Monday, July 7, 2014

New CDC Report on Opiods

The Centers for Disease Control (CDC) recently issued a report on opiod painkillers. It concludes that prescriptions for opiods remain more common in the United States than anywhere else in the world. In 2012 there were 259 million prescriptions written for painkillers in this country. The report concludes this is "enough for every American adult to have a bottle of pills." (In the interest of full disclosure, I did not get mine, so someone must have gotten my share).

Drug overdose and interaction remains a problem in this country. According to the CDC "deaths from drug overdose have been rising steadily over the past two decades." Each day, "113 people die as a result of drug overdose and another 6,748 are treated in emergency departments for the misuse or abuse of drugs." The CDC says that 9 of 10 "poisoning deaths are caused by drugs."

The report quantifies the number of prescriptions per 100 people in each state (in parenthesis that follow). The five states with the most opiod prescriptions were Alabama (143), Kentucky (128), Oklahoma (128), Tennessee (143), and West Virginia (138). These are labelled as the "highest" states in the study. The five states labelled the "lowest" volume were California (57), Hawaii (52), Minnesota (62), New Jersey (63) and New York (60). 

Florida is in the large group of 21 states categorized as "below average" in the study, with 73 prescriptions per 100 people. The study is encouraging in that regard, fifteen states characterized as average, twenty-one as "below average" and the five listed above as the "lowest." Forty-one jurisdictions listed as average or below, and only ten listed as "above average" or "highest."  

The study is not encouraging for the south in general. The five "highest" states includes three traditionally labelled "southern states," Alabama, Kentucky and Tennessee. The five "above average" states include Arkansas (116), Louisiana (118), and Mississippi (120). In the south, Georgia (91 in the "average" group) and Florida (73 in the "below average" group) are the exceptions. 

The report lauds the efforts of a few states specifically, New York, Florida, and Tennessee. 

New York gets credit for their statutory requirement that physicians check the state's prescription drug monitoring program (PDMP) before prescribing painkillers. This was enacted in 2012 and in 2013 New York saw a "75% drop in patients who were seeing multiple prescribers to obtain the same drug." PDMP seek to monitor the volume of prescriptions individuals receive. Letting doctors know who else is prescribing what for their shared patient is powerful knowledge. 

Florida is mentioned for its efforts to regulate pain clinics and the prohibition on physician dispensing of opiod narcotics in 2010. This led to more than a "50% decrease in overdose deaths from oxycodone." Florida has a PDMP also, but physicians here are only required to put information into the database they are not required to check it before making or filling a prescription. 

This compares interestingly with Tennessee, which is lauded by the CDC for their 2012 legislation requiring physicians to check the PDMP before prescribing painkillers. According to the report, this led to a "36% drop in patients who were seeing multiple prescribers to obtain the same drugs."

Obviously, there is some progress across the country. There are periodic news stories that document various state efforts. This spring, the Atlanta Constitution reported on the conviction of two who "operated a pill mill pain clinic" in Cartersville, Georgia. These two "worked to procure and distribute oxycodone," and "directed the clinic's doctor to see as many patients as possible and to prescribe as many pills as possible." Coincidentally, the two convicts were Florida residents.

It may be a coincidence that Florida regulated physician dispensing of opiods in 2010 and Florida residents were shortly thereafter convicted of running a pill mill in neighboring Georgia. It may be coincidence that Florida painkiller prescriptions have dropped so markedly recently. It may be coincidence that the column of states including Michigan, Indiana, Ohio, West Virginia, Kentucky, Tennessee, Mississippi, and Alabama (with the Carolinas and Arkansas, Oklahoma, and Louisiana on the fringes thereof) represent the highest number of prescriptions per 100 people. It may be coincidence that so many of the states with serious issues are in the south and the industrial mid-west.

I have my doubts that coincidence drives the trends. These states face a serious challenge and will have to do more to curb the problems. 

Despite the improvements, there is likely more that can be done. The New York and Tennessee requirements for providers to check the PDMP is perhaps the most encouraging. New York's seventy-five percent drop in patients using multiple prescribers is difficult to argue with. As efforts are undertaken, there is the potential that neighboring states will feel effects. Moving a population away from these medications will not come easily or without continued effort. This is true for the states and for the people that have become accustomed to using these substances. 

There is no reason for drug interaction and overdose deaths to be rising in this country. Unfortunate consequences from these substances will continue to challenge us though, and the real question is what we will do about it. 

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