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July 30, 2017
Ohio doctors cut opioid prescriptions, but experts say it's not enough
By JoAnne Viviano
FRANKLIN COUNTY, Ohio —The amount of opioid pain killers prescribed in Franklin County dropped by 41 percent from 2010 to 2015, but doctors still were prescribing the equivalent of a 14-day supply of the drugs for every person in the county, according to federal data.
Across Ohio, prescriptions for opioids decreased by at least 10 percent in all but 13 of 88 counties. In nine counties, the rate remained relatively stable. In four others — Hocking, Morrow, Ottawa and Van Wert — prescriptions for opioids increased by at least 10 percent, according to the Centers for Disease Control and Prevention (CDC).
Ohio Attorney General Mike DeWine said the numbers are consistent with what he sees when he travels the state.
"We have started to turn this around, but it's tough to change the culture, and the culture in this case I'm talking about is the culture of prescribing," he said. "We're moving in the right direction, but we still have a ways to go."
Across the country, the amount of opioids prescribed dropped by 18 percent. Prescriptions hit a high of what would be the equivalent to 782 milligrams of morphine per person in 2010, falling to 640 by 2015. That's still three times higher than it was in 1999, said Dr. Anne Schuchat, principal deputy director of the CDC.
While nearly half of all U.S. counties saw a significant decrease in prescriptions from 2010 to 2015, nearly 23 percent saw an increase of at least 10 percent, according to the numbers, based on raw prescription data obtained from QuintilesIMS, a pharmaceutical analytics company.
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A crackdown on the unnecessary prescription of drugs has gone on for years as law enforcement officers and state legislatures seek to curb the deadliest drug overdose epidemic in U.S. history. Users of the drugs often become addicted to the prescription pills and then move on to opioid-based street drugs, DeWine said. Three-fourths of people addicted to heroin or the far more powerful fentanyl and carfentanil started with pain medications, he added.
Doctors have become increasingly aware of the opioid problem with the knowledge that 15 to 18 percent of people are susceptible to developing a chemical dependency, said Dr. Steven Severyn, director of the Pain Services and Pain Medicine Fellowship at Ohio State University Wexner Medical Center.
As such, they have come to think not only about clinical risks when prescribing the drugs but also about risks to the community and society at large.
"Prescription narcotic medication really is the dominant form of narcotic use, at least early in drug addiction," Severyn said. "Physicians are responding to that understanding by being certain that the use of medications for the treatment of pain is appropriate in dosing and frequency and, especially, escalation."
In Ohio, Jackson County topped the 2015 list, with doctors prescribing 1,582 morphine milligram equivalents per person, representing a 33-day supply of the drug for each resident. Others at the top were Jefferson, Washington, Pike and Ross counties.
Vinton County saw a 98 percent decrease from 2010 to 2015, dropping to 6 morphine milligram equivalents per person, the lowest in Ohio. Also at the bottom were Holmes, Noble, Paulding and Mercer counties.
In central Ohio, decreases were seen in Delaware (30 percent), Fairfield (28 percent), Licking (19 percent), Pickaway (24 percent) and Union (15 percent) counties. Madison County remained relatively stable, with an increase of just 2 percent. Still, the counties each prescribed the equivalent of at least a 10-day supply of the drugs for every person in those counties in 2015.
Severyn noted that pain medications are still being prescribed because they are the only option for some people who are suffering.
"The other side of the argument, and the difficulty with pain medication, is that often it is the only tool that we really have for the treatment of painful conditions," he said. "They're very necessary."
But a new standard involves helping a patient improve function, not necessarily eliminating pain. Severyn said his program prescribes as few opioids as possible, using other pain management techniques, including surgeries, psychological support, physical therapy, injections, nerve ablation and device implantation.
Physicians have taken a lead and become accountable in addressing the opioid problem, but more needs to be done, especially when it comes to the amount of attention and resources focused on treating people who are addicted, said Reginald Fields, Ohio State Medical Association spokesman.
He said the association assists doctors by offering Smart Rx, an online training program that helps health-care providers stay up to date on rules and regulations regarding opioids. It also gives them best practices for treating pain and offers tips on how to educate patients about the opioid problem.
Also addressing the problem is the Ohio Board of Pharmacy, which has developed prescription guidelines targeted to emergency departments and to physicians who handle chronic or acute pain, said spokesman Cameron McNamee. The board also offers education on best practices, encouraging doctors to look at alternatives before prescribing drugs.
McNamee said the board also focuses on regulations. He pointed to 2014 Ohio legislation that requires doctors to use a prescription-drug monitoring program, which allows them to track whether a patient has received prescriptions from other health-care providers. A proposal going before the legislature's Joint Committee on Agency Rule Review this week would limit the amount of opioids that can be prescribed for acute pain, he said.
"A vast majority of people that develop addiction and move on to heroin or fentanyl use start with prescription opioids," McNamee said. "As we make progress in reducing the amount of legal opioids prescribed, we will start seeing an impact in the amount of people dying of heroin and fentanyl overdoses."