US prescription opioid misuse and deaths increase

The proportion of people reporting use of prescription opioids for reasons other than medical necessity fell between 2003 and 2013, but use disorders and overdose deaths increased, according to a new study.

“The results underscore the importance of addressing the prescription opioid crisis,” said lead author Dr. Beth Han of the Substance Abuse and Mental Health Services Administration (SAMHSA) in Rockville, Maryland.

High-intensity opioid use increased during a time of increased prescribing of these drugs during the 2000s, Han told Reuters Health by email.

The researchers used survey data from 472,000 people who reported their nonmedical use and use disorders related to opioids between 2003 and 2012, as well as national vital statistics on cause of death for the same period.

The rate of nonmedical use of opioids – not using a prescription as directed, or using a prescription that was written for someone else – fell from 5.4 to 4.9 percent over the 10-year period, but during the same time, the rate of use disorders rose from 0.6 to 0.9 percent.

The number of people reporting opioid use for more than 200 days also increased.

The slight decrease in opioid use initiation might be “a hopeful finding,” wrote Dr. Lewis Nelson of the New York University School of Medicine and coauthors in an editorial accompanying the results in the Journal of the American Medical Association.

The Centers for Disease Control and Prevention recently granted 16 states a total of $20 million to study safe prescribing practices and reduce the availability of prescription opioids, they wrote.

But the increase in use disorders and misuse in the new study suggests “more patients are experiencing an inexorable progression from initial opioid use to frequent use,” Han and colleagues wrote.

Drug overdose deaths involving prescription opioids increased from 4.5 to 7.8 per 100,000 people, according to national vital statistics.

The fraction of opioid users with a use disorder also increased between 2003 and 2013, from 12.7 to 16.9 percent.

These numbers could come down if we reduce inappropriate opioid prescribing and use and develop new treatments for pain that are safer, Han said.

Effective training programs are needed to help doctors identify and treat high-risk nonmedical users of prescription opioids, she said.

SAHMSA developed an Opioid Overdose Prevention Toolkit that provides guidance on reducing the risk of death from opioid-related overdose, she noted.

“It offers ways that medical providers, people who use opioids nonmedically, and others can recognize the signs of an overdose and effectively reverse it with naloxone (a lifesaving opioid overdose drug),” she said.

In a research letter in the same issue of JAMA, other researchers found that from 2004 to 2013, use of treatment options for opioid use disorders, in inpatient, outpatient, hospital, office, emergency room, jail or self-help center settings, did not change relative to the number of opioid users.

The number of settings treating patients for the disorder did increase, but medication-assisted treatment may not be available in inpatient settings, the authors write.

“Not everybody is going to want or need the same treatment,” said Brendan Saloner of the Johns Hopkins Bloomberg School of Public Health in Baltimore, who coauthored the research letter.

But access to medications, like methadone maintenance programs, is important: opioid addiction is a chronic condition, like diabetes, and medication can help manage it, he told Reuters Health by phone.

“The last decade has been a time of rapidly growing numbers of people dying from opioid overdoses,” he said, but “the ability of the health system to detect and provide timely access to treatment does not seem to be improving much.”

“There still are 17 states that don’t cover methadone maintenance” under Medicaid, despite the fact that methadone maintenance has the strongest evidence base of increasing recovery rates, he said.