Titan Pharmaceuticals Inc (TTNP)

[TRUISM]

Ending Opioid Abuse
Tom Frieden, MD, MPH
September 09, 2014

Click For medscape.com Link


What Clinicians Can Do




Every day, 46 Americans die from an overdose of prescription opioid narcotics such as Vicodin, OxyContin, and methadone. These drugs are commonly prescribed in every community. Overdoses from opioids are a serious problem across the country and opioid prescribing varies widely among states. Overdose rates tend to be higher where opioids are used more.

In 2012, healthcare providers wrote 259 million prescriptions for opioids, enough for every American adult to have a bottle of pills. Healthcare providers in some states write almost three times as many opioid prescriptions per person as those in other states. That simply doesn't make sense. Health issues that cause pain don't vary much from state to state.

The number of opioid prescriptions ranged from a low of 52 prescriptions for every 100 people in Hawaii to a high of 143 prescriptions per 100 people in Alabama. Southern states had the most prescriptions per person for opioids and benzodiazepines, especially Alabama, Tennessee, and West Virginia. Opioid prescribing rates correlated with benzodiazepine prescribing rates.

The Northeast, especially Maine and New Hampshire, had the most prescriptions per person for long-acting and high-dose opioids. Of all prescription opioids, state prescribing variation was the highest for oxymorphone. Nearly 22 times as many prescriptions per person were written for oxymorphone in Tennessee as in Minnesota.

When we see widespread variation among providers, it's usually because there is no clear consensus on when to use a certain type of drug. For opioids, high rates might also mean that the state has a large population of people who are addicted to drugs. These patients might get multiple prescriptions for their own use and actively seek out prescriptions for long-acting or high-dose forms of these drugs.

Many states report problems with for-profit, high-volume pain clinics -- so-called "pill mills" -- that prescribe large quantities of opioids to people who don't need them for medical reasons.

Antibiotic prescribing rates are also highest in the South, so it is possible that regional healthcare characteristics and patterns might influence the use of prescription drugs in general. We think it's important for all states, especially those where prescribing rates are highest, to examine whether the drugs are being used appropriately.

Crucial steps need to be taken at every level, but change at the state level may well have the greatest promise. A report included in Vital Signs shows data specific to Florida. In 2010 and 2011, Florida regulated pain clinics and stopped healthcare providers from dispensing prescription opioids from their offices. By 2012, oxycodone prescribing had dropped by a quarter and oxycodone overdose deaths had dropped by half.

States should consider ways to increase the use of prescription drug monitoring programs -- state-run information systems that track prescriptions for opioids and can help find problems in overprescribing. These programs are most effective when they make data available in real-time, are used by all prescribers and dispensers for all controlled substances, and are actively managed -- for example, by sending alerts and doing active follow-up for patients and prescribers who may have problems.

States should consider policy options, including laws and regulations, related to pain clinics to reduce prescribing practices that are risky for patients. States can evaluate their own data and programs and think of ways to assess their Medicaid, workers' compensation, and other state-run health programs to detect and address inappropriate prescribing of opioid narcotics.

Finally, states should identify opportunities to increase access to substance abuse treatment and consider expanding first-responder access to naloxone, a drug that can reverse overdose.

Clinicians have an essential role to play. You can use prescription drug monitoring programs to find patients who might be misusing their prescription drugs, putting them at risk for fatal overdose. If a patient has a substance abuse problem, you can help find effective treatments such as methadone or buprenorphine. You can also discuss the risks and the benefits of pain treatment options with your patients, including options that don't involve prescription opioids.

And finally, when prescribing opioids, healthcare providers can follow best practices, including screening for substance abuse and mental health problems, avoiding combinations of prescription opioids and sedatives unless there is a specific medical indication, and prescribing the lowest effective dose and only the quantity needed, depending on the expected duration of pain.

Remember that these medications are dangerous. They are dangerous because they are addictive and because they can kill through respiratory suppression. The risks and the benefits need to be carefully balanced, and for the great majority of patients with chronic non-cancer pain, the risks associated with prescription opioids may well outweigh the benefits.




TRUTH