10 Opioid Epidemic Updates

1. Death by Overdose.

Says the CDC, most drug overdose deaths in the US involve an opioid: > 33,000 opioid-related deaths in 2015 accounted for 63% of drug overdose deaths. Overdose deaths that involve opioids have quadrupled since 1999; 91 Americans die from an opioid-related overdose every day.

2. High Morbidity and Mortality.

High rates of morbidity and mortality were seen in patients with opioid use disorder in a general health care system. Deaths were confirmed in 18.1% of study participants, corresponding to a crude mortality rate of 48.6 per 1000 person-years and standardized mortality ratio of 10.3. The leading causes of death were drug overdose and disorder (19.8%), cardiovascular diseases (17.4%), cancer (16.8%), and infectious diseases (13.5%, including 12% hepatitis C virus).

3. Opioid Deaths Underestimated.

The Minnesota Department of Health (MDH) identified 2253 opioid toxicity deaths among state residents aged > 12 years during 2006-2015 through its Unexplained Death surveillance system. The MDH concluded that the total burden of opioid-associated deaths was underestimated because sorting out the contributions to death of opioid toxicity, infectious disease, and their interactions is difficult.

4. Increased Odds for Chronic Opioid Use.

In opioid naïve, cancer-free adults who received a prescription for opioid pain relievers, the likelihood of chronic opioid use increased with each additional day of medication. The highest probability of continued opioid use at 1 and 3 years was observed in patients who started on a long-acting opioid. Awareness that a second prescription doubles the risk of opioid use 1 year later might deter overprescribing of opioids.

5. Opioid Complications after Surgery.

New persistent opioid use after surgery is more common than previously reported. It’s not significantly different between minor and major surgical procedures but is associated with behavioral and pain disorders, suggesting that its use is not due to surgical pain but addressable patient-level predictors. New persistent opioid use may be considered one of the most common complications after elective surgery.

6. Overuse Driven by Physician Prescribers?

Researchers compared rates of long-term opioid use in a retrospective analysis of Medicare beneficiaries who had an ED visit and had not received prescriptions for opioids within 6 months before. Rates of opioid prescribing varied widely between low-intensity and high-intensity prescribers. Rates of long-term opioid use were increased among patients who had not previously received opioids and received treatment from high-intensity opioid prescribers

7. Risk Index Supports Decision-making.

Researchers conducted a case-control analysis to validate a risk index that estimates the likelihood of overdose or serious opioid-induced respiratory depression in medical users of prescription opioids. The Risk Index for Overdose or Serious Opioid-induced Respiratory Depression had excellent predictive accuracy in a large population of US medical users of prescription opioids. The index is designed to support clinical decision-making for safer opioid prescribing.

8. Drug Monitoring Mandates Reduce Opioid Rxs.

In an analysis of Medicaid drug utilization data, state mandates for prescriber registration with or use of a state’s prescription drug monitoring program adopted in 2011-14 were associated with a 9% to 10% reduction in population-adjusted numbers of CII opioid prescriptions received by enrollees and in Medicaid dollars spent on the prescriptions. The findings support the use of state mandates of registration in prescription drug monitoring programs.

9. Opioids Stored Unsafely in Homes with Kids.

Among adults who had used a prescription opioid pain reliever (OPR) in the past year and had children in their home, safe storage was reported by 32.6% of those with only young children, 11.7% of those with only older children, and 29.0% of those with children in both age groups. Conclusion: Educational messages should address perceived barriers related to safe storage to reduce OPR access among children.

10. Three Steps to Safety.

A new AMA Task Force to Reduce Opioid Abuse recommendation urges physicians to take these 3 steps: (1) Talk with patients, emphasizing that opioids should be used only as directed and that misuse or diversion of prescribed medications can be illegal and deadly; (2) Remind patients to store their medications safely; and (3) Urge patients to dispose of unused medications.