Doctors Top Source of Abused Opioids, CDC Says

A new federal study has found that U.S. doctors are the leading source of prescription painkillers for hardcore addicts — those at highest risk for overdose.

Amid epidemic abuse of prescription painkillers, which leads to more deaths than heroin and cocaine combined, the Centers for Disease Control and Prevention findings upend notions about where the most chronic drug users get their drugs. The study was published in March 2014 in the Journal of the American Medical Association (JAMA).

“Many abusers of opioid pain relievers are going directly to doctors for their drugs,” Dr. Tom Frieden, director of the CDC, said of the findings. “Healthcare providers need to screen for abuse risk and prescribe judiciously by checking past records in state prescription drug monitoring programs. It’s time we stop the source and treat the troubled.”

How big is this public health problem? The CDC says enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for a month.

Of the 12 million Americans over age 12 who used a painkiller the prior year for something other than a diagnosed condition, the report found that most people were still getting the drugs from friends, family, or someone they knew. But among people abusing painkillers the most frequently, a doctor was most often the source.

About 16,000 people a year die of prescription drug overdoses, mostly opiate pain medications, a number that has ballooned steadily in the last several years, according to the CDC. The Los Angeles Times went so far as to say physicians have fueled the painkiller epidemic. The paper reported Tuesday that the study “echoes a 2012 Times investigation that found drugs prescribed by doctors caused or contributed to nearly half of the prescription overdose deaths in Southern California in recent years. The Times also revealed that authorities were failing to mine a rich database of prescribing records to identify and stop reckless prescribers.

Frieden said the new study, along with The Times investigation and a second JAMA article on the widespread use of narcotic painkillers in Tennessee, all showed that physician prescriptions were a key contributor to the crisis of addiction and overdose that has continued to mount since the CDC declared it an epidemic in 2011.

Addiction, Overdose Rates Vary by State

The CDC has called for what it said was “improving the way prescription painkillers are prescribed [to] reduce the number of people who misuse, abuse or overdose from these powerful drugs, while making sure patients have access to safe, effective treatment. “Prescription painkiller” refers to opioid or narcotic pain relievers, including such drugs as Vicodin (hydrocodone), OxyContin (oxycodone), Opana (oxymorphone), and methadone.

  • In  2011, the CDC reported that addiction and overdose rates varied widely state to state. Prescription painkiller sales per person were more than three times higher in Florida, which has the highest rate, than in Illinois, which has the lowest. In 2008-2009, non-medical use of painkillers ranged from one in 12 people (age 12 or older) in Oklahoma to one in 30 in Nebraska.

The U.S. Food and Drug Administration approved a new, stronger hydrocodone-based drug, Zohydro ER, in October, despite protests from doctors, 29 state attorneys general, and its own advisory panel. Critics say the powerful new painkiller will only exacerbate the twin epidemics of prescription drug and heroin abuse. Zohydro will become available in the U.S. next month. New York Sen. Charles Schumer has called on Health and Human Services Secretary Kathleen Sebelius to overturn the FDA’s approval of the drug.

At The Recovery Place, a drug and alcohol treatment center in Florida owned by Elements Behavioral Health, 70 percent of clients are fighting opiate addictions, said Peggy Robinson, director of utilization review. She and others in the treatment field say addicts start with opiate pain pills such as OxyContin, Roxycodone, Percocet, Vicodin, Dilaudid, Lortab and morphine. But they cost about $30 a piece, and addicts often progress to inhaling chopped up pills before they learn that heroin costs $10 or less per bag, leading to a rise in the use of that illegal drug. Lori Van Valkenburg, intake coordinator for The Recovery Place,  noted the effectiveness of the government crackdown on “pill mills,” where opiates are dispensed by prescription at an office with a pharmacy often onsite. “There are real doctors there, albeit ‘crooked’ ones,” Van Valkenburg said. “It is the medical necessity that is absent.”

But these efforts fail to target those at highest risk of overdose: people who use prescription opioids non-medically 200 or more days a year, the CDC’s news release noted. The CDC’s new analysis shows that these highest-risk users get opioids through their own prescriptions 27 percent of the time, as often as they get the drugs from friends or family for free or buy them from friends. And they are about four times more likely than the average user to buy the drugs from a dealer or other stranger.

Researchers examined data for the years 2008 through 2011 from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health (NSDUH).

Besides medical doctors’ prescriptions, the most notorious painkiller abusers also obtained opioids from friends or relatives for free (26 percent), bought them from friends or relatives (23 percent), or bought them from a drug dealer (15 percent).

Startling findings about the abuse of opioids in Tennessee were also issued by the CD. “The authors found that one-third of the population of Tennessee filled a prescription for an opioid each year. “Opioid analgesic-related overdose deaths were strongly associated with being prescribed high dosages of opioids (>100 morphine milligram equivalents a day) and with obtaining opioids from multiple prescribers and pharmacies.”

Published in JAMA Internal Medicine, a report examined the high rate of fatal opioid overdose deaths in the state. The Tennessee Department of Health, Vanderbilt University School of Medicine and the CDC found a rising degree of frequent high-risk opioid use has led to a spike in overdose deaths. “High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in Overdose Deaths” surveyed 2007-2011 and found opioid prescribing rates increased 32 percent (from 108 to 143 prescriptions per 100 population).

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