U.S. Rx opioid overdose deaths triple over decade

Deaths attributable to overdose from prescription opioid analgesics increased from approximately 4,000 in 1999 to nearly 15,000 in 2008, CDC researchers reported in Morbidity and Mortality Weekly Report.

"These increases occurred despite numerous warnings and recommendations over the past decade for voluntary education of providers about more cautious use of prescription opioid pain relievers" they wrote.

Drug overdoses accounted for 36,450 deaths in 2008, and came close to the number of people that died in motor vehicle crashes (n=39,973) that same year.

Among the 20,044 drug overdose deaths in 2008 in which prescription medications were implicated, 73.8% involved opioid pain relievers. The number of deaths caused by these drugs now surpasses those involving heroin and cocaine combined, according to the researchers.

Rx opioid analgesic death rates were higher among whites and American Indian/Alaska Natives than among blacks and Hispanics, and varied from state to state, ranging from 5.5 per 100,000 population in Nebraska to 27 per 100,000 in New Mexico.

States with lower death rates generally had lower opioid analgesic sales rates and lower rates of nonmedical prescription opioid use, the researchers found.

Illinois ranked lowest in terms of prescription opioid sales at 3.7 kg per 100,000 population, whereas Florida ranked highest at 12.6 kg. States with the highest sales rates tended to cluster in the Southeastern and Northwestern regions.

Prescription opioid sales and the number of patients admitted to substance abuse treatment programs correlate with overdose death rates, the researchers found. Sales were four times higher in 2008 than they where in 1999 and treatment admissions rose six times during the same time period.

“By 2010, enough OPR were sold to medicate every American adult with a typical dose of 5 mg of hydrocodone (Vicodin, Lortab) every four hours for one month,” the researchers wrote.

Irresponsible opioid prescribing in “pill mills,” health care settings in which clinicians hand out opioids to any patient that complains of pain, account for a large proportion of the problem, according to the researchers.

In one study analyzing opioid prescription rates in California, 3% of physicians prescribed 62% of all opioid pain relievers administered.

“Health-care providers should only use opioid pain relievers in carefully screened and monitored patients when non-opioid pain relief treatments have not been sufficient to treat pain, as recommended in evidence-based guidelines,” the researchers wrote.

They suggested that monitoring programs at the state level could help identify doctors and patients that behave irresponsibly. A combination of economic measures on the part of public insurers to hold providers accountable for prescribing behaviors, along with action from professional licensing boards and law enforcement agencies may help reduce opioid misuse.

"Improving the way prescription painkillers are prescribed can reduce the number of people who misuse, abuse, or overdose from these drugs," the researchers wrote.

Study limitations included the self-reported nature of the data, which may have resulted in under-reporting and exclusion of data on buprenorphin, an opioid used primarily for substance abuse treatment that is occasionally prescribed for pain.

CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers — United States, 1999—2008. MMWR. Nov. 1, 2011; 60:1-6.

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