The CDC’s report this week about binge drinking among U.S. adults got a lot of media attention. Turns out a lot of us drink a lot, and often.
That report has all but overshadowed another article in Thursday’s weekly CDC bulletin that highlights the extent to which people in this country abuse — and overdose on — prescription drugs.
According to the report, unintentional drug overdose death rates have risen dramatically in recent years, fueled by increasing use of the prescription painkillers known as opioid analgesics. Since 2003, the report says, more overdose deaths have involved these painkillers than heroin and cocaine combined.
The report says about 9 million people use such opioids long term and for medical purposes — and about 5 million use them for “nonmedical” purposes, meaning without a prescription or medical need. It further notes, “In an attempt to treat patient pain better, practitioners have greatly increase their rate of opioid prescribing over the past decade,” with the amount prescribed per person jumping by 600 percent from 1997 to 2007.
“Persons who abuse opioids have learned to exploit this new practitioner sensitivity to patient pain, and clinicians struggle to treat patients without overprescribing these drugs,” the report observes.
The paper identifies four key subgroups of prescription drug users. The vast majority — about 80 percent — of those prescribed opioids are offered low doses by a single practitioner. That group account for about 20 percent of prescription drug overdoses. About 10 percent are prescribed high doses, but still by single practitioners; they account for about 40 percent of prescription opioid overdoses. Then there’s the last 10 percent, which the report describes as being “of greatest concern.”
As the authors explain: “These are patients who seek care from multiple doctors and are prescribed high daily doses, and account for another 40 percent of opioid overdoses. Persons in this third group not only are at high risk for overdose themselves but are likely diverting or providing drugs to others who are using them without prescriptions. In fact, 76 percent of non-medical users report getting drugs that had been prescribed to someone else, and only 20 percent report that they acquired the drug from their own doctor. Furthermore, among persons who died of opioid overdoses, a significant proportion did not have a prescription in their records for the opioid that killed them.”
The report suggests a handful of measures that could help rein in this problem, including using insurance-restricted prescription records to track instances in which drugs are being secured from multiple sources (in a practice known as “doctor shopping”). Physicians also need to be educated as to the subtleties of prescribing these drugs and the potential consequences of over-prescribing. (As I wrote in December, doctors have been called upon to help curb illicit use of prescription drugs sold through “rogue” online pharmacies). And states should step up enforcement of existing laws against doctor shopping.