CDC: Physicians are Fueling Prescription Painkiller Overdoses
Jul 2, 2014, 11:30 AM
Inappropriate and dangerous prescription practices for painkillers are driving high addiction and overdose rates—46 people die of a prescription painkiller overdose every day—according to a new Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC).
The CDC has also found wide variation in prescription practices across the country:
- Southern states had the most prescriptions per person for painkillers, especially Alabama and Tennessee.
- The Northeast, especially Maine and New Hampshire, had the most prescriptions per person for long-acting and high-dose painkillers.
- Nearly 22 times as many prescriptions were written for oxymorphone (a specific type of painkiller) in Tennessee than were written in Minnesota.
In total, doctors wrote 259 million prescriptions for painkillers in 2012—or enough for a bottle of prescription pain pills for every American adult in the country.
“Prescription drug overdose is epidemic in the United States. All too often, and in far too many communities, the treatment is becoming the problem,” said CDC Director Tom Frieden, MD, MPH. “Overdose rates are higher where these drugs are prescribed more frequently. States and [medical] practices where prescribing rates are highest need to take a particularly hard look at ways to reduce the inappropriate prescription of these dangerous drugs.”
According to the CDC, deaths from drug overdoses have been rising steadily over the past two decades and have become the leading cause of injury death in the United States—linked strongly to the overuse of prescription painkillers. In 2011, of the 41,340 drug overdose deaths in the United States, 55 percent were related to pharmaceuticals, and almost three quarters of those were from prescription painkillers.
Among the factors driving the increase in painkiller use:
- Health care providers in different parts of the country don't agree on when to use prescription painkillers and how much to prescribe.
- Some of the increased demand for prescription painkillers is from people who use them non-medically, sell them, or get them from multiple prescribers at the same time.
- Many states report problems with for-profit, high-volume pain clinics (so-called "pill mills") that prescribe large quantities of painkillers to people who don't need them medically.
But the CDC is also reporting that states that have put laws in place to monitor pain medication prescriptions have seen a reduction in use and overdose deaths. In Florida, for example, after statewide legislative and enforcement actions in 2010 and 2011, painkiller prescriptions declined and the death rate from prescription drug overdose decreased 23 percent by 2012 (after increasing between 2002 and 2010).
Actions states can take to reduce prescription painkiller use and overdoses include:
- Prescription drug monitoring programs (state-run databases that track prescriptions for painkillers and can help find problems in overprescribing).
- Laws and regulations relating to pain clinics to reduce prescription practices that are risky to patients.
- Education programs for health providers on reducing the number of pills they prescribe; patients are often given a month’s worth of powerful prescription pain relievers and can easily become addicted.
Many people who become addicted to prescription painkillers have been given the medications for an injury or to help recover from surgery, but take the drugs for longer than warranted. While there are alternatives to prescription painkillers—such as physical therapy, exercise and relaxation—drugs are the fastest acting and easiest. Recognizing the dangers, earlier this month the American Medical Association held a webinar for physicians to provide guidance on how to talk to patients about reducing or discontinuing opioid therapy.
A new, recent tactic toward preventing opioid overdoses from prescription painkillers or illegal narcotic drugs—which some people turn to once they develop a tolerance for prescription painkillers—is to arm police officers with the drug naloxone, which can reverse the effects of an opioid overdose if given promptly. Many New York City police officers will soon carry naloxone, after a pilot program in one of its suburbs resulted in 194 saved lives since 2012.
This commentary originally appeared on the RWJF New Public Health blog.