do more to provide evidence-based, comprehensive treatment for pain and for substance use disorders. Physicians must also lead efforts to reverse the opioid epidemic by using prescription drug monitoring programs, eliminating stigma, prescribing the overdose reversal drug naloxone, and enhancing their education about safe opioid prescribing and effective pain management.
The CDC also recommends that healthcare providers follow these guidelines when prescribing pain medication for chronic pain:
- Prescribe opioids only when benefits outweigh risks.
- Start with the lowest effective dose of immediate-release opioids. For acute pain, prescribe only the number of days that the pain is expected to be severe enough to require opioids.
- Reassess benefits and risks when considering dose increases.
- Use state-based prescription drug monitoring programs to help identify patients at risk of addiction or overdose.
Another recommendation comes from Johns Hopkins Medicine: Avoid handwritten orders for painkillers. A new study of opioid prescriptions filled at a Johns Hopkins Medicine outpatient pharmacy found that handwritten orders for the drugs contribute heavily to a trio of prescribing and processing errors in contrast to those created electronically. Overall, the investigators found that 92% of handwritten prescriptions either failed to meet ideal practice standards, contained such errors as the absence of at least two patient identifiers or failed to comply with federal opioid prescription rules.
“Mistakes can be made at any point in the prescribing, transcribing, processing, distribution, use and monitoring of opioids, but research has rarely focused as we have on prescribing at the time of hospital discharge or on written prescriptions prescribed for adults,” Mark Bicket, M.D., assistant professor of anesthesiology and critical care medicine, and the paper’s lead author, said in the study announcement.