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PAINSCAN LITERATURE REVIEW
Issue 1, Volume 3
Abuse-Deterrent Technologies
14 Articles in this Series
Introduction
The effect of a potentially tamper-resistant oxycodone
Commentary: Why Prescribers Need to Adopt Abuse-Deterrent Opioids
Review: The Impact of Abuse-Deterrent Formulations on Prescribing and Abuse
Abuse-Deterrence Guidance Further Highlights Federal Focus
The Burden of Undiagnosed Opioid Abuse Among the Commercially Insured
Reductions in Reported Deaths Following Introduction of Abuse-Deterrent Oxycodone ER (OxyContin)
Abuse-Deterrent Opioids—Evaluation and Labeling
Generic patches containing fentanyl: abuse deterrent evaluation
FDA Advisory Committee Meetings on Abuse-Deterrent Opioids
Regulatory Update: FDA Takes Additional Abuse-Deterrent Steps
Related: At-Risk Patients and Urine Drug Monitoring
Extended-Release Formulations Enter US Market
Development and Impact of Prescription Opioid ADF Technologies
Trends in Opioid Analgesic Abuse and Mortality in the United States

Trends in Opioid Analgesic Abuse and Mortality in the United States

Rates of opioid abuse and mortality stabilized or decreased between 2011 and 2013
N Engl J Med. 2015;372(3):241-248

Introduction: Over the past 2 decades, rates of prescription opioid medication abuse and diversion have increased. To understand the effects of local, regional, state, and federal interventions to prevent opioid abuse and diversion, this study was designed to examine the trends in diversion and abuse of prescription opioid analgesic from 2002 through 2013.

Methods: Researchers evaluated trends in the diversion and abuse of oxycodone, hydrocodone, hydromorphone, fentanyl, morphine, and tramadol from the following 5 programs in the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System:

  • Poison Center Program
  • Drug Diversion Program
  • Opioid Treatment Program
  • Survey of Key Informants’ Patients (SKIP) Program
  • College Survey Program

Results: The number of prescriptions dispensed for opioid analgesic increased from 2002 to 2010 and then showed an overall slight decrease between 2011 in 2013 (despite a peak of 62 million per quarter in 2012). In 2013, the rate was 60 million per quarter. In contrast, heroin use increased over time.

With the exception of the College Survey Program, the other 4 RADARS System programs showed significant increases in the rate of opioid diversion and abuse from 2002 to 2010 followed by a flattening or decrease in rates from 2011 through 2013.

The rate of opioid-related deaths rose and fell in a similar pattern, with a decrease in dealths recorded between 2010 and 2013 (Figure left, adapted from Figure 3 by Dart et al). In contrast, the rate of heroin-related deaths was inversely related to rate of opioid-related deaths, with an increase from 0.014 to 0.03 per 100,000 population in the same time period.

Conclusions: The rate of prescription opioid diversion and abuse stabilized or decreased between 2011 and 2013, after increasing between 2002 and 2010. The rates of heroin abuse and overdose increased between 2011 and 2013, suggesting that patients may have switched from abusing prescription opioids to abusing heroin. 

 

Commentary

The paper by Dart et al updates us on rates of abuse from multiple community sources. It is critical that clinicians, educators, policymakers, and law enforcement officers stay current on trends in prescription drug abuse. Most of these individuals are not familiar with the intense efforts being made to curb abuse and diversion, and ignorance about an improved landscape is harmful to pain patients who need this important class of analgesic to maintain function and quality of life.

As clinicians, we commend the hundreds of programs implemented by local, state, and federal governments aimed at improving opioid prescribing, reducing doctor-shopping, and limiting questionable practices by pain clinics. In addition, other organizations (including pharmaceutically funded CME) have implemented a myriad of educational programs promoting guidelines for responsible opioid prescribing and risk evaluation and mitigation strategies (REMS). Furthermore, toxicology companies have educated prescribers about screening and compliance monitoring, and prescription-monitoring programs now operate in most states. Finally, new opioid analgesic formulations that resist tampering have been introduced.

The paper by Dart et al is hopefully the first of many to follow suggesting that these efforts to curb opioid abuse and diversion have been effective. As pain management clinicians who utilize opioids, we are thrilled to see that our actions as a whole (federal, state, local and individual) have begun to take effect.

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