Opioid prescriptions have fallen since peaking in 2010
Prescribing rate is three times the ‘99 levels
WASHINGTON — The amount of opioid painkillers prescribed in the United States peaked in 2010, a new federal analysis has found, with prescriptions for higher, more dangerous doses dropping the most sharply — by 41 percent — since then.
But the analysis, by the federal Centers for Disease Control and Prevention, also found that the prescribing rate in 2015 remained three times as high as in 1999, when the nation’s problem with opioid addiction was just starting. And there is tremendous regional variation in how many opioids doctors dole out, with far more prescribed per capita in parts of Maine, Nevada and Tennessee than in most of Iowa, Minnesota and Texas.
Overall, the analysis found that the amount of opioids prescribed fell 18 percent from 2010-2015, though it increased in 23 percent of the counties. Dr. Anne Schuchat, acting director of the CDC, said the quantity of opioids prescribed in 2015 would be enough to provide every American with round-theclock painkillers for three weeks.
Numerous recent attempts to tamp down opioid prescribing are not reflected in the analysis, which did not look beyond 2015. But earlier actions, like state crackdowns on pain clinics and prescribing guidelines released by the Department of Veterans Affairs in 2010, may have contributed to the declines.
The decline documented in the analysis also coincided with the federal government’s tightening of prescribing rules in 2014 for one of the most common painkillers: hydrocodone combined with a second analgesic, like acetaminophen.
In many states, including Ohio, restrictions on prescribing have coincided with increases in overdose deaths from heroin and its more powerful, synthetic relative, fentanyl. But Schuchat, pointing to several studies, said the CDC had found no clear-cut evidence that tighter prescribing played a role in the rising use of illicit opioids.
Some experts warned that averages could be misleading.
“An enormous amount of opioid volume is driven by a very small number of prescribers,” said Dr. Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. “They need to be intervened upon, targeted with educational outreach and, if necessary, professional or regulatory sanction.”
Attempts to restrict opioid prescribing have upset many patients with chronic pain, who say their needs are being ignored in the rush to stamp out the addiction epidemic.
“One group I think has been affected without question is patients who are compliant with their regimen, who have a clear diagnosis and have been managed appropriately, but now find they can’t continue to receive opioids that allowed them to continue to function,” said Dr. Daniel Carr, director of Tufts Medical School’s program on pain, research education and policy.
But others say there is very little evidence to suggest opioids are effective for chronic pain that is not caused by cancer. The CDC prescribing guidelines published last year, which were bitterly opposed by many pain doctors and drug industry groups, recommend that doctors first try ibuprofen or aspirin to treat pain. The guidelines, which are nonbinding, also recommend limiting opioid treatment for shortterm pain to less than a week.
“If you are on opioids longer than three months, your risk of being addicted increases by 15-fold,” Schuchat said.
Despite the national decline in the amount of opioids prescribed, the analysis found that the average number of days that opioid prescriptions were meant to last actually increased in 73 percent of the counties from 2010-2015.