Opioid use has decreased, but overdoses have increased: How is that possible? Over the last decade, prescriptions for opioids have gone down significantly. Despite this, the number of drug related overdoses has increased. How can we have fewer prescriptions, fewer opioids and yet more people dying from overdoses? How does this impact our patients and prescribers?
You may have seen a recent report from the American Medical Association showing a 44.4% decrease in opioid prescriptions in the last decade. Meanwhile, according to the Centers for Disease Prevention and Control (CDC), in 2020 there were 93,000 deaths from drug overdoses, which is roughly a 30 percent jump from 2019. Regardless of which statistic you focus on, both numbers are significant, but what are they really telling us?
The short answer is that not all overdoses are coming from legally prescribed opioids. According to the CDC, the increase in overdoses is mainly from illicit fentanyl, fentanyl analogs, methamphetamine and cocaine. Physicians have largely done a great job of increasing their use of state prescription drug monitoring programs (PDMPs). PDPMs are electronic databases that track controlled substance prescriptions and help identify patients who may be receiving multiple prescriptions from multiple prescribers. Over the last 5 years, use of PDMPs has increased in every state.
States have in place restrictions on opioid prescribing quantities, but this alone cannot be the answer. These restrictions have had unintended consequences for patients who require pain management or treatment for opioid use disorder. The COVID-19 pandemic has not helped the situation. According to the AMA report, every state has reported increases in overdoses during the pandemic and it has impacted both patients with pain and those with OUD.
What does the FDA recommend you do as a prescriber?
In an earlier post titled “The FDA Recommends Prescribers Discuss Naloxone when Prescribing Opioids”, I discussed FDA recommendations for providers and they include:
- Routinely discuss the availability of naloxone with all patients when prescribing or renewing an opioid analgesic or medicine to treat OUD.
- Consider prescribing naloxone to patients prescribed medicines to treat OUD and patients prescribed opioid analgesics who are at increased risk of opioid overdose. Patients receiving medicines to treat OUD have a lower risk of opioid overdose than those with OUD who are not being treated; however, they are still at risk of relapse and opioid overdose.
- Consider prescribing naloxone when a patient has household members, including children, or other close contacts at risk for accidental opioid ingestion or opioid overdose.
- Even if the patients are not receiving a prescription for an opioid analgesic or medicine to treat OUD, consider prescribing naloxone to them if they are at increased risk of opioid overdose.
- Educate patients and caregivers on how to recognize respiratory depression and how to administer naloxone.
- Inform patients about their options for obtaining naloxone as permitted by their individual state dispensing and prescribing requirements or guidelines for naloxone.
- Emphasize the importance of calling 911 or getting emergency medical help right away, even if naloxone is administered.
- Educate patients and caregivers on proper storage and disposal of opioids.
- Report adverse events involving naloxone, opioids, or other medications to the FDA MedWatch program.
These steps will go a long way in helping to educate and reduce opioid related overdoses, but let’s not stop here. To be successful, addressing the opioid crisis and specifically overdoses, must be a collaborative approach that involves additional action from all stakeholders, including lawmakers, health insurance plans and national pharmacy chains.
Below is a list of actions the AMA is recommending state legislators take:
- Stop prior authorization for medications to treat opioid use disorder. Prior authorization is a cost-control process that health insurance companies and other payers use that requires providers to obtain prior approval from the insurer or payer before performing a service or obtaining a prescription. It is used to deny and delay services—including life-saving ones—as physicians are required to fill out burdensome forms and patients are forced to wait for approval.
- Ensure access to affordable, evidence-based care for patients with pain, including opioid therapy when indicated. While opioid prescriptions have decreased, the AMA is greatly concerned by widespread reports of patients with pain being denied care because of arbitrary restrictions on opioid therapy or a lack of access to affordable non-opioid pain care.
- Take action to better support harm reduction services such as naloxone and needle and syringe exchange services. These proven harm reduction strategies save lives but are often stigmatized.
- Improve the data by collecting adequate, standardized data to identify and treat at-risk populations and better understand the issues facing communities. Effective public health interventions require robust data, and there are too many gaps to implement widespread interventions that work.
As the opioid crisis rages on, there are many steps we can take to adequately treat our patient’s pain, while at the same time minimizing the risks. Overcoming the increasing number of opioid related overdoses will take a team effort with ongoing education and collaboration.
There are additional implications at the facility level when it comes to reducing risks with opioids that are beyond the scope of this post. If you have questions about this post or would like to discuss your facility’s control substance management process, please reach out to us.
The Consultant Pharmacists at OctariusRx provide guidance on safe medication management, survey readiness and cost savings to ambulatory healthcare facilities/surgery centers, senior care facilities and pharmacies. We also help individual patients optimize their medications to improve their quality of life and save money. Contact us for assistance.