Study: Targeting Prescription Misuse Alone Not Enough to Turn the Tide in Opioid Fight

By Jonathan Springston, Editor, Relias Media

Although focusing on reducing the number of needless prescriptions written for opioids is important, the results of an investigation published earlier this month suggest this tactic alone will not be nearly good enough to dramatically reduce opioid-related deaths in the United States.

Using data from the National Survey on Drug Use and Health (NSDUH) and the CDC that was collected between 2002 and 2015, researchers conducted a systems dynamic model study. In this mathematical model of the U.S. opioid epidemic, investigators reproduced observed trends in opioid misuse and opioid overdose deaths in the United States from 2002 to 2015. Then, they used the model to project outcomes of simulated individuals who engage in nonmedical prescription or illicit opioid use from 2016 to 2025.

The researchers estimated the yearly and total opioid overdose deaths that might occur between 2016 and 2025. Further, the investigators considered whether these deaths would be caused by prescription opioids or illicit opioid use under four different scenarios: no change in annual incidence of prescription opioid misuse from 2015 and beyond; a decline in the incidence of prescription opioid misuse of 7.5% per year (this is the same rate observed from 2008 to 2015, per the NSDUH data) from 2016 to 2025; a decrease in the incidence of prescription opioid misuse of 11.3% annually; and no new incidence of prescription opioid misuse after 2015.

If current conditions hold, the researchers projected the number of opioid-related overdose deaths would rise from 33,100 in 2015 to more 81,700 in 2025. Most of the 81,700 deaths in 2025 would be related to illicit opioids (67,900). The remaining 13,800 projected overdose deaths in 2025 would be related to prescription opioids, a rate that actually would mark a 3% decline from 14,200 such deaths reported in 2015.

“Across all interventions tested, further lowering the incidence of prescription opioid misuse from 2015 levels is projected to decrease overdose deaths by only 3.0% to 5.3%,” the authors wrote. Even under the most optimistic projected scenarios, the investigators found that the number of opioid-related deaths in 2025 would outpace the reported 2015 figures.

“This study’s findings suggest that interventions targeting prescription opioid misuse such as prescription monitoring programs may have a modest effect, at best, on the number of opioid overdose deaths in the near future,” the authors concluded. “Additional policy interventions are urgently needed to change the course of the epidemic.” They suggested improving access to treatment, expanding harm-reduction interventions, and lowering exposure to illicit opioids.

Two recent episodes of the ongoing Rounds With Relias podcast series center on opioids. In one episode, an insider provides practical advice for reducing drug diversion at healthcare facilities and protecting patients. In another episode, listeners can learn how leaders in the field are working to combat the crisis and how providers can avoid burnout while treating this deadly epidemic.

In addition to Relias Media’s expansive book, The Opioid Epidemic 2018: Policies, Treatments, Alternatives, our writers continue investigating the battle from many angles in our subscription publications. In the upcoming March issue of ED Management, author Dorothy Brooks explores how small, rural facilities, often hamstrung by a lack of access to resources, are finding innovative ways to help patients presenting with addictions.

When it comes to prescription opioids, some states are collecting more data to learn what is happening and address the root causes. To learn about such a program in Ohio, check out the upcoming March issue of Same-Day Surgery.

Certainly, healthcare providers are looking to reduce opioid-related deaths by focusing less on mindlessly writing prescriptions and turning their attention instead to pain management alternatives. For example, in the upcoming March issue of Hospital Case Management, author Melinda Young talks to case managers who are turning to physical therapy to help patients alleviate chronic pain.