Controversial Pain Prescriptions Increase: Misuse and Abuse of Opioids

The number of people filing prescriptions for opioids declined  between the years 2009 and 2013, yet the number of prescriptions and the number of days of medication per prescription increased in that time period according to a report published by the Express Scripts Lab. The report, entitled “A Nation in Pain,” focused on trends in how opioids are used for both short-term and long-term pain treatment among Americans. Recognizing the need for medication for people suffering from severe, chronic pain who truly need continued access to these medications, researchers noted the real challenge is “finding the right balance between abuse prevention and availability of these medications for patients in real pain.”

Opioid Use, In General

The Express Scripts Lab introduced the findings of the study stating that “opiate pain medications, also known as opioids, are one of the most controversial classes of pain therapy” because, while these substances often provide the most effective relief of pain in patients, “their extremely addictive properties pose a serious risk to patients, and make them prone to misuse and abuse.” Specifically, the report studied the use of opioids—including codeine, morphine, Oxycontin®, and Vicodin®—through a review of 36 million de-identified pharmacy claims of over 6.8 million insured individuals. Moreover, the report investigated both short-term and long-term pain treatment trends using opioids in the proscribed period. Short-term pain treatment was defined as prescriptions that would produce a total supply of opiate pain medications that lasted 30 days or less and long-term treatment were those prescriptions that would yield the same type of medication for more than 30 days.

Trends

As a result, the authors identified the following key findings: (1) while the number of individuals filing prescriptions for opioids decline 9.2 percent, the number of prescriptions filled and the number of days of medication per prescription increased by 8.4 percent; (2) short-term use of prescription opioids declined 11.1 percent while long-term use remained steady; and (3) approximately half of patients that took opioids for more than 30 days in one year continued to take them over the following three years or longer.

Moreover, the report highlighted higher percentages of opioid use in younger individuals and women. Specifically, 30 percent more woman than men took opiates in the year 2013 and adults aged 20 to 44 years filled more prescriptions and had the largest increase of the number of days of medication prescribed due to these substances than any other age group across the reviewed time period. However, the report also noted that the elderly have the highest prevalence of opioid use. The study recognized that opioid pain prescriptions were most prevalent in small, southeastern cities in four states (Kentucky, Alabama, Georgia, and Arkansas). Finally, the report revealed that almost 60 percent of opioid users were “taking a combination of drugs that are dangerous and potentially fatal; among this mixtures, almost one in three patients were prescribed anti-anxiety drugs…along with an opioid,” which is, according to the authors, the most common cause of multiple drug overdose death.

Misuse and Abuse

Because of the propensity for opioid users to misuse and become addicted to these substances, a number of initiatives to control the use and access to these products have been created by both federal and state agencies. In particular, the report discussed the formation of prescription drug monitoring programs (PDMPs) in 49 states. The PDMPs administer electronic databases that track prescriptions filled for controlled substances within the state. However, Jo-Ellen Abou Nader, the Senior Director of Fraud, Waste, and Abuse at Express Scripts noted: “these systems, however, vary dramatically from state to state, and only 16 states require prescribers to use PDMPs when writing prescriptions.” The report noted extreme drops in states that effectively administered their PDMPs, such as Florida and Tennessee.