According to a new report released on July 1 by the Centers for Disease Control and Prevention (CDC), prescription drug abuse is widespread through the United States. In addition, the prescription rates vary widely from state to state. Individuals in need of pain medication do not vary significantly between states; however, prescription rates for opioid (narcotic) painkillers are about three times higher in the highest prescribing states compared to the lowest prescribing states. On a positive note, California is among the lowest prescribing states; however, significant abuse exists in the state. The highest prescription rates are found in the South.
Prescription painkillers are opioid or narcotic pain relievers, including drugs such as Vicodin (hydrocodone plus acetaminophen), OxyContin (oxycodone), Opana (oxymorphone), and methadone. The report notes that each day in the US, 46 individuals die from an overdose of prescription painkillers. In 2012, healthcare providers wrote 259 million prescriptions for painkillers, enough for every American adult to have a bottle of pills. The report also notes that twice as many painkiller prescriptions per person are written in the US, compared to Canada. The CDC data suggest that where healthcare providers practice influences their prescribing rate. Higher prescribing rates are associated with more overdose deaths. The CDC notes that more can be done at every level to prevent overprescribing while ensuring patient access to safe, effective pain treatment.
The report notes that changes at the state level have particular promise. States can develop methods to increase use of prescription drug monitoring programs, which are state-run databases that track painkiller prescriptions and can help determine problems in overprescribing. Use of these programs is greater when they make prescribing information available in real-time, are universal (used by all prescribers for all controlled substances), and are actively managed (e.g., sending alerts to a prescriber when a problems is identified). The CDC recommends that states should consider policy options (including laws and regulation) relating to pain clinics (facilities that specialize in pain treatment) to reduce prescribing practices that are risky to patients.
As previously noted, Southern states had the most prescriptions per person for painkillers, particularly Alabama, Tennessee, and West Virginia. The Northeast, particularly Maine and New Hampshire, had the most prescriptions per person for long-acting and high-dose painkillers. In Tennessee, almost 22 times as many prescriptions were written for oxymorphone than in Minnesota.
The report offered some possible explanations for the prescribing discrepancies. Healthcare providers in different parts of the nation do not agree on when to use prescription painkillers and how much to prescribe. Some of the increased demand for prescription painkillers is from individuals who use them nonmedically (using drugs without a prescription or just for the high they cause), sell them, or obtain them from multiple prescribers at the same time. Many states report problems with for-profit, high-volume pain clinics (often termed “pill mills”) that prescribe large quantities of painkillers to individuals who do not have medical indications for their use.
The CDC offers some suggestions for improving the situation. It recommends the support of states that want to develop programs and policies to prevent prescription painkiller overdose, while ensuring patient access to safe, effective pain treatment. Patient safety could be improved by supplying healthcare providers with data, tools, and guidance for decision making based on proven practices. The report also recommended increasing access to mental health and substance abuse treatment through the Affordable Care Act. The CDC recommends that prescription drug should be beefed up and regulation of pain clinics increased.
The CDC recommends that healthcare providers should use prescription drug monitoring programs to identify patients who might be misusing their prescription drugs; thus, placing them at risk for overdose. The providers should use effective treatments such as methadone or buprenorphine for patients with substance abuse problems. They should discuss with patients the risks and benefits of pain treatment options, including ones that do not involve prescription painkillers. They should follow best practices for responsible painkiller prescribing, including: screening for substance abuse and mental health problems; avoiding combinations of prescription painkillers and sedatives unless there is a specific medical indication; and prescribe the lowest effective dose and only the quantity needed depending on the expected length of pain.
The report offers suggestions for individuals: (1) Avoid taking prescription painkillers more often than prescribed; (2) Dispose of medications properly, as soon as the course of treatment is done, and avoid keeping prescription painkillers or sedatives around “just in case;” and Help prevent misuse and abuse by not selling or sharing prescription drugs. Never use another person’s prescription drugs.
Help is available for substance abuse problems at 1-800-662-HELP. Call Poison Help 1-800-222-1222 if you have questions about medicines. The Los Angeles County Department of Public Health offers information regarding substance abuse prevention and control at this link.