For the first time in decades, the number of opioid prescriptions in the United States is starting to fall, according to a recent report by the New York Times based on data from IMS Health For each of the past three years – 2013, 2014, and 2015 – prescriptions for opioids have declined. This marks the first sustained drop since OxyContin hit the market in 1996.
Some experts believe that the drop is an early signal that the long-running and often-discussed opioid epidemic may have reached its peak and that doctors and prescribers have begun to heed the warnings about the highly addictive nature of the drugs. It’s also possible that state and federal legislation and efforts to curb the epidemic are having an effect.
According to Dr. Bruce Psaty, a researcher at the University of Washington in Seattle who studies drug safety, “[t]he culture is changing. We are on the downside of a curve with opioid prescribing now.”
However, the rate of fewer prescriptions has not yet led to fewer deaths – fatal overdoses from opioids have continued to rise. In 2014 alone, more than 28,000 lives were lost from opioids, including prescription painkillers (Percocet, Vicodin, OxyContin) and illegal opioids, such as heroin.
Dr. Nora Volkow, the director of the National Institute on Drug Abuse, believes that “[t]he urgency of the epidemic, its devastating consequences, demands interventions that in some instances may make it harder for some patients to get their medication. 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.”
Some doctors believe that efforts to rein in prescribing practices have actually gone too far and are penalizing the patients who take the medicines responsibly and need them for relief. Dr. Daniel B. Carr, the director of Tufts Medical School’s program on pain research education and policy, stated, “[t]he climate has definitely shifted. It is now one of reluctance, fear of consequences and encumbrance with administrative hurdles. A lot of patients who are appropriate candidates for opioids have been caught up in that response.”
Historically, not many physicians prescribed opioids, and those that did often did so aimed at the pain that follows surgery or with terminal illnesses. In the 1990s, however, medical experts began arguing that opioids could be used to treat chronic pain conditions without addicting patients.
Some of the biggest declines in prescriptions have been in the prescribing of hydrocodone. These drugs do remain the most broadly prescribed opioids, especially for following routine dental work or minor procedures. Prescriptions for OxyContin also declined, but those for generic oxycodone went up.
Why the Decline?
One possible factor in the decline is the 2014 regulations enacted by the federal government that tightened prescribing rules for one of the most common painkillers: hydrocodone combined with a second analgesic, i.e. acetaminophen. The first year following the regulation saw a 22% decline in dispensed prescriptions.
The decision by medical schools over the past few years to impress upon students the dangers of opioid prescribing may also have had an effect. Dr. Branson Page, an emergency medicine doctor in Raleigh, North Carolina, stated, “When I was a resident, treating patients’ pain as a vital sign was assumed. Now, more of us are aware that even prescribing a small number of opioids to a patient who’s never taken them before is rolling the dice on whether that patient will become addicted.”
Dr. Jeanmarie Perrone, a professor of emergency medicine at the University of Pennsylvania’s Perelman School of Medicine, believes that there may be some danger to the way new doctors are being taught to be overly-cautious when it comes to prescribing opioids. “Sometimes now I will see a patient with a resident who says, ‘I don’t want to give them opioids.’ But of course they need opioids – they have lung cancer and worsening pain.”
While there has been a decline, some experts are calling it only a “half victory,” believing that the rise of deaths from heroin and fentanyl, are a huge concern that need to be addressed before the opioid epidemic can truly be considered to be slowing down.