20 May Prescriptions for Opioids Stabilize After Huge Increase in 10-Year Span
Prescription opioids are widely used medications intended to help individuals affected by serious pain and certain other medical ailments. Unfortunately, substantial numbers of people abuse these medications and ultimately develop cases of opioid addiction. In a study published in March 2014 in the journal Public Health Reports, researchers from Columbia University’s Mailman School of Public Health tracked the success of national- and state-level efforts to limit inappropriate access to opioid medications. These researchers concluded that the overall prescription and consumption rates started tapering off several years ago. However, they also concluded that the success of prescription opioid control efforts varies considerably by state.
Commonly prescribed opioid medications in the U.S. include oxycodone, hydrocodone, morphine, meperidine, fentanyl, methadone and hydromorphone. Each of these substances has specific purposes in medical treatment and comes with guidelines designed to inform doctors on their proper use. Whatever their source or intended purpose, all opioid substances are capable of fostering physical dependence by changing the balance of key chemicals in the human brain. In turn, people affected by opioid dependence run a very real risk of developing the highly dysfunctional symptoms of opioid addiction. In addition to setting the stage for prescription opioid addiction, prescription opioid abuse can set the stage for the use of other opioid substances. For example, the National Institute on Drug Abuse has specifically identified the abuse of prescription opioid medications as one of the primary pathways for eventual involvement in use of the exceptionally powerful, illegal opioid heroin.
Monitoring and Limiting Prescription Opioid Use
The U.S. Drug Enforcement Agency tracks prescription opioid use through a program called the Automation of Reports and Consolidated Orders System (ARCOS). In coordination with federal tracking efforts, the majority of states in the U.S. have implemented state-level monitoring programs designed to detect prescription drug abuse and take steps to curb or eliminate such abuse. Both the state and federal programs specifically track the use and misuse of the most commonly prescribed opioid medications. Between 1991 and 2010, the number of opioid prescriptions issued across the country increased at a rate of almost 200 percent. Between 1999 and 2008, the raw amount of opioids contained in prescriptions increased by more than 400 percent.
Are Prescriptions Leveling Off?
In the study published in Public Health Reports, the Columbia University researchers used information gathered through the ARCOS program between 1999 and 2008 to analyze the long-term trend for opioid prescriptions in the U.S. This analysis focused on both the national level and the trends in effect in various states; it included all of the most commonly prescribed opioid medications. The researchers concluded that the national trend in increasing opioid prescriptions started to level off in 2007. They also concluded that, overall, state-level efforts to curb prescription opioid use have apparently not had much of an impact on the raw amount of opioid medications consumed across the country.
Still, among the 31 states that have ongoing prescription drug monitoring programs, the effectiveness of control efforts varies substantially. For example, nine states with such programs experienced a significant decline in prescription opioid use during the study period; two states in particular (Wyoming and Texas) experienced a decline in prescription opioid consumption of 48 percent or greater. In another 14 states, prescription drug monitoring efforts did not appear to change the long-term rate of prescription opioid intake in a positive or negative way. In eight states, the rate of prescription opioid use actually went up after the implementation of statewide detection and control efforts. The biggest rise in opioid medication intake in a state with a monitoring program (61 percent) occurred in Connecticut.
It’s likely that some of the reported increase in opioid prescriptions over the last 20-plus years comes from a rise in the legitimate use of opioid painkillers. Still, abuse of these medications is fairly common and the increase is also clearly linked to the misuse of oxycodone, hydrocodone and other medications. Citing the wide variation in the success of state-level control efforts, the authors of the study published in Public Health Reports emphasize the need to improve the overall usefulness of statewide programs. They also note that states with programs run by health departments seem to fare better than states with programs run by opioid control bureaus or other agencies.
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