Lauffenburger 1

John Lauffenburger

Dr. Colombo

UWRT 1104-018

28 February 2017

Are Physicians Overprescribing Painkillers?

Is there a such thing as overprescribing painkillers?

What are the consequences of overprescribing painkillers?

Who is most at risk for becoming addicted to opioids through prescribed painkillers?

Who is responsible for the rise in prescription opioid addiction?

Can new narcotic laws about the way prescription drugs are treated helping the epidemic?

Works Cited
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Is there a such thing as overprescribing painkillers?

Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014, but there
has not been an overall change in the amount of pain Americans report. During this time
period, prescription opioid overdose deaths increased similarly (CDC).
In 2012, health care providers in the highest-prescribing state wrote almost 3 times as
many opioid prescriptions per person as those in the lowest prescribing state. Health
issues that cause people pain do not vary much from place to place, and do not explain
this variability in prescribing (CDC).

Prescription painkiller sales have increased by over 300% in the last decade: sales
increased from 1.75 kilograms per 10,000 people in 1999 to about 7.1 kilograms per
10,000 people in 2010, (Shepherd 88).

These sources strongly suggest physicians are overprescribing painkillers because of two
reasons: their sales have exponentially increased in the last ten to fifteen years and Americans
pain has not changed on average during that span.

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What are the consequences of overprescribing painkillers?

Studies on children prenatally exposed to maternal opioid and poly-substance abuse

show an increased risk of regulatory problems, such as behavioral and emotional
problems, aggression, attention deficits and ADHD symptoms (Nygaard, et al).

Notably, 75% of heroin addicts today say that they used prescription opioids before
turning to the drug. And according to the CDC, 45% of people who have used heroin in
the last four years were simultaneously addicted to prescription painkillers. These survey
results help illuminate the disturbing trend that many modern-day heroin users are
arriving at that addiction from prescription pain pill addiction. The CDC states that the
prescription opioid-dependent are 40 times more likely to abuse heroin (Opioid Rx
Linked to Heroin).

Heroin-related deaths have jumped 39% in just one year, from 2012 to 2013, and
looking over the course of the last decade, from 2002 to 2013, the rate of heroin-related
overdose deaths nearly quadrupled, the Centers for Disease Control and Prevention
reports (Opioid Rx Linked to Heroin).

The majority of overdose deaths in the US involve pharmaceuticals, and three quarters
of those pharmaceutical related overdose deaths involve opioid analgesics. In January
2013, a US FDA advisory committee voted to tighten the rules governing the prescription
of hydrocodone-containing medicines. While some believe such changes will
dramatically cut down on the drugs misuse, others are concerned that they will make it
more difficult for legitimate patients to receive the medication they need (McMillan).

The abuse of, and overdose deaths from, prescription painkillers have imposed
significant costs on the nation. A recent study has estimated that nonmedical use of
prescription opioids in 2006 cost $42 billion for lost productivity, $8.2 billion for
criminal justice costs, $2.2 billion for drug abuse treatment, and $944 million for
medical complications. Furthermore, the financial impact to health insurers from
nonmedical use of prescription painkillers is estimated to be $72.5 billion in direct
healthcare costs annually. Aggregating these two estimates of mostly distinct cost
factors, prescription painkiller abuse costs the United States more than $125 billion
dollars annually, (Shepherd 89).

These sources attest to a few of the several consequences of overprescribing painkillers: those
prescribed can become addicted to their medication; if patients become addicted to their
medication they may turn to heroin; if patients become addicts and have children, their children
are more likely to have attention and behavioral issues; and the most obvious consequence of
addiction, death.

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Who is most at risk for becoming addicted to opioids through prescribed painkillers?

Notably, 75% of heroin addicts today say that they used prescription opioids before
turning to the drug. And according to the CDC, 45% of people who have used heroin in
the last four years were simultaneously addicted to prescription painkillers. These survey
results help illuminate the disturbing trend that many modern-day heroin users are
arriving at that addiction from prescription pain pill addiction. The CDC states that the
prescription opioid-dependent are 40 times more likely to abuse heroin (Opioid Rx
Linked to Heroin).
The researchers looked at asked over 6,000 high school seniors to complete
questionnaires about drug use. The subjects were then followed until age 23. Overall,
healthcare provider-recommended prescription opioid use by grade 12 was independently
associated with a 33% increase in risk for opioid misuse later (Opioid Rx Linked to
Heroin).
[An increase in infants born addicted to opioids] is especially noticeable in rural areas,
(Singal).
[The infants received at the hospitals born addicted to opioids] are mostly white babies,
(Singal).
Prescription opioid use varies according to age, gender, and ethnicity: Older adults (aged
40 years and older) are more likely to use prescription opioids than adults aged 20 39.
Women are more likely to use prescription opioids than men. Non-Hispanic whites are
more likely to use prescription opioids than Hispanics. There are no significant
differences in prescription opioid use between non-Hispanic whites and non-Hispanic
blacks (CDC).

These articles suggest that white individuals are more likely to abuse prescription painkillers and
to give birth to an opiate-addicted child. However, there seems to be a slight discrepancy
between who the CDC and author of Opioid Rx Linked to Heroin believes are more at risk of
an opioid addiction. The author of Opioid Rx Linked to Heroin uses a study to convey the
likelihood of adolescents younger than their senior year in high school are most at risk, but the
CDC suggests women 40 and older may be more likely to develop an addiction. These articles
also state that a prior addiction to heroin will significantly increase ones chances of becoming
addicted to prescription painkillers and vice versa.

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Who is responsible for the rise in prescription opioid addiction?

...those who are at highest risk of overdose (using prescription opioids nonmedically 200
or more days a year) get them in ways that are different from those who use them less
frequently. These people get opioids using their own prescriptions (27 percent), from
friends or relatives for free (26 percent), buying from friends or relatives (23 percent), or
buying from a drug dealer (15 percent). Those at highest risk of overdose are about four
times more likely than the average user to buy the drugs from a dealer or other stranger
(CDC).

Drug abusers use various methodssuch as doctor shopping, paying with cash, and
filling prescriptions in different statesto avoid detection and obtain prescription
painkillers for illegitimate uses. A few rogue physicians and pharmacists, lured by
substantial profits, enable drug abusers by illegally prescribing or supplying controlled
substances. Even ethical physicians rarely have adequate training to recognize and
address prescription drug abuse, and as a result, prescribe painkillers to patients who are
not using them for legitimate medical purpose. However, under current reporting
systems, pharmacists lack the ability to access several important indicators of drug abuse,
making it extremely difficult to detect drug abuse with certainty. As a result, drug abusers
are able to obtain prescription painkillers from even the most vigilant pharmacies,
(Shepherd 86).

These sources are quite clear on who bears part of the blame the increase in opioid addiction,
including patients doctor shopping (by getting a prescription legally), patients illegally buying
the drugs, physicians purposefully prescribing these medications even when they know better.
Shepherd also mentions pharmacists limitations to check patients backgrounds and histories as
a contributor to the rise in addiction.

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Can new narcotic laws about the way prescription drugs are treated helping the epidemic?
While state governments have established prescription drug monitoring programs
(PDMPs) to crack down on prescription drug abuse, these programs have proven to be
inadequate. The programs currently suffer from inadequate data collection, ineffective
utilization of data, insufficient interstate data sharing, and constraints on sharing data
with law enforcement and state agencies, (Shepherd 86).
The abuse of prescription painkillers has escalated to the level of a national
epidemic, but existing state PDMPs are unlikely to be fully effective within any
reasonable timeframe. An alternative, national controlled substance reporting
framework that builds on existing PBM-pharmacy networks could provide a timely
and cost-effective solution, (Shepherd 109).
In an effort to crack down on what he states is a `citywide and national epidemic of
prescription drug abuse,' NYC Mayor Michael Bloomberg created a multi-agency Task
Force on Prescription Painkiller Abuse, co-chaired by Deputy Mayor for Health and
Human Services Linda Gibbs and Chief Policy Advisor John Feinblatt, (McMillan).

Opposing the proposed hydrocodone changes is the American Academy of Physician

Assistants (AAPA), which is urging policymakers to be cautious when legislating
policies that will limit access to pain medications for patients with legitimate clinical
needs (McMillan).

Resources have been put in place to allow greater data sharing, regarding suspicious
patterns of prescribing or prescription filling, with local health departments. Also, to
address the prevalent problem of prescription pad theft, the State Legislature passed a law
requiring all New York doctors to switch to electronic prescribing for controlled
substances by the end of 2014 (McMillan).

These sources disagree because Shepherd claims the PDMPs are inadequate, but McMillan
views these positively, stating laws in New York have allowed greater data sharing to crack down
on suspicious prescription filling.

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Works Cited
CDC. Prescribing Data. Centers for Disease Control and Prevention, Centers for Disease

Control and Prevention, 20 Dec. 2016, www.cdc.gov/drugoverdose/data/prescribing.html.

McMillan, Steve. Overprescribing Opioids - Unreasoned Expectations and Underestimated

Risks Underpin Epidemic. Reactions Weekly, vol. 1445, no. 1, 2013, pp. 34. Academic

Search Complete, doi:10.1007/s40278-013-2139-5. Accessed 17 Feb. 2017.

Nygaard, Egil, et al. Behavior and Attention Problems in Eight-Year-Old Children with Prenatal

Opiate and Poly-Substance Exposure: A Longitudinal Study. Plos One, vol. 11, no. 6,

2016. Academic Search Complete, doi:10.1371/journal.pone.0158054. Accessed 18 Feb.

2017.

"Opioid Rx Linked To Heroin Use Later." Running & Fitnews 33.6 (2015): 7-8. Academic

Search Complete. Web. 13 Feb. 2017.

"SAMHSA: 400 Percent Increase In Prescription Painkiller Admissions." Alcoholism & Drug

Abuse Weekly 22.27 (2010): 1-3. Academic Search Complete. Web. 13 Feb. 2017.

Shepherd, Joanna. Combating the Prescription Painkiller Epidemic: A National Prescription

Drug Reporting Program. American Journal of Law and Medicine, vol. 40, no. 1, 1 Mar.

2014, pp. 85112. CrossRef,

journals.sagepub.com.librarylink.uncc.edu/doi/abs/10.1177/009885881404000103?

journalCode=jlma&volume=40&year=2014&issue=1. Accessed 19 Feb. 2017.

Singal, Sam. Nightly News Full Broadcast (January 8th). NBC Nightly News with Lester Holt,

NBC, 8 Jan. 2017, www.nbcnews.com/nightly-news/video/nation-s-heroin-epidemic-

taking-unprecedented-toll-on-newborns-850370627951. Accessed 19 Feb. 2017.