Rx painkillers aren’t driving opioid overdoses anymore

Opioid overdoses are climbing. But prescription painkillers aren’t driving them anymore. – Vox – by sarah.frostenson@vox.com Apr 1, 2017,

The crackdown on opioid prescriptions to rein in the raging epidemic of opioid abuse and overdoses is picking up steam.

Ten states have passed legislation that limits new opioid prescriptions to 10 days or less (in line with 2016 Centers for Diseases Control and Prevention guidelines), and more states are likely to follow suit. 

But as prescriptions for oxycodone and morphine get more restrictive, opioids sold on the black market are eclipsing them as a bigger threat, at least when it comes to overdoses.  

Incredibly potent synthetic opioids like fentanyl are also responsible for more drug overdose deaths. Deaths from fentanyl more than doubled in 2014, from 1,905 deaths in 2013 to 4,200 deaths.

“What’s happening now is the number of prescription opioid overdoses are stabilizing,” said Chinazo Cunningham, a professor of internal medicine at Albert Einstein College of Medicine who helped review the 2016 CDC guidelines on opioid prescriptions. “But opioid overdose rates have not plateaued, because heroin use is dramatically increasing.”

For instance, a 2016 paper analyzing data from Jefferson County, the most populous county in Alabama, found that drug overdose deaths more than doubled from 2010 to 2015, but starting in 2013, more drug overdose deaths were coming from heroin and fentanyl.

By 2015, prescription opioids accounted for only about 15 percent of all drug overdose deaths in the county.

Other states are seeing a similar trend. A review of drug overdose deaths in Massachusetts from 2013 to 2014 found that heroin or fentanyl was involved in 85 percent of all opioid-related deaths, with prescription opioids involved in only 22 percent.

In Cleveland, fentanyl’s toll has been even more dramatic, causing 86 percent of Cleveland’s reported drug overdose deaths as of August 2016. Commonly prescribed opioids were only found in 17 percent of overdose deaths.

CDC data reflects the trend at the national level. In 2010 and 2011, oxycodone (a commonly prescribed opioid) was the leading cause of drug overdose deaths nationally, but in 2012 heroin was responsible for more overdoses than oxycodone.

Health officials worry that drug overdose deaths from heroin could continue to climb as heroin use becomes more widespread.

A 2017 JAMA study found that heroin use is not always linked to prescription opioid use, and part of its increased prevalence may be driven by commonly prescribed drugs like oxycodone obtained on the black market.

We pain patients have known this for years, but health officials and agencies are slow to admit that prescriptions for pain relief are NOT causing heroin overdoses.

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