Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-22T15:49:22.424Z Has data issue: false hasContentIssue false
  • English
  • Français

An Effective Intervention: Limiting Opioid Prescribing as a Means of Reducing Opioid Analgesic Misuse, and Overdose Deaths

Published online by Cambridge University Press:  01 January 2021

Brandi C. Fink ,
Olivier Uyttebrouck  and
Richard S. Larson
Get access Rights & Permissions [Opens in a new window]

Abstract

Overdose deaths involving prescription opioids killed more than 17,000 Americans in 2017, marking a five-fold increase since 1999. High prescribing rates of opioid analgesics have been a substantial contributor to prescription opioid misuse, dependence, overdose and heroin use. There was recognition approximately ten years ago that opioid prescribing patterns were contributing to this startling increase in negative opioid-related outcomes, and federal actions, including Medicare reimbursement reform and regulatory actions, were initiated to restrict opioid prescribing. The current manuscript is a description of those actions, the effect of those actions on opioid prescribing and related patient outcomes. We also describe our proposal of methods of expanding these efforts as an important piece to further reduce opioid-related misuse, dependence, and overdose death.

Type
Symposium Articles
Information
Journal of Law, Medicine & Ethics , Volume 48 , Issue 2: Opioid Controversies: The Crisis — Causes and Solutions , Summer 2020 , pp. 249 - 258
Copyright
Copyright © American Society of Law, Medicine & Ethics 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Volkow, N. D. and McClellan, A. T., “Opioid Abuse in Chronic Pain – Misconceptions and Mitigation Strategies,” New England Journal of Medicine 374, no. 13 (2016): 1253-1263; Van Zee, A., “The Promotion and Marketing of Xxycontin: Commercial Triumph, Public Health Tragedy, American Journal of Public Health, 99, no. 2 (2009): 221-227; Guy, G. P. Jr., Zhang, K., Bohm, M. K., et al., “Vital Signs: Changes in Opioid Prescribing in the United States, 2006-2015, MMWR Morbitity Mortality Weekly Report 66, no. 26 (2017): 697-704.CrossRefGoogle Scholar
deShazo, R. D., Johnson, M., Eriator, I., and Rodenmeyer, K., “Backstories on the US Opioid Epidemic: Good Intentions Gone Bad, An Industry Gone Rogue, and Watch Dogs Gone to Sleep,” American Journal of Medicine 131, no. 6 (2018): 595-601.CrossRefGoogle Scholar
Centers for Disease Control and Prevention (CDC), Multiple Cause of Death 1999-2017, available at <http://wonder.cdc.gov/mcd-icd10.html> (last visited April 3, 2020); Bohnert, A.S., Valenstein, M., Bair, M. J., et al., “Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths,” Journal of the American Medical Association 305, no. 13 (2011): 1315-1321.CrossRefGoogle Scholar
See CDC, supra note 3.Google Scholar
See CDC, supra note 3.Google Scholar
Guy, G. P. Jr., Zhang, K., Schieber, L. Z., Young, R., and Dowell, D., “County-Level Opioid Prescribing in the United States, 2015 and 2017,” Journal of the American Medical Association: Internal Medicine 179, no. 4 (2019): 574-576.Google Scholar
Substance Abuse and Mental Health Services Administration (SAMHSA), “Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health,” (2018); HHS Publication No. SMA 18-5068 NSDUG Series H-53, available at <https://www.samhsa.gov/data> (last visited April 6, 2020).+(last+visited+April+6,+2020).>Google Scholar
See SAMHSA, supra note 7.Google Scholar
Centers for Disease Control and Prevention (CDC), U.S. Opioid Prescribing Rate Maps (2019), available at <https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html> (2019) (last visited April 3, 2020).+(2019)+(last+visited+April+3,+2020).>Google Scholar
FDA, FDA Analysis of Long-Term Trends in Prescription Opioid Analgesic Products: Quantity, Sales, and Price Trends (Washington, DC: Food and Drug Administration, 2018), available at <https://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Reports/UCM598899.pdf> (last visited April 3, 2020); DiBonaventura, M. D., Sadosky, A., Concialdi, K., et al., “The Prevalence of Probable Neuropathic Pain in the US: Results from a Multimodal General-Population Health Survey,” Journal of Pain Research 10, no. 2017 (2017): 2525-2538.Google Scholar
Wunsch, H., Wijeysundera, D. N., Passarella, M. A., and Neuman, M. D., “Opioids Prescribed After Low-Risk Surgical Procedures in the United States, 2004-2012,” Journal of the American Medical Association 315, no. 15 (2016): 1654-1657.CrossRefGoogle Scholar
Bicket, M. C., Long, J.J., Pronovost, P. J., Alexander, G. C., and Wu, C. L., “Prescription Opioid Analgesics Commonly Unused After Surgery: A Systematic Review,” Journal of the American Medical Association: Surgery 152, no. 11 (2017): 1066-1071.Google Scholar
Theisen, K. M., Myrga, J. M., and Hale, N., et al. “Excessive Opioid Prescribing After Major Urologic Procedures,” Urology 123 (2019): 101-107.CrossRefGoogle Scholar
See Bicket, supra note 12.Google Scholar
See SAMHSA, supra note 7.Google Scholar
Brummett, C. M., Waljee, J. F., and Goesling, J., et al., “New Persistent Opioid Use after Minor and Major Surgical Procedures in US Adults,” Journal of the American Medical Association: Surgery 152, no. 3 (2017): e170504.Google Scholar
See Brummett, supra note 16; Hooten, W. M., St. Sauver, J. L., McGree, M. E., Jacobson, D. J., and Warner, D. O., “Incidence and Risk Factors for Progression From Short-term to Episodic or Long-term Opioid Prescribing: A Population-Based Study,” Mayo Clinic Proceedings 90, no. 7 (2015): 850-856.CrossRefGoogle Scholar
See Brummet, supra note 16; Wunsch, H., Wijeysundera, D. N., Passarella, M. A., and Neuman, M. D., “Opioids Prescribed after Low-Risk Surgical Procedures in the United States, 2004-2012,” The Journal of the American Medical Association 315, no. 15 (2016): 1654-1657.CrossRefGoogle Scholar
Dowell, D., Haegerich, T. M., and Chou, R., “CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016,” Journal of the American Medical Association. 315, no. 15 (2016): 1624-1645.Google Scholar
Shah, A., Hayes, C. J., and Martin, B. C., “Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006-2015,” MMWR Morbitity and Mortality Weekly Report 66, no. 10 (2017): 265-269.CrossRefGoogle Scholar
See Shah, supra note 20.Google Scholar
See Shah, supra note 20.Google Scholar
See Dowell, supra note 19.Google Scholar
Peckham, A. M., Fiarman, K. A., Awanis, G., and Early, N. K., “High-Risk Opioid Prescribing Trends in the Outpatient Setting Prior to Issuance of Federal Guidance,” Preventive Medicine Reports 15 (2009): 100892.Google Scholar
Centers for Disease Control and Preventions, “Vital Signs: Overdoses of Prescription Opioid Pain Relievers — United States, 1999-2008,” MMWR Morbitity Mortality Weekly Report 60, no. 43 (2011): 1487-1492.Google Scholar
Compton, W. M., Jones, C. M., and Baldwin, G. T., “Relationship Between Nonmedical Prescription-Opioid Use and Heroin Use,” New England Journal of Medicine 374, no. 2 (2016): 154-163.Google Scholar
Muhuri, P. K., Gfroerer, J. C., and Davies, M. C., “Assciations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States,” Centers for Behavioral Health Statistics and Quality Data Review (2013) 1-17, available at <http://www.samhsa.gov/data/2k13/DataReview/DR006/nonmedical-pain-reliever-use-2013.pdf> (Last visited April 6, 2020).+(Last+visited+April+6,+2020).>Google Scholar
Substance Abuse and Mental Health Services Administration (SAMHSA), “Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health,” (2018), HHS Publication No. SMA 18-5068 NSDUG Series H-53, available at <https://www.samhsa.gov/data> (Last visted April 5, 2020).+(Last+visted+April+5,+2020).>Google Scholar
See Compton, supra note 26.Google Scholar
Federal Drug Administration (FDA), “FDA Analysis of Long-Term Trends in Prescription Opioid Analgesic Products: Quantity, Sales, and Price Trends,” (Washington, DC: Food and Drug Administration, 2018), available at <https://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Reports/UCM598899.pdf> (last visited April 5, 2020).+(last+visited+April+5,+2020).>Google Scholar
See CDC, supra note 3.Google Scholar
Samuels, E. A., Ross, J. S., and Dhruva, S.S., “Medicare Formulary Coverage Restrictions for Prescription Opioids, 2006 to 2015,” Annals of Internal Medicine, 167, no. 12 (2017): 895-896; Garcia, M. C., Dodek, A. B., and Kowalski, T., et al., “Declines in Opioid Prescribing after a Private Insurer Policy Change — Massachusetts, 2011-2015,” MMWR Morbitity and Mortality Weekly Report 65, no. 41 (2016): 1125-1131.Google Scholar
Food and Drug Administration, “FDA Analysis of Long-Term Trends in Prescription Opioid Analgesic Products: Quantity, Sales, and Price Trends,” (Washington, DC: Food and Drug Administration; 2018).Google Scholar
Jones, C. M., Lurie, P. G., and Throckmorton, D. C., “Effect of US Drug Enforcement Administration's Rescheduling of Hydrocodone Combination Analgesic Products on Opioid Analgesic Prescribing,” Journal of the American Medical Association: Internal Medicine 176, no. 3 (2016): 399-402.Google Scholar
See Jones, supra note 33.Google Scholar
Drug Enforcement Agency, “DEA Reduces Amount of Opioid Controlled Substances to be Manufactured in 2017,” (2016), available at <https://www.dea.gov/press-releases/2016/10/04/dea-reduces-amount-opioid-controlled-substances-be-manufactured-2017> (last visited April 5, 2020).+(last+visited+April+5,+2020).>Google Scholar
FDA, Oxymorphone (marketed as Opana ER) Information, (2017), available at <https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm562339.htm> (last visited April 5, 2020).+(last+visited+April+5,+2020).>Google Scholar
Broz, D., Zibbell, J., and Foote, C., et al., “Multiple Injections Per Injection Episode: High-Risk Injection Practice Among People who Injected Pills During the 2015 HIV Outbreak in Indiana,” International Journal on Drug Policy 52 (2018): 97-101.CrossRefGoogle Scholar
Rutkow, L., Vernick, J. S., and Alexander, G. C., “More States Should Regulate Pain Management Clinics to Promote Public Health,” American Journal of Public Health 107, no. 2 (2017): 240-243.Google Scholar
Johnson, H., Paulozzi, L., Porucznik, C., Mack, K., and Herter, B., “Decline in Drug Overdose Deaths after State Policy Changes — Florida, 2010-2012,” MMWR Morbitity and Mortality Weekly Report 63, no. 26 (2014): 569-574.Google Scholar
McGinty, E. E., Stuart, E. A., Caleb Alexander, G., Barry, C. L., Bicket, M. C., and Rutkow, L., “Protocol: Mixed-Methods Study to Evaluate Implementation, Enforcement, and Outcomes of U.S. State Laws Intended to Curb High-Risk Opioid Prescribing,” Implementation Science 13, no. 1 (2018): 37.Google Scholar
Prescribing Policies: States Confront Opioid Overdose Epidemic, (2017), available at <http://www.ncsl.org/Portals/1/Documents/Health/prescribingOpioids_final01-web.pdf> (last visited April 5, 2020).+(last+visited+April+5,+2020).>Google Scholar
See Prescribing Policies, id.Google Scholar
Henke, R. M., Tehrani, A. B., Ali, M. M., Mutter, R., Mazer-Amirshahi, M., O'Brien, P. L., and Mark, T. L., “Opioid Prescribing to Adolescents in the United States from 2005-2016,” Psychiatric Services 69, no. 9 (2018): 1040-1043.CrossRefGoogle Scholar
Huang, X., Keyes, K. M., and Li, G., “Increasing Prescription Opioid and Heroin Overdose Mortality in the United States, 1999-2014: An Age-Period-Cohort Analysis,” American Journal of Public Health 108, no. 1 (2018): 131-136.CrossRefGoogle Scholar
Kertesz, S. G., Satel, S. L., DeMicco, J., Dart, R. C., and Alford, D. P., “Opioid Discontinuation as an Institutional Mandate: Questions and Answers on Why we Wrote to the Centers for Disease Control and Prevention,” Substance Abuse 40, no. 4 (2019), DOI: 10.1080/08897077.2019.1635973CrossRefGoogle Scholar
Weiss, R. D., Potter, J. S., Griffin, M. L., et al., “Reasons for Opioid Use Among Patients with Dependence on Prescription Opioids: The Role of Chronic Pain,” Journal of Substance Abuse Treatment 47, no. 2 (2014): 140–145; Kosten, T. R., Baxter, L. E., “Effective Management of Opioid Withdrawal Symptoms: A Gateway to Opioid Dependence Treatment,” The American Journal on Addiction 28, no. 2 (2019): 55-62.Google Scholar
See Kosten, supra note 47.Google Scholar
Food and Drug Administration, “FDA Analysis of Long-Term Trends in Prescription Opioid Analgesic Products: Quantity, Sales, and Price Trends,” (Washington, DC: Food and Drug Administration, 2018).Google Scholar
See FDA, supra note 49.Google Scholar
See SAMHSA, supra note 28.Google Scholar
Wilson, M. N., Hayden, J. A., Rhodes, E., Robinson, A., and Asbridge, M., “Effectiveness of Prescription Monitoring Programs in Reducing Opioid Prescribing, Dispensing and use Outcomes: A Systematic Review,” Journal of Pain 20, no. 12 (2019), doi: 10.1016/j.jpain.2019.04.007.CrossRefGoogle Scholar
Khobrani, M., Perona, S., and Patanwala, A. S., “Effect of a Legislative Mandate on Opioid Prescribing for Back Pain in the Emergency Department,” American Journal of Emergency Medicine 37, no. 11 (2019). doi.org/10.1016/j.ajem.2019.02.031.CrossRefGoogle Scholar
Sun, B. C., Charlesworth, C. J., and Lupulescu-Mann, N., et al., “Effect of Automated Prescription Drug Monitoring Program Queries on Emergency Department Opioid Prescribing,” Annals of Emergency Medicine 71, no. 3 (2017): 337-347.CrossRefGoogle Scholar
Weiner, S. G., Price, C. N., Atalay, A. J., Harry, E. M., Pabo, E. A., et al., “A Health System-Wide Initiative to Decrease Opioid-Related Morbidity and Mortality,” Joint Commission Journal on Quality and Patient Safety 45, no. 1 (2019): 3-13.CrossRefGoogle Scholar
See CDC, supra note 3.Google Scholar
McDonald, R., Campbell, N. D., and Strang, J., “Twenty Years of Take-Home Naloxone for the Prevention of Overdose Deaths from Heroin and other Opioid: Conception and Maturation,” Drug and Alcohol Dependence 178, (2017): 176-187.CrossRefGoogle Scholar
Levy, B., Spelke, B., and Paulozzi, L. J. LJ, et al., “Recognition and Response to Opioid Overdose Deaths: New Mexico 2012,” Drug and Alcohol Dependence 167 (2016): 29-35.CrossRefGoogle Scholar
Comerci, G., Katzman, J., and Duhigg, D., “Controlling the Swing of the Opioid Pendulum,” New England Journal of Medicine 378, no. 8 (2018): 691-693, doi: 10.1056/NEJMp1713159.CrossRefGoogle Scholar
Muhuri, P. K., Gfroerer, J. C., and Davies, M., “Assciations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States,” CBHSQ Data Review (2013), available at <http://www.samhsa.gov/data/2k13/DataReview/DR006/nonmedical-pain-reliever-use-2013.pdf> (last visited April 8, 2020).+(last+visited+April+8,+2020).>Google Scholar
Miech, R., Johnston, L., O'Malley, P. M., Keyes, K. M., and Heard, K., “Prescription Opioids in Adolescence and Future Opioid Misuse” Pediatrics 136, no. 5 (2015): e1169-1177. doi: 10.1542/peds.2015-1364.CrossRefGoogle Scholar
Guarino, H., Mateu-Gelabert, P., Teubl, J., and Goodbody, E., “Young Adults' Opioid Use Trajectories: From Nonmedical Prescription Opioid Use to Heroin, Drug Injection, Drug Treatment and Overdose,” Addictive Behaviors 86 (2018): 118-123, doi: 10.1016/j.addbeh.2018.04.017.CrossRefGoogle Scholar
British Pain Society, Opioids for Persistent Pain: Good Practice: A Consensus Statement Prepared on Behalf of the British Pain Society, the Faculty of Pain Medicine of the Royal College of Anaesthetists, the Royal College of General Practitioners and the Faculty of Addictions (London: British Pain Society, 2010); Chou, R., Fanciullo, G. J., Fine, P. G., Adler, J. A., et al., “American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel: Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain,” Journal of Pain 10, no. 2 (2009): 113–30; Noble, M., Treadwell, J. R., Tregear, S. J., Coates, V. H., Wiffen, P. J., Akafomo, C., and Schoelles, K. M., “Long-Term Opioid Management for Chronic Non-cancer Pain,” Cochrane Database Systematic Reviews 1 (2010): 1–64.Google Scholar
Davey, P., Brown, E., and Charani, E., et al., “Interventions to Improve Antibiotic Prescribing Practices for Hospital Inpatients,” The Cochrane Database of Systematic Reviews 4 (2013): CD003543; Malani, A. N., Richards, P. G., Kapila, S., Otto, M. H., Czerwinski, J., and Singal, B., “Clinical and Economic Outcomes from a Community Hospital's Antimicrobial Stewardship Program,” American Journal of Infection Control 41, no. 2 (2013): 190-197.Google Scholar
Weiner, S. G., Price, C. N., and Atalay, A. J., et al., “A Health System-Wide Initiative to Decrease Opioid-Related Morbidity and Mortality,” Joint Commission Journal on Quality and Patient Safety 45, no. 1 (2019): 3-13.CrossRefGoogle Scholar
See SAMHSA, supra note 28.Google Scholar
See CDC, supra note 3.Google Scholar
See McGinty, supra note 40; Parker, A. M., Strunk, D., and Fiellin, D. A., “State Responses to the Opioid Crisis,” Journal of Law, Medicine & Ethics 46, no. 2 (2018): 367-381.CrossRefGoogle Scholar
Supra note 23.Google Scholar
Supra note 17.Google Scholar
Supra note 35.Google Scholar
Supra note 19.Google Scholar
Supra note 24.Google Scholar
Supra note 25.Google Scholar
Supra note 17.Google Scholar
Supra note 18.Google Scholar
Supra note 17.Google Scholar
Supra note 24.Google Scholar
Supra note 25.Google Scholar
Supra note 18.Google Scholar
Supra note 23.Google Scholar
Supra note 22.Google Scholar
Supra note 35.Google Scholar
Supra note 20.Google Scholar
Supra note 17.Google Scholar