| Epidemic of Opoid Analgesic Deaths |
 |
 |
 |
|
Morbidity and Mortality Weekly Report (MMWR) Weekly Vital Signs: Overdoses of Prescription Opioid Pain Relievers --- United States, 1999--2008 [Excerpts] Background: Overdose deaths involving opioid pain relievers (OPR), also known as opioid analgesics, have increased and now exceed deaths involving heroin and cocaine combined. This report describes the use and abuse of OPR by state. Methods: CDC analyzed rates of fatal OPR overdoses, nonmedical use, sales, and treatment admissions. Results: In 2008, drug overdoses in the United States caused 36,450 deaths. OPR were involved in 14,800 deaths (73.8%) of the 20,044 prescription drug overdose deaths. Death rates varied fivefold by state. States with lower death rates had lower rates of nonmedical use of OPR and OPR sales. During 1999--2008, overdose death rates, sales, and substance abuse treatment admissions related to OPR all increased substantially. Conclusions: The epidemic of overdoses of OPR has continued to worsen. Wide variation among states in the nonmedical use of OPR and overdose rates cannot be explained by underlying demographic differences in state populations but is related to wide variations in OPR prescribing. Implications for Public Health Practice: Health-care providers should only use OPRs in carefully screened and monitored patients when non-OPR treatments are insufficient to manage pain. Insurers and prescription drug monitoring programs can identify and take action to reduce both inappropriate and illegal prescribing. Third-party payers can limit reimbursement in ways that reduce inappropriate prescribing, discourage efforts to obtain OPR from multiple health-care providers, and improve clinical care. Changes in state laws that focus on the prescribing practices of health-care providers might reduce prescription drug abuse and overdoses while still allowing safe and effective pain treatment. Conclusions and Comment The epidemic of prescription drug overdoses in the United States has worsened over the last decade, and by 2008, drug overdose deaths (36,450) were approaching the number of deaths from motor vehicle crashes (39,973), the leading cause of injury death in the United States. Parallel trends in deaths and OPR sales between 1999 and 2008, combined with continuing upward trends in ED visits, OPR abuse treatment admissions, and OPR sales after 2008 suggest that the death rate also has increased since 2008. Preliminary 2009 death data are consistent with such an increase. These increases occurred despite numerous warnings and recommendations over the past decade for voluntary education of providers about more cautious use of OPR. Differences in OPR overdose mortality by race/ethnicity match the pattern for medical and nonmedical use of OPR, with the lowest rates for medical and nonmedical use among Asians and blacks and the highest rates among American Indians/Alaska Natives and non-Hispanic whites. Differences in OPR overdose mortality by race and ethnicity cannot explain the wide variation in death rates among states, given the equally large differences in non-Hispanic white mortality between states. Nor can demographic differences fully explain the wide variations among states in the nonmedical use and sales of OPR. Montana and Iowa, for example, have largely non-Hispanic white populations but widely varying rates of nonmedical use and sales of OPR. By 2010, enough OPR were sold to medicate every American adult with a typical dose of 5 mg of hydrocodone every 4 hours for 1 month. Increased use of OPR has contributed to the overall increases in rates of overdose death and nonmedical use, and variation among states in OPR sales probably contributes to state variation in these outcomes. Given that 3% of physicians accounted for 62% of the OPR prescribed in one study, the proliferation of high-volume prescribers can have a large impact on state use of OPR and overdose death rates. Large increases in overdoses involving the types of drugs sold by illegitimate pain clinics (i.e., "pill mills") have been reported in Florida and Texas. Such clinics provide OPR to large volumes of patients without adequate evaluation or follow-up. Another possible contributor to state disparities is poverty, which was associated with greater increases in state death rates during 1999--2008. Medicaid populations are at greater risk of OPR overdose than non-Medicaid populations. The findings in this report are subject to at least four limitations. First, vital statistics underestimate the rates of prescription and illicit drugs because the type of drug is not specified on many death certificates. Second, respondents might underreport nonmedical use of OPR in surveys such as the NSDUH. Third, ARCOS data reflect sales to retail outlets by state, but some drugs might have been used by nonstate residents or sent to other states by mail-order pharmacies or otherwise not used by state residents. Finally, sales data did not include buprenorphine, an opioid primarily used for substance abuse treatment, though sometimes prescribed for pain. Its inclusion with drugs primarily used to treat pain would have inappropriately increased sales rates. Public health interventions to reduce prescription drug overdose must strike a balance between reducing misuse and abuse and safeguarding legitimate access to treatment. To find this balance, health-care providers should only use OPR in carefully screened and monitored patients when non-OPR treatments have not been sufficient to treat pain, as recommended in evidence-based guidelines. States, as regulators of health-care practice, have the responsibility and authority to monitor and correct inappropriate and illegal prescribing. Data from state prescription drug monitoring programs, which collect records of prescription drugs prone to abuse from pharmacies, and Medicaid claims data can be used to identify and address OPR misuse and abuse. State Medicaid programs and other public insurers can use economic measures to hold providers accountable for their prescribing of OPR and other controlled prescription drugs. State professional licensing boards can take action against prescribers misusing their licenses, and law enforcement agencies can take action against illegal activities. State policies that focus on providers operating outside of normal medical practice, such as laws prohibiting so-called "pill mills," are a promising approach. All interventions need to be evaluated further and new interventions developed. Concerted attempts to address this problem, especially in states with high rates of OPR sales, nonmedical use, or overdose mortality, might help control the epidemic.
Click here to see complete article: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm
Source: Centers for Disease Control and Prevention |
Our Partners in Recovery
