Monday, March 16, 2020
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Opioid or narcotic analgesics, also known as prescription painkillers, include hydrocodone plus acetaminophen (Vicodin), oxycodone (OxyContin), oxymorphone(Opana), and methadone. Different US regions vary in use of opioid or narcotic analgesics and amount prescribed.
Increased demand for these drugs is partly the result of nonmedical or recreational use, with illegal street sale and/or those involved procuring the drugs from multiple prescribers simultaneously. Many US states, especially in the South, report problems with for-profit, high-volume pain clinics prescribing large quantities of these drugs to people without documented medical indications.
Forty-six individuals die every day in the United States from an overdose of prescription painkillers, according to a new report from the Centers for Disease Control and Prevention (CDC).
Healthcare providers wrote 259 million prescriptions for opioid painkillers in 2012.
"That's enough for every American adult to have their own bottle of pills," CDC director Tom Frieden, MD, said during a media briefing.
Prescriptions for opioid painkillers were distributed unevenly throughout the United States. Healthcare providers in the highest prescribing state wrote almost 3 times as many opioid painkiller prescriptions per person as those in the lowest prescribing state.
Ten of the highest prescribing US states for painkillers are in the South; Alabama, Tennessee, and West Virginia had the most painkiller prescriptions per person.
"The opioid prescriptions ranged from a low of 52 for every 100 people -- which is still awfully high -- in Hawaii to an extraordinary 143 per 100 people in Alabama," Dr. Frieden said.
The Northeast had the most per-person prescriptions for long-acting painkillers and for high-dose painkillers, especially Maine and New Hampshire.
"When you look at specific opioids, the inconsistencies are even larger," Dr. Frieden said.
"There were nearly 22 times as many prescriptions written for the opioid oxymorphone [Opana] in Tennessee as were written in Minnesota. Many of the states with high rates are the ones that have the most serious problems with opioid overdoses. We think opioids are likely to be overprescribed in these states," Dr. Frieden said.
The findings are based on an analysis of prescribing data for 2012 that were collected from retail pharmacies in the United States.
Florida Making Strides
The good news, Dr. Frieden said, is that states can take steps to curb overprescribing and reduce opioid-related deaths. Florida is a prime example.
After statewide legislative and enforcement actions in 2010 and 2011, the number of opioid prescriptions and related deaths decreased significantly. "These changes may well represent the first well-documented, substantial decline in drug overdose mortality in any state during the past 10 years," Dr. Frieden said.
Healthcare providers also have an essential role to play, he noted. "One of the things these state programs can do is empower healthcare providers with more information about the drugs that their patients are receiving from other sources and with more tools that they can use to provide services to patients who come in with pain that requires some form of treatment. Just because someone has pain doesn't mean they need an opiate."
"Healthcare providers can use prescription drug monitoring programs to identify patients who might be misusing drugs, putting them at risk for overdose, and use effective treatment, such as methadone, for appropriate patients with substance abuse problems. They can also discuss with patients the risks and the benefits of pain treatment options, including options that don't include prescription opiates or benzodiazepines," Dr. Friedan said.
CDC Vital Signs. "Opioid Painkiller Prescribing." Full text
