A recent article published by Colorado Public Radio reported that doctors in Colorado succeeded in reducing opioid prescriptions by 14% — a small but important accomplishment in reigning in the problem with over-prescribed opioids.
Data from the Centers for Disease Control and Prevention (CDC) suggest that doctors are prescribing opioids less:
Doctors wrote opioid prescriptions at a rate of 72.4 per 100 people in 2006
- This rate went up and peaked in 2010, then dropped steadily through 2017
- In 2017, doctors wrote 58.5 prescriptions for opioids, per 100 people
- This represents a 19.4% reduction in opioid prescriptions between 2006 and 2017
- During the same period, the number of prescriptions for high-dose opioids dropped by 56.5%
During the same period, the rate of overdose deaths from opioids in the United States increased from 6.1 per 100,000 population in 1999, to 19.8 per 100,000 in 2016. The sharpest increase was between 2014 and 2016, when it increased by 18% per year. This increase was attributed to the increased presence of synthetic opioids (besides methadone), specifically fentanyl and carfentanil.
Data published by the U.S. National Institute on Drug Abuse shows that nearly 80% of heroin users started by using prescription opioids. So, the prescriptions that doctors write for opioids has a direct impact on the opioid-related deaths, including those attributed to street drugs.
A 2017 study by the Harvard School of Public Health and Harvard Medical School showed that there is great variability between individual doctors in how they prescribe opioids and that this variability has a significant impact on the development of opioid addiction.
The Harvard study found that patients of doctors who are high prescribers of opioids are three times more likely to get a prescription for opioids and 30% more likely to become long-term opioid users.
It is important to remember that although the synthetic opioids in street drugs are fuelling the increase in opioid overdose deaths, prescription opioids are also deadly. Data from the CDC show that from 1999 to 2017, nearly 218,000 Americans died from a prescription opioid overdose and that prescription opioid overdose deaths were five times higher in 2017 than they were in 1999.
Targeting physician prescribing habits directly can have an impact on the opioid crisis. A large review of prescribing data showed that physician education plays a major role in reducing the amount of opioid prescriptions made. The study also found that it is the physician prescribing habits rather than patient characteristics that drive addiction rates.
Physician regulation can be an important modifier of prescription opioid diversion and misuse. Some states instituted drug-monitoring programs that allow doctors and pharmacists to check on patients’ prescription history and thereby identify patients who may be abusing opioids. A survey of doctors found that only 53% of them use these programs and that 22% were not even aware of them. Research by the U.S. National Bureau of Economic Research showed that these programs are much more effective at reducing prescription opioid abuse when doctors are required by law to use them.
The American Medical Association published an infographic that shows which states have taken action to regulate opioid prescribing and physician education as of 2019. Only 18 states and Washington D.C. are listed as having initiated such programs, showing that there remains much to be done. Unfortunately, medical experts still have no data about how these programs affected opioid prescribing, opioid addiction rates and opioid overdose deaths.
The increasing reluctance of doctors to prescribe opioids has led to the “other opioid crisis,” which is the situation where people who are genuinely in need of these medications are unable to obtain them. However, there is a counter-argument that this point of view is unfounded because many people who receive opioid prescriptions for legitimate reasons are still at risk for opioid dependence. Therefore, the debate goes on.
While Colorado should be applauded for its reduction in physician opioid prescriptions, the country is still greatly lacking in such efforts overall. There remains much work to be done on this important factor of the opioid crisis.
American Medical Association. “Opioid Task Force 2019 progress report.” 2019. Accessed June 24, 2019.
Centers for Disease Control and Prevention. “2018 annual surveillance report of drug-related risks and outcomes.” August 31, 2018. Accessed June 24, 2019.
Centers for Disease Control and Prevention. “Prescription opioid data.” December 19, 2018. Accessed June 24, 2019.
Daley, John. “Prescriptions fall 14% as Colorado doctors cut back on opioids.” June 10, 2019. Accessed June 24, 2019.
Harvard School of Public Health. “Physicians’ opioid prescribing patterns linked to patients’ risk for long-term drug use.” February 15, 2017. Accessed June 24, 2019.
Lyapustina, Tatyana; Alexander, Caleb. “The prescription opioid addiction and abuse epidemic: How it happened and what we can do about it.” The Pharmaceutical Journal, June 11, 2015. Accessed June 24, 2019.
National Bureau of Economic Research. “Mandatory access prescription drug monitoring programs and prescription drug abuse.” June 2017. Accessed June 24, 2019.
National Institute on Drug Abuse. “Prescription opioids and heroin.” January 17, 2018. Accessed June 24, 2019.
Owens, Brian. “Opioid prescriptions down but some patients fear doctors now too strict.” Canadian Medical Association Journal, April 24, 2019. Accessed June 24, 2019.
Schnell, Molly; Currie, Janet. “Addressing the opioid epidemic: Is there a role for physician education?” American Journal of Health Economics, 2018. Accessed June 24, 2019.
Whitmore, Rebecca; Whisenant, David. “Opioid prescribing limits across the states.” February 5, 2019. Accessed June 24, 2019.