Outlook on Opiate Abuse: There’s Good News and Bad News

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It’s no secret that the abuse of prescription opioid painkillers, like OxyContin and Percocet, has reached epidemic levels in the United States. But a recently published study highlights a strange trend: Non-medical use of opiates has decreased, while prescription opioid use disorders, frequency of use and related deaths has actually increased.

Non-Medical Abuse vs Prescription Abuse

Between 2003 and 2013, the proportion of people illicitly using opiate painkillers The rate of non-medical use of opioids, which means using a prescription not as directed or using someone else’s prescription, actually fell according to a study in the October 13 issue of the Journal of the American Medical Association (JAMA).

“The results underscore the importance of addressing the prescription opioid crisis,” said lead author of the study, Dr. Beth Han of the Substance Abuse and Mental Health Services Administration (SAMHSA) in Rockville, Maryland. She said there was a rise in high-intensity opioid use during the 2000s when more doctors began prescribing these drugs.

For this study, researchers surveyed 472,000 people on their opioid use between 2003 and 2012, then examined national statistics on cause of death during the same time period. The rate of non-medical use of opioids fell from 5.4 to 4.9 percent over these ten years. But during the same time, the rate of use disorders rose from 0.6 to 0.9 percent. There was also an increase in the number of people who reported using opioids for more than 200 days.

The slight decrease in nonmedical opioid use is a “hopeful” sign, wrote Dr. Lewis Nelson of the New York University School of Medicine and coauthors in a report accompanying the study.

At the same time, however, the rise in opioid misuse and disorders related to opiate abuse suggests more patients are progressing from prescribed opioid use to frequent use or misuse, according to Han and her colleagues.

Inappropriate Prescribing

Between 2003 and 2013, overdose deaths involving prescription opioids nearly doubled, going from 4.5 to 7.8 per 100,000 people, according to national statistics. And the proportion of opioid users with a use disorder also increased from 12.7 to 16.9 percent during the same period.

To combat the problem of inappropriate prescribing, Han suggests the following:

  • Reducing “inappropriate” opioid prescribing by doctors and developing safer alternatives for pain treatment could help drive down these numbers.
  • Doctors also need to undergo more effective training to learn how to identify and treat high-risk nonmedical prescription opioid users.

Providing New Resources

One new resource, developed by the Substance Abuse and Mental Health Services Administration (SAMHSA), is the Opioid Overdose Prevention Toolkit, which guides medical professionals on how they can recognize symptoms of opioid misuse and reduce the risk of death by identifying the signs of an overdose and reversing it with lifesaving opioid overdose drug, Naloxone.

Many medical professionals and institutions are still unequipped to treat opioid use disorders and overdoses. For example, from 2004 to 2013, even though the number of opioid users rose, the use of treatment options for opioid use disorders remained the same, according to JAMA. This includes inpatient, outpatient, hospital, office, emergency room, jail or self-help center treatment options.

Treatment of opioid addiction frequently requires medication, like the opioid substitutes Methadone or Suboxone. Due to problems related to stigma and abuse, however, many hospitals and clinics refuse to carry or provide these medications.

“The last decade has been a time of rapidly growing numbers of people dying from opioid overdoses,” said Brendan Saloner of the Johns Hopkins Bloomberg School of Public Health in Baltimore, who co-authored this report, but “the ability of the health system to detect and provide timely access to treatment does not seem to be improving much.”
Additional Reading: Taking Action: How to Intervene During an Overdose
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