Nonmedical Prescription Opioid Use and Use Disorders Among Adults Aged 18 Through 64 Years in the United States, 2003-2013

Opioid abuse has become a ubiquitous problem in the United States, one that leads to violence, pilfering, negligence, and all of the other vices associated with drug abuse. A unique aspect of painkiller abuse is the fact that the drugs are often obtained illegally from medical professionals instead of shady street corner dealers. Studying the patterns of opioid abuse are crucial to understanding the role that healthcare providers, especially pharmacists, can play in stopping this epidemic.

This particular study produced two interestingly yet insightfully contradictory results. It found that nonmedical use of prescription opioids decreased over the duration of this study, but the prevalence of prescription opioid use disorders increased. This means that although recreational use of prescription opioids is decreasing in popularity (albeit likely more due to the increased availability of heroin in recent years than any sort of anti-drug abuse policy), the symptoms of abuse are increasing in frequency. Essentially, people are still abusing prescription opioids at increasing rates, they either do so under the veil of a false or obsolete diagnosis, or they truly have an abuse problem relating to the severity of the pain which they experience.

This study highlights the immense importance which the pharmacists and physicians have in preventing and alleviating prescription drug abuse. Abuse through medically prescribed opioids is often preventable, and can be prevented by playing an active role in counseling patients on these risky drugs. Pharmacists play an integral role in preventing drug abuse.

Han B, Compton WM, Jones CM, Cai R. Nonmedical prescription opiod use and use disorders among adults aged 16-64 years in the United States, 2003-2013. Jama. 2015: 314(14): 1468-1478.

Relationship between Nonmedical Prescription-Opioid Use and Heroin Use

Prescription opioid abuse has become a major public health issue in the United States and even locally here in Pittsburgh. In 2013, 10.3 million persons reported that they were using opioids for a nonmedical reason. Emergency room visits that involved misuse or abuse of opioids gotten from a prescription in the ED has increased 153% from 2004-2011. Death rates from these overdoses as quadrupled in 14 years.

Some people use heroin when they are unable to get prescription opioids. With the preventative measures put in place to decrease prescription opioid use there has been an increase in heroin use and deaths of heroin overdose. Heroin is pharmacologically similar to opioids. There has been evidence showing the substantial decrease in the cost of heroin in the last 30 years. The purity of the heroin on the streets has also increased which could be a factor in the increase in the rate of heroin.

In conclusion, data has indicated that nonmedical opioid use has a high risk factor for heroin use. A majority of current heroin users report having prescriptions opioids nonmedically before they use heroin. But, heroin use among people who use prescription opioids for nonmedically reasons is rare and the transition to heroin use is low. The article goes to talk about the best way to minimize overall opioid-related deaths is to help people that are already addicted and efforts to help prevent addiction. I definitely agree with this statement. I think that opioid prescriptions need to be better monitored similarly to the way certain cold medicines require scanning the customer’s ID before they can buy the product to keep track of the amount of them purchased. I think this is the first step in preventing opioid abuse.

Citation:

N Engl J Med. 2016; 374:154-163.

http://www.nejm.org/doi/full/10.1056/NEJMra1508490

 

The Need for More Education on Prescribing Opioids

When hearing the term “opioids” several ideas come to mind: addiction, abuse, under-treatment, overtreatment, severe pain, and suspicion are just a few. Opioids are undoubtedly an extremely successful route of treatment for severe pain and play a huge role in daily pain management cases. However, there is always a discussion of the risks associated with prescribing this medication.

There is often an air of distrust between physician and patient when a patient insists on opioid therapy. Unfortunately, pain cannot be measured, and there needs to be trust when prescribing this drug class. The prescriber will not know if the patient really needs the opioid for pain management or if they have developed a dependence on it. The physician is put in a position where they could under-treat the patient by refusing therapy because of the risk of abuse, or they could over-treat the patient by believing their plea for a medication they were addicted to.

There are several guidelines already in place regarding opioid prescribing, but still, much of it is up to the physician’s discretion. Right now, there is a big push for more prescriber education on the topic. For example, in 2012, the FDA encouraged a single shared Risk Evaluation and Mitigation Strategy (REMS) which required manufacturers of extended release or long acting opioids to fund accredited education on safe opioid prescribing. Currently, this program has not reached its goal number of prescribers. However, I believe with the advancement of this program, physicians will be able to make more educated and thorough decisions when it comes to prescribing opioids.

Managing pain is extremely complex, yet education on the topic is lacking. The ultimate goal would be to maintain a patient-centered approach and treat the patient in a manner in which they are comfortable and compliant with. Perhaps with more education on the topic, the physician and pharmacist can work together to make a confident decision in how to proceed with drug therapy, and hopefully avoid the mistakes that have been occurring concerning opioid therapy.

I personally see this as an opportunity for pharmacists to get more involved in the prescribing process, as they have a stronger background education on the topic. Do you think this could play a role in pharmacists eventually gaining prescribing rights?

 

Read the full article here.

Alford, Daniel P.  Opioid Prescribing for Chronic Pain — Achieving the Right Balance through Education. N Engl J Med. 2016;374:301-3

 

Substantial Decline in Hydrocodone Prescribing

Opioid abuse is a major concern to be addressed today in the United States. In 2011, there were about 100,000 drug abuse-related emergency department visits due to hydrocodone combination analgesic products. In response to this growing problem, the United States Drug Enforcement Administration rescheduled hydrocodone from schedule III to a more stringent schedule II. This action provided stricter prescribing laws for hydrocodone, including prohibition of prescription refills.

As a result of this rescheduling, the year of 2015 had 26.3 million less prescriptions for hydrocodone. Data from the IMS Health National Prescription Audit concluded that hydrocodone combination product prescriptions fell 22% within the first 12 months after rescheduling, predominantly due to the restriction of refills. With the decline of hydrocodone prescriptions, there was a 5% rise in prescriptions for nonhydrocodone combination product analgesics in the first year after rescheduling. Most health care professional specialities dispensed less hydrocodone combination products, most specifically in primary care physicians and surgeons.

JAMA Intern Med. Published online January 25, 2016.

Link to article

The United States Drug Administration has made great efforts to reduce the amount of drug abuse that is currently occurring in our community. It is important for pharmacists to join their effort in the reduction of overall drug abuse. Other than refusing to fill, what what else do you think pharmacists can do to contribute?