Prescriptions for painkillers declining

The number of drug overdose deaths in Arkansas increased slightly last year, while the number of prescriptions for opioid pain medication fell, state Department of Health officials said Monday.

According to the department, 384 Arkansans died of drug overdoses in 2016, compared with 383 in 2015.

Over the same period, the number of prescriptions filled for opioid medications fell by about 50,000, to 3.6 million in 2016, Health

Department Director Nate Smith told state legislators during a committee meeting Monday.

In 2014, about 3.7 million opioid prescriptions were filled.

The number of pills dispensed also fell, from 242 million in 2015 to 235 million last year, he said.

“I think we’re starting to make an impact,” Smith said of efforts to reduce the prescribing of addictive painkillers and shut down illegal sources of the medications.

The number of drug deaths in the state each year “seems to be plateauing off,” although it remains high compared with the early 2000s, he said.

Smith gave lawmakers an update on opioid use in the state during a joint meeting of the Legislature’s Public Health, Welfare and Labor and Agriculture, Forestry and Economic Development committees.

He credited the state’s Prescription Monitoring Program, law enforcement efforts

to shut down “pill mills” that offered prescriptions for cash, and prescribing guidelines issued by the U.S. Centers for Disease Control and Prevention last year with helping to reduce opioid use in the state.

But he noted, “We do have a lot of Arkansans who are dependent on opiates.”

“They need to be weaned down,” he said. “They can’t be stopped abruptly.”

At one time, Smith said, opioids were used primarily to treat acute pain, such as after a surgery, or to relieve the pain from a terminal illness.

In the late 1990s, doctors began prescribing opioids to treat chronic pain, leading patients to become dependent on the drugs, he said.

Opioids are drugs such as hydrocodone, codeine, morphine and others that act on the human nervous system to relieve pain. Some opioids are synthetic and others are derived from opium.

The CDC guidelines recommend that doctors try other methods for managing chronic pain and consider opioids “only if expected benefits for both pain and function are expected to outweigh risks to the patient.”

Nationwide, the CDC reported last week, opioid prescriptions per person peaked in 2010 and fell 13 percent from 2010 to 2015.

Established in 2013, the state’s Prescription Monitoring Program collects information from pharmacies on prescriptions for pain medication and other frequently abused drugs.

Act 820, passed by the Legislature this year, requires doctors to check the program’s database before prescribing such medications, unless the drug is prescribed before or after surgery, for a terminal illness or to a nursing home resident.

The law also requires the Health Department to use information from the database to identify patients who appear to be misusing the drugs and provide the information in quarterly reports to doctors and pharmacists.

Denise Robertson, the program’s administrator, said she expects the first reports to go out early next year.

Act 820 also calls on the state boards that license doctors, pharmacists, nurses, dentists, optometrists and veterinarians to develop rules

limiting the amount of opioids that can be prescribed or dispensed to patients.

Smith said the database already appears to have helped reduce “doctor shopping” among patients.

During the first three months of 2015, the department counted 40 patients who had seen seven or more physicians and visited seven more pharmacies during a 90day period.

During the last three months of last year, the department counted only 20 such patients, he said.

Rep. Deborah Ferguson, D-West Memphis, said placing too many restrictions on opioids could lead patients to turn to illegal sources.

Asked by Ferguson whether the state has enough treatment options for addicts, Smith responded, “I would really question whether our current treatment services for opiate dependents are adequate to treat all of those who need it.”

“Getting our medical community, our behavioral health community ramped up and fully engaged is going to be a big priority,” he said.