The trend suggests that public outrage over the opioid epidemic and regulatory, legislative, clinical and commercial measures have begun to curb their use by physicians and patients.
Steps to address the public health crisis have intensified recently, with state laws that limit prescribing of the drugs and voluntary actions by companies. Walmart started giving out a powder with prescriptions that could be used to coat excess pills in a gel, allowing patients to dispose of medicine safely. CVS Health expanded its drug disposal collection program and its pharmacy limits certain prescriptions to a seven-day supply.
But the progress remains modest. Over the last 25 years, the volume of prescription opioids grew into a mountain, and even now it has receded only to the levels of 2006 and 2007.
“I think the challenge is to continue to go down, but in a way that doesn't go overboard for patients,” said Joshua Sharfstein, a professor at the Johns Hopkins Bloomberg School of Public Health.
Even as prescriptions for opioids have declined, federal data show the number of deaths from drug overdoses — which include not just prescription painkillers, but also illicit opioids such as heroin -- have continued to rise.
And while the report found a reduction in the number of patients that start on opioids for the first time, the number of people who started on medication-assisted therapy to treat opioid dependence almost doubled, to 82,000 per month.
Public health experts raise concerns that if the use of prescription opioids falls off a cliff too quickly, it could drive up total U.S. drug deaths. People who had found a way to manage chronic pain with opioids might turn to illicit drugs.
“It's part of the unfortunate situation we're dealing with two problems at once — and they interact,” Sharfstein said. “There's some reason to believe that if you came down too fast in this graph [of opioid use], you could create more problems in the other graph [of drug overdose deaths]. Both have to be managed.”
Correction: A previous version of the chart accompanying this story did not specify that the prescription opioid volume is measured in billions of milligrams of morphine equivalents.