The hidden danger of prescription painkiller restrictions

Prescription painkiller abuse may finally be on the decline, according to a new study published in the New England Journal of Medicine, but efforts at reduction may have created a new problem.

Prescription opioid overdoses were the cause of 100,000 emergency department (ED) visits in 2010 at a cost of more than $2 billion to hospitals, FierceHealthcare previously reported. Two-thirds of ED visits for overdoses were for prescription overdoses.

But researchers, led by Richard Dart, M.D., Ph.D., found opioid diversion and abuse soared between 2002 and 2010, but then plateaued or decreased from 2011 to 2013, with opioid-related deaths similarly rising before starting to decline in 2009. This suggests that, despite concerns they are overly restrictive, increased regulation of painkiller prescribing may have reduced abuse. Narcotic painkiller sales rose 300 percent between 1999 and 2008, according to a Centers for Disease Control and Prevention report, bringing with them an increase in both abuse and diversion, or theft for non-medical purposes. In addition to overdoses, diversion in a medical setting increases the risk of infection and patient harm.

However, Dart and his team also found data suggesting an increase in heroin abuse and overdoses, suggesting that those unable to obtain prescription drugs may take up heroin in place of them. This indicates the solution to addiction must involve treatment rather than simply trying to restrict legal access, Adam Bisaga, M.D., an addiction psychiatrist at the New York State Psychiatric Institute in New York City, told HealthDay.

"You can't get rid of addiction just by decreasing the supply of painkillers," he said. Furthermore, Bisaga said, the typical profile of heroin addicts has changed to middle-class people living in the suburbs who started out using prescription painkillers.

"You see drug cartels expanding into smaller towns. Heroin is reaching rural areas where it was never seen before," he told HealthDay. "And that is going to be around for a long time."

Dart agreed that the key to meaningful reduction is cutting demand through increased education and access to addiction services.

The federal government is also taking steps to help drive down opioid dependancy and overdose deaths. In remarks made this morning at New America in the District of Columbia, Department of Health and Human Services Secretary Sylvia M. Burwell said that in 2012, clinicians wrote approximately 259 million opioid prescriptions, "enough for every American adult to have a bottle."

Burwell said it will take a multi-faceted approach to truly reduce dependency on these painkillers, including data sharing, clinical decision-making and incentives to develop abuse-deterrent opioids. 

To learn more:
- here's the study abstract
- read the HealthDay article