Although President Trump declared the opioid epidemic a “public health emergency” in 2017, substance abuse providers and government officials have been battling the problem since well before then. After years of hard work, statistics suggest their efforts could be paying off — though challenges remain.
Nationwide, the total number of opioid overdose deaths and prescriptions are down. Plus, large pharmaceutical companies accused of sparking the epidemic are paying out billions to settle litigation.
Now, new research suggests that significantly fewer Americans are being prescribed opioids, too. Unlike previous research, which has focused largely on the number of total opioid prescriptions, a new study published in the January issue of Health Affairs examines the total number of adults who have been prescribed opioids.
Specifically, the number of Americans prescribed opioids dropped about 20% between 2014 and 2016.
While those findings likely come as welcome news to substance abuse providers, they also come with a caveat: Doctors could be keeping opioids from the wrong people, potentially creating problems on the back end for operators — and leading to illicit opioid use among pain patients.
That’s according to lead researcher and Columbia University psychiatry professor Mark Olfson. His reasoning? The prescription decrease hit people with moderate to severe pain harder than those with “less-than-moderate” pain.
“We were surprised to learn that there has been a larger decrease in opioid prescribing to adults with more rather than less severe pain,” Olfson told Behavioral Health Business.
For example in 2016, doctors prescribed opioids to 3.75 million fewer adults with moderate to severe pain than in 2014, according to the study. Yet, during the same period, they prescribed opioids to only 2.2 million fewer people who reported experiencing less-than-moderate pain.
That breakdown could represent a double-edged sword, Olfson explained.
“The decline in the number of Americans receiving opioid prescriptions is good news,” Olfson said. “However, the pattern of the reduction suggests that the decrease has not been narrowly focused on patients with less severe pain who might be able to be managed in a safer manner with non-opioid pain medications.”
On top of that, people with severe to moderate pain who are unable to get prescriptions may turn to black market options to manage their symptoms, Olfson explained.
“If … opioid prescriptions are decreasing in a manner that leaves more people with unbearable pain, a reduction in opioid prescribing could have paradoxical adverse effects as people seek to relieve chronic pain with opioids obtained from illicit sources,” he said.
To fix the problem, Olfson suggests prescribing physicians focus their opioid reduction efforts on those will mild pain. He recommended interventions such as acetaminophen, physical therapy and exercise, in addition to other non-opioid options.
However, it could be up to federal and state governments to make sure that happens.
“Recent policies aimed at reducing inappropriate opioid prescribing may not have been appropriately focused on adults with less severe pain,” Olfson said. “Instead of evaluating opioid prescription control policies based on the sheer number of opioid prescriptions dispensed, the new results underscore the importance of evaluating pain management practices in a more clinically nuanced manner.”