Opiates are prescribed regularly by physicians in all medical specialities for pain.  Patients frequently request opiates from their physicians when they are in pain.  Recent studies show a trend of increasing prescriptions.  Opiates, when taken in excess, or when they are taken on a regular basis, create addiction, by causing tolerance, that phenomenon where increasing doses of the medication are necessary to ameliorate the pain.  Opiate addiction increases the risk of overdose and death.  Opiate-related overdose and death has increased dramatically over the past few years, and now surpasses deaths from heroin and cocaine combined.  Physicans may be in violation of acceptable standards of practice by excessive prescribing and poor pain management practices.  The following study compares the use and abuse of opiate pain relievers by State.

Comment

The epidemic of prescription drug overdoses in the United States has worsened over the last decade, and by 2008, drug overdose deaths (36,450) were approaching the number of deaths from motor vehicle crashes (39,973), the leading cause of injury death in the United States. Parallel trends in deaths and OPR sales between 1999 and 2008, combined with continuing upward trends in ED visits,[4] OPR abuse treatment admissions,[14] and OPR sales after 2008 suggest that the death rate also has increased since 2008. Preliminary 2009 death data are consistent with such an increase.[15] These increases occurred despite numerous warnings and recommendations over the past decade for voluntary education of providers about more cautious use of OPR.[16]

Differences in OPR overdose mortality by race/ethnicity match the pattern for medical and nonmedical use of OPR, with the lowest rates for medical and nonmedical use among Asians and blacks and the highest rates among American Indians/Alaska Natives and non-Hispanic whites.[4,17] Differences in OPR overdose mortality by race and ethnicity cannot

 

References

1.      CDC. WONDER [Database]. Atlanta, GA: US Department of Health and Human Services, CDC; 2010. Available at http://wonder.cdc.gov. Accessed September 27, 2011.

2.      Warner M, Chen L, Makuc D. Increase in fatal poisonings involving opioid analgesics in the United States, 1999– 2006. NCHS Data Brief. Hyattsville, MD: National Center for Health Statistics; 2009. Available at http://www.cdc.gov/nchs/data/databriefs/db22.htm. Accessed October 3, 2011.

3.      Substance Abuse and Mental Health Services Administration. Highlights of the 2009 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visits. The DAWN Report. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 2010. Available at http://oas.samhsa.gov/2k10/dawn034/edhighlights.htm. Accessed October 3, 2011.

4.      Substance Abuse and Mental Health Services Administration. Results from the 2009 National Survey on Drug Use and Health: volume 1: summary of national findings. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2010. Available at http://oas.samhsa.gov/nsduh/2k9nsduh/2k9resultsp.pdf. Accessed October 3, 2011.

5.      Coalition Against Insurance Fraud. Prescription for peril: how insurance fraud finances theft and abuse of addictive prescription drugs. Washington, DC: Coalition Against Insurance Fraud; 2007. Available at http://www.insurancefraud.org/downloads/drugDiversion.pdf. Accessed September 26, 2011.

6.      CDC. Overdose deaths involving prescription opioids among Medicaid enrollees—Washington, 2004–2007. MMWR 2009;58:1171–5.

7.      Paulozzi LJ, Ryan GW. Opioid analgesics and rates of fatal drug poisoning in the United States. Am J Prev Med 2006;31:506–11.

8.      Hall AJ, Logan JE, Toblin RL, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA 2008;300:2613–20.

9.      Paulozzi LJ, Xi Y. Recent changes in drug poisoning mortality in the United States by urban–rural status and by drug type. Pharmacoepidemiol Drug Safety 2008;17:997–1005.

10.   Xu J, Kochanek KD, Murphy S, Tejada-Vera B. Deaths: final data for 2007. Natl Vital Stat Rep 2010;58(19). Available at http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf. Accessed October 3, 2011.

11.   Substance Abuse and Mental Health Services Administration. State estimates of substance use and mental disorders from the 2008–2009 National Surveys on Drug Use and Health. NSDUH Series H-40. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 2011. Available at http://store.samhsa.gov/shin/content/SMA11-4641/SMA11-4641.pdf. Accessed October 3, 2011.

12.   US Department of Justice. Automation of Reports and Consolidated Orders System (ARCOS). Springfield, VA: US Department of Justice, Drug Enforcement Administration; 2011. Available at http://www.deadiversion.usdoj.gov/arcos/index.html. Accessed September 26, 2011.

13.   Gammaitoni AR, Fine P, Alvarez N, McPherson M, Bergmark S. Clinical application of opioid equianalgesic data. Clin J Pain 2003;19:286–97.

14.   Substance Abuse and Mental Health Services Administration. Quick statistics from the Drug and Alcohol Services Information System. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2011. Available at http://www.oas.samhsa.gov/quick.cfm. Accessed September 29, 2011.

15.   Kochanek KD, Xu JQ, Murphy SL, et al. Deaths: preliminary data for 2009. Natl Vital Stat Rep 2011;59(4). Available at http://www.cdc.gov/nchs/products/nvsr.htm#vol59. Accessed September 30, 2011.

16.   Kuehn BM. Efforts aim to curb opioid deaths, injuries. JAMA 2009;301:1213–5.

17.   CDC. Health, United States, 2006. Hyattsville, MD: US Department of Health and Human Services, CDC, National

Center for Health Statistics; 2006. Available at http://www.cdc.gov/nchs/data/hus/hus06.pdf. Accessed September

27, 2011.

18.   Swedlow A, Ireland J, Johnson G. Prescribing patterns of schedule II opioids in California Workers’ Compensation.

Oakland, CA: California Workers’ Compensation Institute; 2011. Available at http://www.cwci.org/document.php?

file=1438.pdf. Accessed October 3, 2011.

19.   CDC. Drug overdose deaths—Florida, 2003–2009. MMWR 2011;60:869–72.

20.   Forrester MB. Ingestions of hydrocodone, carisoprodol, and alprazolam in combination reported to Texas poison

centers. J Addictive Dis 2011;30:110–5.

21.   Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, et al. Clinical guidelines for the use of chronic

opioid therapy in chronic noncancer pain. J Pain 2009;10:113–30.

 

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