Has our nation’s reliance on prescription painkillers gotten out of hand? (Stephen Lam/Corbis)
The epidemic of opioid overdoses is continuing to take its deadly toll on Americans: The rate of deaths involving prescription painkillers like Oxycontin and Vicodin more than tripled between 1999 and 2012, according to a new CDC report. The heroin-related death rate is also on the rise, increasing nearly threefold in the same time period.
Despite these troublesome numbers, the CDC analysis did reveal one encouraging trend: From 2011 to 2012, the rate of prescription painkiller-related deaths dropped by 5 percent, marking the first such decrease in more than a decade.
“The rate of drug-poisoning deaths involving opioid analgesics is now starting to level off,” Dr. Holly Hedegaard, a CDC epidemiologist who worked on the report, tells Yahoo Health. However, she cautions, this decline wasn’t statistically significant. “I wouldn’t say this is the start of a downward trend — the death rate is just not increasing at the pace that it was between 2000 and 2006, when it was increasing about 18 percent per year,” she says. “What will it be like in 2013 or 2014? There’s no way I can project that.”
Dr. Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing, takes a similarly conservative approach in interpreting the new data. “I don’t think there’s anything to celebrate about until we see opioid overdose deaths in general coming down,” he tells Yahoo Health. “And that hasn’t happened yet.”
The burgeoning opioid epidemic can be traced back to the late 1990s, when doctors began aggressively prescribing the drugs for chronic pain — a shift that Kolodny, also chief medical officer for Phoenix House, a nonprofit addiction treatment agency, blames on marketing campaigns launched by the makers of prescription painkillers.
“The message was that the compassionate way to treat complaints of pain — even common conditions like low-back pain, fibromyalgia, headache — was with an opioid prescription,” Kolodny says. Doctors were told that these patients didn’t face a high risk of addiction, “since the maker of Oxycontin saw a fear of addiction as a barrier to sales,” he says.
Consequently, as the rate of opioid prescriptions rose, there were parallel increases in addiction and overdose deaths.
Of course, not all of the nation’s overdoses occur in opioid addicts — the death rates include young people experimenting for the first time and patients with chronic pain who accidentally take too many pills. “Those deaths are significant,” Kolodny says. “But the vast majority of deaths are occurring in people who are likely to be opioid-addicted.”
These aren’t necessarily the young pill poppers you might expect: The average painkiller overdose occurs in an adult between the ages of 45 to 54, says Kolodny. “It’s middle-aged folks,” he says. “This is a group that doesn’t have to switch to heroin because they’re able to get pills from doctors. In fact, the increase in overdose deaths and medical visits for opioids has been greatest in the middle-aged and elderly population.”
However, he adds, “I do think the medical community is beginning to recognize that we made a big mistake. So the medical community is beginning to prescribe more cautiously, which is what needs to happen to bring the epidemic under control.”
But even that isn’t without its downside: As prescription painkillers become tougher to acquire, the shift to heroin may continue to accelerate.
Starting in the early 2000s, some painkiller addicts — often those who used the drugs recreationally — began switching to heroin (also an opioid), probably because it was easier to acquire. “They have a harder time getting painkillers because they’re young and don’t have any medical issues,” Kolodny explains.
That may explain why heroin overdoses typically occur in 20-somethings, who are “actually dying at a much lower rate than the middle-aged and older folks who can get these pills directly from doctors,” he says. One explanation: Heroin users typically take lower doses of the drug, compared to prescription pill users, since they’re unable to afford or acquire more. By contrast, “the pain patients are getting massive, massive doses from doctors,” Kolodny says. “And they don’t have to run around for it. Their insurance is paying for it.”
In 2012, there were about 6,000 overdoses involving heroin, compared to 16,000 involving prescription painkillers, according to the CDC report. Even so, heroin overdosing is a growing issue: Unlike the rate of deaths due to prescription painkillers, which recently declined, the heroin death rate leapt 35 percent from 2011 to 2012 alone.
Part of the problem: Young addicts are often afraid to seek medical attention for friends who overdose, reducing their odds of survival. “They use with their peers frequently — they’ll inject together, they’ll buy drugs together,” Kolodny says. “When a peer has overdosed, people are afraid to call 911, because the police might come on the scene, and they’re worried they’ll get arrested.” Some states have passed Good Samaritan laws to circumvent this problem, yet the overdose rate is still rising.
Similarly, efforts to curb prescription painkiller abuse — for example, creating “abuse-deterrent” capsules — don’t seem to be as effective as hoped. “Making pills harder to crush and snort doesn’t make them less addictive,” says Kolodny.
And although the CDC has named ending opioid abuse a top priority, “the Food and Drug Administration continues to approve new opioids and continues to let them be marketed for conditions where they’re not safe or effective,” he says. “There are states across the country struggling to do what they can, but they’re really not getting the support they need from the federal government.”
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