Doctors cut back use of opioids

Despite decline, prescriptions remain excessive, study finds

South Florida’s doctors are prescribing far less potentially addictive and deadly pain medication after a statewide crackdown, but the numbers are still too high, according to a new study from the Centers for Disease Control and Prevention.

Greater monitoring and new regulations aimed at shutting down pill mills in Florida more than halved per-person rates of opioid prescribing in Broward and Palm Beach counties from 2010 to 2015, according to CDC data obtained by the Sun Sentinel. MiamiDade County nearly halved its rate and had the lowest prescribing level in South Florida.

But doctors in the three counties continued to prescribe opioids at a rate higher than the norm in 1999, when overdose deaths began to climb, CDC officials said. Prescribing declined nationally but varied widely across the country and even within Florida.

“Despite these overall declines, the bottom line remains we still have too many people getting opioid prescriptions for too many days at too high a dose,” said Dr. Anne

Schuchat, CDC’s acting director.

Enough opioid painkillers were prescribed nationally in 2015 to medicate every American around the clock for three weeks, according to the CDC.

Liberal prescribing of drugs like oxycodone and hydrocodone puts patients at risk of addiction, overdose and death, Schuchat warned.

Palm Beach County had a per-person opioid prescribing rate in 2015 of 648 morphine milligram equivalents, or MMEs, down 54 percent from 2010.

Broward County saw an even bigger decrease falling to 519 MMEs, a 62 percent drop. Miami-Dade County had one of the lowest prescribing rates in the state at 230 MMEs, down 43 percent.

The national average was 640 MMEs, more than three times higher than in 1999 when it was at 180 MMEs.

CDC researchers found that the highest-prescribing counties nationally tended to be in rural areas, where more people were white, were in bad health and were unemployed. Those counties had prescribing rates six times higher than the lowest-prescribing counties.

The risks of overdose and addiction outweigh benefits provided by opioids when treating common afflictions like back pain, headaches and arthritis, the CDC tells doctors. Instead, the CDC recommends over-thecounter pain medicine, such as Tylenol, Advil and Motrin, along with exercise and therapy.

Seven years ago, Florida was known as the nation’s pill mill capital, where doctors handed out oxycodone and other powerful painkillers like candy at storefront clinics. In 2010, 98 of the top 100 opioid-prescribing physicians were in Florida, according to the Drug Enforcement Agency.

The state banned doctors from dispensing opioids directly from pain management clinics. It created a prescription monitoring database in 2011 to guard against doctor shopping.

Those reforms had a “big impact,” Schuchat said. Opioid prescribing declined in 80 percent of Florida counties from 2010-15, according to the CDC.

“It’s fairly impressive how much improvement there was throughout the state of Florida,” Schuchat said. “It’s actually the most decreased state that you can find. Although there’s still some high-prescribing counties, they did have quite a big impact.”

Local governments in South Florida are considering other actions in response to the surge in opioid prescribing. Palm Beach County and Delray Beach are mulling lawsuits accusing drug makers of misleading doctors and patients about the dangers of opioids.

While the state’s crackdown curbed prescription drug abuse, it didn’t solve the addiction causing the problem, said Jim Hall, a drug abuse epidemiologist at Nova Southeastern University.

Many people hooked on pain pills switched to heroin, a drug being mixed with ultra-potent fentanyl and carfentanil manufactured in foreign labs, Hall said. Carfentanil — a drug used as an elephant tranquilizer — is 10,000 times stronger than morphine.

In 2016, opioid overdose deaths surpassed 1,000 people in South Florida, according to medical examiners. In Palm Beach County, the number of opioid deaths jumped from 307 in 2015 to 592 last year. In Broward County, opioids claimed 582 lives last year, up from 260 in 2015.

“As long as we have people addicted there is going to be a demand, and there is always going to be someone who wants to profit off it,” Hall said. “It just takes a few bad apples to create hundreds of deaths.”