The number of overdose deaths from opioid prescription pain relievers (OPRs) in the United States has reached epidemic proportions and is now greater than fatalities from heroin and cocaine combined, according to a new report released by the Centers for Disease Control and Prevention (CDC).
According to CDC director Thomas Frieden, MD, MPH, 1 out of every 20 adults in the United States — 12 million individuals — has a history of inappropriate narcotic use, a problem that largely stems from inappropriate prescribing.
Data from the Drug Enforcement Administration shows sales of OPRs to pharmacies and healthcare providers have increased by more than 300% since 1999.
According to the report, enough prescription painkillers were prescribed in 2010 to medicate every American adult around the clock for a month. Although most of these pills were prescribed, many were diverted and ended up being abused.
"The burden of dangerous drugs is being created more by a few irresponsible doctors than drug pushers on street corners," Dr. Frieden told reporters attending a press briefing.
Fastest-Growing Drug Problem
The issue of prescription opioid abuse has been front and center for some time and garnered particular attention in April 2011 when the Drug Enforcement Administration (DEA) announced a comprehensive action plan to stem the United States' national drug epidemic.
Among other initiatives, the federal plan called for pharmaceutical companies to pay for targeted educational initiatives for prescribers and included support for the expansion of state-based prescription drug monitoring programs and support for law enforcement efforts that reduce the prevalence of "pill mills" and doctor shopping.
"Prescription drug abuse is our nation's fastest-growing drug problem... and the facts as outlined are truly devastating," said Gil Kerlikowske, director of National Drug Control Policy.
Kerlikowske added that state laws and policies can make a major difference to curbing the prescription drug problem in the United States. So far, 48 of 50 states have implemented state-based monitoring programs designed to reduce medication diversion and doctor shopping.
In addition, the Department of Justice has conducted a series of takedowns of rogue pain clinics operating as "pill mills."
The Obama Administration has also signed into law the Secure and Responsible Drug Disposal Act, which will allow states and local communities to collect and safely dispose of unwanted prescription drugs and support the DEA's efforts to collect unneeded or expired prescription drugs.
Wide Variation in Mortality Rates
To better understand the scope of the problem, the CDC analyzed rates of fatal OPR overdoses, nonmedical use, sales, and treatment admissions.
The investigators found that in 2008 drug overdoses in the United States caused 36,450 deaths. Of the 20,044 prescription drug overdose deaths, OPRs were involved in 14,800 (73.8%) — more than 3 times the rate in 1999.
Sales of OPRs quadrupled between 1999 and 2010, and the researchers found that nearly half a million emergency department visits in 2009 were due to misuse or abuse of prescription painkillers.
Further, death rates varied 5-fold by state. For instance, they ranged from a high of 27 deaths per 100,000 population in New Mexico to a low of 5.5 deaths per 100,000 in Nebraska.
Perhaps not surprisingly, the study also showed that states with lower death rates had lower rates of nonmedical use of OPRs and OPR sales.
With a rate of prescription opioid sales of 12.6 kg per 10,000 population, Florida had the highest rate of OPR sales. Illinois had the lowest rate of OPR sales, at 3.7 kg per 10,000 population.
The CDC estimates that nonmedical used of prescription painkillers costs health insurers up to $72.5 billion annually in direct healthcare costs.
Treatment of Last Resort
According to Dr. Frieden, opioids should be used only when all other treatments fail. It is possible, he said, to provide patients with adequate pain relief without necessarily resorting to narcotics. Such strategies range from addressing mood disorders to prescribing physical therapy for pain relief.
"There are many things that can be done to increase patients' comfort and functionality without risking a lifetime of addiction," he said.
In cases where narcotics are necessary, he added, physicians should prescribe only the quantity of pain medications needed based on the expected length of pain.
"For example," said Dr. Frieden, "if someone comes in with acute pain, 3 days rather than 30 days [of OPR] should be the standard."
He noted that many hospital emergency departments around the country are rethinking their use of long-acting narcotics, recognizing that perhaps the clinician who provides the patient's ongoing care is the best source for these types of highly addictive medications.
Patient education is also critical, said Dr. Frieden, and it is important for them to understand the risks of opioids and how to use, store, and dispose of them safely.
"Nonmedical use of prescription pain killers costs the healthcare system an estimated $70 billion a year, but there are measures that can be taken, particularly by states, where we have a huge variation in the rate of prescriptions and the rate of prescription overdose and overdose deaths.
"Through better monitoring and by taking appropriate action for patients and providers that are using these medications inappropriately; by cracking down on pill mills and doctor shopping and doctors who are prescribing inappropriately and by promoting good medical practice...it is possible to make a big difference and reduce this epidemic to controllable levels," said Dr. Frieden.