The US may have finally turned a corner when it comes to opioid prescription abuse. According to a New York Times report, prescriptions for painkillers including OxyContin and Vicodin have declined for the first time in two decades. Since its arrival in 1996, OxyContin has been widely blamed for driving the country’s current drug epidemic. “Doctors were writing so many prescriptions for powerful opioid painkillers that, in recent years, there have been enough for every American adult to have a bottle,” the Times reported. However, over the last three years data shows that opioid prescriptions are actually falling—which suggests that physicians might be thinking twice before breaking out their script pad.
What’s In a Number?
The Times cites encouraging data from two different sources: IMS Health—a global IT firm—and a second data company, Symphony Health Solutions, a pharmaceutical consulting, data and analytics firm. The former found a “12 percent decline in opioid prescriptions nationally since a peak in 2012.” Symphony Health Solutions reported a “drop of about 18 percent during those years.” The findings are a welcome change of pace after decades of sobering stats about opioid addiction.
However, the CDC still sees a national epidemic and claims that “the majority of drug overdose deaths (more than six out of 10) involve an opioid.” Since 1999, overdose deaths involving prescription painkillers and heroin almost quadrupled. What’s even worse is that as painkillers become harder to find, heroin use increases. Dr. Nora Volkow, the director of the National Institute on Drug Abuse presented to Congress that painkiller abuse had “skyrocketed in the past 25 years.” She minced no words about the role America has played in its own problem: “The number of prescriptions for opioids … have escalated from around 76 million in 1991 to nearly 207 million in 2013, with the United States their biggest consumer globally, accounting for almost 100 percent of the world total for [Vicodin] and 81 percent for [Percocet].” Those are mind-boggling stats, given that the level of pain in the US can’t be greater than in other countries. Volkow also claimed that prescription opioids began eclipsing heroin and cocaine as a leading cause of death in 2002.
Not Out Of the Woods Yet
While opioid prescriptions are falling, the number of deaths involving opioids aren’t following that same trend. Instead, opioid-related deaths are on the rise. Times writer Sabrina Tavernise claimed on the PBS show NewsHour that in 2014 there were “28,000 opioid deaths; about 18,000 are prescription and 10,000 are heroin and other illegal drugs. And over-prescribing has been very closely associated with the rise in deaths and the rise in overdoses.” By understanding that link, Tavernise suggests we’ll be able to take the first steps toward stemming addiction for good.
Experts argue about what the prescription decline actually means. In fact, many excited reactions to the prescription decline have been countered by a collective “not so fast” from the medical community. Some contend that opioid prescriptions for oxycodone and hydrocodone are simply normalizing—meaning that they’re only now being issued at medically-appropriate levels. The Times also considered that there are many patients out there who legitimately need prescription painkillers like Vicodin after a standard procedure like a root canal or other outpatient surgeries. “The urgency of the epidemic [and]its devastating consequences demands interventions that in some instances may make it harder for some patients to get their medication,” Dr. Volkow suggested. “We need to set up a system to make sure they are covered. But we cannot continue the prescription practice of opioids the way we have been. We just can’t.” In other words a sudden change in attitude about opioids doesn’t solve the problem—quite the opposite. This could spell doom for the people who really need help.
Downturn or Upswing?
Opioid addiction remains a tricky, thorny subject for policymakers. When it comes to prescriptions, there is no “on/off switch.” The Times observes that opioids are now “so essential to so many Americans [that]health officials remain deadlocked…over how to handle them.” Opioids weren’t always commonplace and historically their prescriptions were far more limited and, daresay, more thoughtful. Opioids were primarily used to treat cancer patients rather than, say, someone who just had knee surgery. Still, it wasn’t long before “drug companies and medical experts argued that opioids could be used to treat chronic conditions like back pain without addicting patients,” the Times said.
They were dead wrong.
Two separate factors, however, may help drive down opioid addiction. First, in 2014, the federal government tightened laws around how Vicodin is prescribed. According to the Times, within a year, “dispensed prescriptions declined by 22 percent, and pills by 16 percent.” The law also made it far more difficult to secure refills which “accounted for 73 percent of the decline.” Also, medical students are now being trained differently. Previously, they were taught to treat pain as the “fifth vital sign” following temperature, heart rate, respiration rate and blood pressure. And that’s where opioids swept in to save the day. “The culture is changing,” a researcher said in the Times. “We are on the downside of a curve with opioid prescribing now.”
49 states have seen sharp decreases in opioid prescriptions in the past few years. “Some of the sharpest decreases [were seen]in West Virginia, the state considered the center of the opioid epidemic, and in Texas and Oklahoma,” the article said. (South Dakota is the sole outlier, showing an increase in opioid prescriptions.) Regardless, the trends are promising.
As attitudes continue to shift around opioid prescriptions, only time will tell when it comes to whether addiction patterns will also shift. One thing is for certain: physicians are clearly more aware of their roles and responsibilities in the future of both treatment and addiction. Doctors now know they aren’t just prescribing painkillers—they’re potentially prescribing crippling addictions, too. And while we may be on a downturn when it comes to prescriptions—for addicts, the climb back up from opioid dependence may be too steep.
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