State-based efforts to further regulate access to opiate prescriptions have helped drive down use of these drugs nationwide, according to a new federal report, but there is significant local variation and addiction levels remain stubbornly high in some communities.
The Centers for Disease Control and Prevention found that differences in county prescription rates depend in part on the number of medical providers in the area and their prescribing patterns, according to the July issue of Vital Signs, issued Thursday. The role of prescribers has become a growing focus in recent years as healthcare experts look for ways to stem the tide of opiate addiction.
But while fewer new prescriptions are being written, existing patients are receiving larger doses and for longer periods of time, factors that doctors said contribute to persistent addiction levels. A separate report found the diagnoses of opiate-use disorders spiked nearly 500 percent between 2010 and 2016, according to an analysis of 30 million members of the Blue Cross Blue Shield system, a network of three dozen independent insurance companies nationwide.
“Taking opioids for longer periods increases the risk of opioid-use disorder, overdose, and death,” wrote a trio of doctors, Anne Schuchat, Debra Houry, and Gery P. Guy in an article published in the JAMA Network on Thursday to accompany the CDC report. “Reducing overprescribing practices prevents people from becoming addicted in the first place, potentially changing the demand for opioids.”
The CDC findings, based on data from 2010 to 2015, suggest that New Jersey’s new law to strictly limit the number of opioids available to acute-pain patients could help curb the state’s addiction epidemic. The law, adopted in February and considered the nation’s strictest, permits most pain patients to receive only five days worth of opiate-based painkillers.
The governor has also required greater use of the state’s prescription-monitoring database, designed to reduce “doctor-shopping” and other improper access to these drugs, and has linked it to systems in a growing number of states. Efforts to limit the amount of opiates in circulation and educate providers and patients on the potential danger of these drugs are critical in reducing unnecessary use and addiction, the CDC said.
“We know that the majority of heroin addicts first became addicted through the use of prescription opioids,” Christie said when he outlined the prescription limit in his annual State of the State address in January. “Limiting the supply of opioid-based pain medication is just one step to prevent addiction before it starts,” he said. Tens of thousands of New Jersey residents seek treatment for opiate addiction each year and nearly 1,500 lost their life to the disease in 2015, according to the CDC.
State of the states
In the JAMA article, the three physicians credited opioid prescriptions guidelines outlined by the U.S. Surgeon General in 2016 for some of the drop in drug availability and said state-level policies implemented in Ohio, Kentucky, and Florida also helped. “The policies implemented in these states have been shown to reduce both the amount of opioids prescribed and opioid overdose death rates. These types of state innovations demonstrate that substantial changes are possible,” they wrote.
According to the CDC, opioid use ramped up in recent decades as doctors became more comfortable prescribing the powerful drugs to combat chronic pain, when in the past they had largely been limited to cancer treatment and palliative care. Opiate levels peaked in 2010 and fell for each of the next five years. However, in 2015, there were still enough drugs available to keep every American medicated around the clock for three weeks — three times the amount available in 1999.
In addition, the CDC found opioid use decreased in only half the counties nationwide and, by 2015, some jurisdictions were awash with six times the drugs available elsewhere. Within New Jersey, opiate use ranged from the lowest-level designation (up to 453 morphine milligram equivalents, or MME, per person) in a cluster of urban counties close to New York City, to the highest level (from 959 to 5,543 MME per person) throughout most of South Jersey.
Demographics contributed to about a third of the variation, the CDC said, with high-prescribing counties more likely to include small cities or large towns, a significant white population, low levels of insurance, high rates of unemployment, disability, and chronic disease, and a large population of primary-care physicians and dental providers.
“The pattern of opioid prescribing — including dose and duration — and the patient’s risk factors of age, gender, and condition are major determinants of whether a patient becomes dependent,” the Blue Cross Blue Shield report noted. Patients who take the drugs for longer are seven times more likely to become addicted than those issued short-term prescriptions, Blue Cross Blue Shield found, and patients issued more powerful doses are up to 40 times more likely to be hooked.
The Blue Cross data revealed that nearly half the prescriptions issued in 2015 were for two weeks or less, with one-third of the patients getting less than seven days of doses. But one in four patients were given opiates for more than a month, including 15 percent who were on the drugs for up to three months. According to the JAMA article, the average duration of prescriptions increased by one-third between 2006 and 2015.