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Prescription Opioid Use and Misuse: 10 Myths or Facts

Prescription Opioid Use and Misuse: 10 Myths or Facts


  • An overwhelming majority of drug overdose deaths in the US involve a prescription opioid.

  • Myth: Less than one-third of drug overdose deaths in 2015 involved a prescription opioid.

  • Opioid overdose, abuse, and addiction in the US is estimated at more than $75 billion/year.

  • Myth: Opioid overdose, abuse, and addiction in the US costs more than $78 billion/year.

  • The number of US opioid prescriptions and amount of opioids prescribed increased between 2010 and 2015.

  • Myth: Between 2010 and 2015 the amount of opioids prescribed in the US declined as did the number of opioid prescriptions.

  • The amount of opioids prescribed in 2015 was the lowest in the US in the past 20 years.

  • Myth: The amount of opoids prescribed in 2015 was more than 3x higher than in 1999.

  • The level of US opioid prescribing correlates with a reduction in the number of people suffering pain.

  • Myth: No research supports the fact that more opioid prescribing has lessened suffering of people with pain.

  • State prescription drug monitoring programs have been shown to increase use of heroin.

  • Myth: There is no evidence that state policies to decrease opioid misuse have resulted in increased heroin use.

  • The amount of per capita opioids prescribed is higher in the US than in European countries.

  • Fact: In 2015, opioid prescriptions in the US were nearly 4x the per capita amount prescribed in Europe.

  • The reduction in US opioid prescribing seen between 2010 and 2015 occurred evenly throughout US counties.

  • Myth: There was wide variation in the amount of opioids prescribed in US counties; in the highest-prescribing county it was 6x that seen in the lowest-prescribing county.

  • Higher amounts of opoioids prescribed in a county are associated with a larger percentage of non-hispanic white residents.

  • Fact: Higher amounts of opioid prescribing are associated with more non-Hispanic whites, higher rate of uninsured/Medicaid enrollment, more physicians and dentists per capita.

  • It is only after one month of use after an initial prescription that a person's likelihood of continued use at one year increases.

  • Myth: 6% of patients who take opioids for longer than one day will go on to use them for a year; that rate more than doubles when opoids are taken for 8 days or more.

  • The most common source of prescription opioids for non-medical use is from drug dealers or other strangers.

  • Myth: The most common source of opioids for non-medical use is a friend or relative who provides them for free. Physicians become the more predominant source among those using opioids for 200 or more days in the past year.

  • Physicians are much less likely to prescribe opioids for patients with mental health disorders, eg, anxiety and mood disorders.

  • Myth: More than one-half of the opioids prescribed in the US are to those with mental health conditions despite the fact that same increase risk of abuse and addiction.

The CDC recently published a report on changes in national- and county-level opioid prescribing between 2006 and 2015.

See if you know Myths from Facts about the ebb and flow of opioid use and misuse in the United States. Click through this slide challenge created by pain specialist Steven A. King, MD, MS.

 

Image credits:

Slide background: ©amasterphotographer/Shutterstock.com; Unicorn, ©Lifeking/Shutterstock.com; Green check:©MisterEMil/Shutterstock.com

References: 
  1. Guy GP, Zhang K, Bohm MK, et al. Vital signs: changes in opioid prescribing in the United States, 2006-20015. MMWR Morb Mortal Wkyly Rep. 2017;66:697-704. https://www.cdc.gov/mmwr/volumes/66/wr/mm6626a4.htm
  2. Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid use-United States, 2006-2015. Morb Mortal Wkly Rep. 2017;66:265-269. https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm
  3. CDC. Opioid overdose. Prescribing Data. https://www.cdc.gov/drugoverdose/data/prescribing.html
  4. Davis MA, Lin LA, Liu H, et al. Prescription opioid use among adults with mental disorders in the United States. J Am Board Fam Med. 2017;30(4);doi:10.3122/jabfm.2017.04.170112.

Comments

Opiod epidemic due in large part to FDA ordering Darvon compounds off the market to be replaced by OxyContin which is 20 times as addicting as darvon and is deadly when mixed with other psychotropics or alcohol.Typical bureaucratic stupidity! Left chronic pain suffers with I only Non-steroidal anti inflammatory drugs which are devestratingly nephrotoxic in elderly populations.

Jack @

Opiod epidemic due in large part to FDA ordering Darvon compounds off the market to be replaced by OxyContin which is 20 times as addicting as darvon and is deadly when mixed with other psychotropics or alcohol.Typical bureaucratic stupidity! Left chronic pain suffers with I only Non-steroidal anti inflammatory drugs which are devestratingly nephrotoxic in elderly populations.

Jack @

Trump added billions to the health care proprosal to fight addiction and Oregon is legalizing heroin etc. What a joke. I work in a drug rehab and I see repeat admissions 2-3 times a month. They can't even stay clean a day after detoxing in some cases.

elizabeth @

shame that conservatives agreed to add billions to the health care proposal especially since Oregon is trying to make it legal to buy "small amounts" of illegial opoids including heroine.

elizabeth @

I am one of those "users" not all of us are opiod addicts or over users. I am 73 years old and was prescribed oxycodone after tramadol wasn't working for my back and leg pain. I am not a canidate for surgery. before anyone talks of addictive behavior . I drink alcohol daily, was a smoker for 50 years and am perfectly satisfied taking 10 mg of oxycodone once a day as needed for back and leg pain to let me sleep. My RX says bild , I chose qd. prn. Now I will let you in on a secret. I am a PA. for years in Arizona and in the Coast Guard I had access to controlled meds. never had it crossed my mind that I would need them for quality of life and that is exactly why many my age or those who had debilitating injuries require opilates. Granted there are those who are addicted or sellers, but I always felt those who needed the opiates (before my situation) were beilng punished for those didn't and I felt so helpless when it was my profession to aleiviate suffering when the law said I couldn't. It should be up to the provider to judge and evaluate the patients physch and phys condiltion not the rules made up from non medical and political persons. for there own self gain. As a provider there is only so much you can do expalining why you cannot provide pain relief to an elderly with tears in there eyes from pain. I could go on but I wont. those who read this know what I am saying and will agree or disagree but the hipporatic oath still rules.and it is my guideline and my life.

Sheldon @

There is another obvious reason why there has been an increase in the number of prescriptions for opioids. IT IS THE AGING OF AMERICA!!! This is a big dah factor that a lot of articles and people trying to demonize opioids like to ignore. We read articles all of the time about how the percentage of aging Baby Boomers is adjusting the percentage of the population which is older. Add the fact that for decades families have reduced the number of children they are having from 4 to 6 in the 1950's and 1960's to couples now having 1 at the most 2 children and the number of DINKS with no children and in addition the fact that modern medicine has made if possible for people to live longer you have an older population with old age pain related illnesses. RA, OA, Spinal disk deterioration. Wearing out of the cartilage in many joints especially the knees, hips, shoulders, etc. All of these common old age wearing out of the body causes pain and our parents and grandparents should not have to suffer and live in pain because of the few drug addicts die from overdoses. "One bad apple should not ruin the entire basket". In other words the elderly should not be punished because of the relatively small population of people in their teens, twenty and thirties use drugs (opiates) and many other drugs including alcohol to deal with their problems.

Brenda @

The use of opioids after surgery to control pain and for individuals with chronic pain does not lead to opioid abuse. The studies are demonizing opioids to the point that patients who truly need it may be left in pain. Most patients only use their pain medication as needed to control their discomfort and do not suddenly in their say 40's, 50's, 60's or older start to abuse pain meds and become addicts. This is an exaggeration and makes it difficult for patients with diagnosed chronic pain to manage their pain and it makes extra work for doctors to have to write paper scripts every month. Especially when you have known your patient for decades and know what is causing their pain.

Brenda @

Are you using real statistics gathered by the coroner's office or some biased research done in a university center office paid by big Pharma?

Alfonso @

Are you using real statistics gathered by the coroner's office or some biased research done in a university center office paid by big Pharma?

Alfonso @

Agreed. That is by far the most annoying way to present sponsor content I have ever experienced, It is a gross insult to your target audience, and as a result, I will never click on another of your presentations.

Cynthia @

Great slide show! The detraction was the incessant pop-ups each time a new slide was selected. Annoying.

Leon @

Great slide show! The detraction was the incessant pop-ups each time a new slide was selected. Annoying.

Leon @

TELL THE WHOLE TRUTH

ADDICTION ENABLING DOCTORS--
SO YOU WANT TO STOP THE HEROIN AND DRUG ABUSE EPIDEMIC?
By Samuel A. Nigro, MD November 2015 Copyright c Samuel A. Nigro, MD 2015
Cleveland Ohio

PLEASE PUBLISH AND PROMULGATE and maybe some real prevention of drug abuse will occur.

"Doctors Enabling Addiction" by Richard A. Friedman, NYTimes, 11-8-15 and "Time to renew the fight against the heroin epidemic" by Liam Garvin, Cleveland Plain Dealer 11-8-15 offer feeble steps in the right direction. The irrefragable are prompted:

1. First, the government should get out of the "practicing medicine" business. The Law of Unforeseen Consequences always rears its ugly head. Giving semi-monopoly of medicines to any subspecialty only results in calculated (and invidious?) enhancement of the sub-specialty with other doctors deprived of opportunities to help. This has happened with methadone for addiction subspecialty and with opioids for pain subspecialty. Regardless, law worship cannot cope with the complex art and inexact science of medicine. There are trillions of synapses; billions of neurons; thousands of overlapping pathways; hundreds of neurochemicals, and patients' chemistries differ more and change more than their faces. The law could better regulate the weather, than render always effective medical care.

2. The addiction subspecialty secured, by insouciant law, the solitary use of methadone for their addiction clinics so they were the only ones able to prescribe methadone. That they censored the fact that propoxyphene (Darvon) was at times equal in effectiveness as methadone has never been acknowledged. Propoxyphene would have reduced the need for the new addictionologists' "Methadone Clinics". The actions of addiction subspecialty founders were unethical, unprofessional, anti-Hippocratic, counter-productive, but, most importantly, still profit-making for themselves. No other medical specialty got law know-it-alls to prevent routine effective meds from being used by other physicians or disgracefully censored what else could be helpful-- Psychiatrists, cardiologists, neurologists, and so on, never sought monopolies on their meds or monarchy status for their subspecialty. I discovered this because, for years, I cared for psychiatric patients and used only propoxyphene for the few with pain symptoms. Suddenly, I realized that I had a bunch of young patients telling me "Please do not change the meds you have me on...I have my family back...my job back...and I do not have to get high with my buddies any longer. I do not want to go back to street drug use!" They all were on, for years, several psychiatric meds for their psychiatric disorders and propoxyphene for their pain. So, planning to do a study, I write the FDA being worried about "off label" prescribing, i.e., prescribing propoxyphene to prevent opioid drug abuse as described by my few patients. The FDA wrote back encouraging me with "The FDA considers off-label use to be the practice of medicine." So I researched propoxyphene and discovered that early addiction specialists debated whether to use propoxyphene or methadone for their nascent clinics--and they chose methadone for obvious self-serving sub-specialty enhancing reasons and, at the same time, censored (conspired?) propoxyphene as an obvious competitor because it could not be monopolized by the addiction subspecialists as could methadone. It gets worse: About a year after I notify the FDA of my propoxyphene re-discovery, it is taken off the market, after over 50 years of overwelmingly benign usage for pain. My cynicism has today's addiction specialists protecting their methadone clinic volume again by removing propoxyphene from the market. Regardless, if any one wants to help reduce addiction, they must promote propoxyphene and its pending analogues! Not to do this is criminal now that it has been re-discovered to help addicted patients.

3. The pain subspecialty secured a semi-monopoly of pain meds by self-aggrandizing laws giving them a monitoring aegis of opioid pain meds when used by other non-pain specialty physicians--the latter not really caring and almost relieved to transfer these difficult patients to the pain docs. But then, the pain specialty CHANGES, as does all medicine about every two or so years (which is why etched-in-stone legal omniscience will never well regulate medical practice). Naturally, all medicine (and science) changes, and the pain docs developed more lucrative "injection" procedures with less and less need for pain meds. Upset, pain patients and their families complain; and thus from the White House and Congress, comes "THE DECADE OF PAIN 2000-2010", which promoted pain med use by instructive flyers to all physicians; many listings and info of pain meds; making pain scales to be part of "vital signs"; requiring pain evaluation efforts in nursing notes for each shift each day of every patient in all hospitals; and the releasing of methadone for general pain use by all doctors. With abortion and opening of medical records, the Oath of Hippocrates was undone, and physicians had become more and more mercenary with "pill mills" negatively impacting the addiction problem. Laws also criminalized medical care, especially physicians who unwisely succumbed to, implemented, and were seduced by the already mentioned DECADE OF PAIN promotion of pain meds. By 2006 or so, the current heroin/opioid epidemic is silently developing, with immutable laws galore being passed to solve all problems again for the inexact science and art of medicine, unforeseen consequences still always to undo any lasting benefits. Regardless, if any one wants to help reduce addiction, all laws regulating medical practice must be repealed; and the Hippocratic Oath must be re-established by physicians committed to "natural death" with complete closure of medical records and commitment to the rest of the Oath. (Readers relax, because lawyers and judges will do all abortions, death-with-dignity, and euthanasia at the nearest justice center or government facility. "Unatural death" procedures can be done by almost anybody without many complications, and if you know how to have sex, doing an early abortion is easily taught in a few days at law schools along with the other metastatic LEGAL procedures like death-with-dignity and euthanasia.) Physicians must become free again to help the drug addicted who now are being treated like HIV patients were treated 30 years ago.

4. Besides freeing medicine from selfish subspecialty control, mind altering medications must be replaced by newer meds which do not offer the highs sought by addicts. Steroids, autonomic blockers, non-steroidal anti-inflammatory agents, aspirin, acetaminophen, vitamins, and analogues must be used. Rotation of these meds must be required because there is adaptation with long term use of pain meds especially. I had the opportunity of reviewing many incarcerated criminals by thousands of hours of conversation. Most laughingly said pain meds stopped working but the highs continued and discretely said that long term pain med use was a "con." In summary, almost all criminals began drugs by 12 years of age. Almost all had multiple psychiatric symptoms: anxiety, depression, attention deficit disorder, learning disabilities, mood swings, rage attacks, sleep disturbances, psychotic thinking, lack of stable identity, unnatural sex normalized, sexual abuse as victim and abuser, and an almost total lack of virtue understanding with no awareness of words of salutary behavior to replace or correct their life experiences of no childhood, no traditional family life, no virtue based fathering, no stable parenting, and no productive self-development. All were raised in a subculture teaching them adult masturbation and contemptible violence. One hundred percent said they got into drugs to ESCAPE from the overt or covert horror of their lives, again almost all beginning at age 12 or before. Regardless, if any one wants to help reduce addiction, children must have the right to a salutary childhood without adult craziness, with a safe self-developing education, and at least with knowing of the coping words derived from traditional virtues (Perhaps no child under 12 should be exposed to current television, movies and other technologically expanded press/media programming development destroying idiocies).

Reference: "Decade of Pain Control 2000-2010" on Yahoo.com

Sam @

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