Good news, bad news: Opioid prescriptions down in Pennsylvania, but ...
The latest numbers for the state’s Prescription Drug Monitoring Program show a 12 percent decrease in opioid prescriptions in the last quarter of 2017 over the previous year, part of an effort to slow the amount of pain pills finding their way to street dealers who sell them to addicts, sometimes with fatal consequences.
But despite that significant drop, the number of people dying from opioid overdoses continues to rise, and some experts question whether public health officials know what a healthy number would be for prescriptions written for opioids in Pennsylvania, considering the steep rise in their use over the last two decades.
The federal Centers for Disease Control and Prevention, in its 2017 annual surveillance report of drug-related risks and outcomes, lists overprescribing of opioids as one of the main causes of today’s epidemic. The CDC report also says the majority of heroin users say their journey to drug addiction began with prescription opioids.
Dr. Joanna Starrels, an associate professor of medicine at Albert Einstein College of Medicine in New York City, said reducing the number of prescriptions remains key to stemming the opioid epidemic, but added that “to a larger extent, the cat is already out of the bag.”
“We’re struggling to play catch up now,” she said. “And the real challenge in reducing the number of opioid prescriptions is no one is really sure what the correct number should be.”
Dr. John Gallagher, chair of the Pennsylvania Medical Society’s opioid task force, agreed.
“Any decrease in prescribing is to be celebrated,” Gallagher said. “But prescription opioids, even at these lessened levels, are still three times higher than the prescribed levels in 2000.”
Pennsylvania — which more than a year ago started the monitoring program that requires doctors to report all opioid prescriptions they write to a state agency — ranked fourth-highest in the United States for drug-related deaths last year, according to the CDC report. Lehigh Valley officials have said they expect 2017 opioid-related deaths, when finally tabulated, to set a record.
And the real challenge in reducing the number of opioid prescriptions is no one is really sure what the correct number should be
Dr. Joanna Starrels, Albert Einstein College of Medicine in NYC
Even with Gov. Tom Wolf’s recent disaster declaration for the “heroin and opioid epidemic” raging across Pennsylvania, and with programs like the state’s prescription drug monitoring program, Starrels, Gallagher and other experts expect opioid deaths to keep rising for the next several years, as public health officials struggle to create the programs necessary to combat the epidemic.
According to the office of the Pennsylvania physician general, opioid prescriptions for the last quarter of 2017 totaled 2.5 million, down 12 percent from the 2.8 million written in the last quarter 2016.
Physician General Rachel Levine, a medical doctor who has made combating the opioid epidemic a priority, said reducing the number of opioid prescriptions is part of the progress taking place on many fronts.
“The opioid epidemic has been developing over the last 20 to 30 years and there aren’t any short-term fixes to eradicate it,” Levine said.
She said the first step in what she called opioid stewardship is helping physicians “judiciously” prescribe opioids.
She said Wolf’s administration has worked with physicians, dentists and medical societies to develop prescribing guidelines for patients ranging from pediatrics to those who suffer from chronic pain. State officials are also working with the deans of the state’s medical schools to develop curricula for medical students on how to prescribe opioids, Levine said.
Gallagher, of the Pennsylvania Medical Society, said the group is concerned that the outcry over the opioid epidemic will make it difficult for doctors to prescribe medication for patients who truly need it.
“In the ’90s, we were told we were undertreating patients’ pain,” Gallagher said. “Now we are told we are prescribing too many. There is a clinical medical ground we have yet to reach.”
A decade ago, the number of deaths involving prescription opioids were higher than deaths from heroin and cocaine combined, according to the CDC. But since 2010, many drug-overdose deaths are linked to deadly synthetic opioids like fentanyl, often in a combination with other drugs, both illicit and prescribed.
While Gallagher and others say reducing prescriptions is an important step in stemming the tide of deaths related to the opioid epidemic, they also see it as a way of limiting the number of new opioid users who could be susceptible to abuse.
Opioids have a “vital role” when used properly to treat patients with chronic pain, Gallagher said, while noting that the longer a patient uses an opioid, the greater the risk of dependency.
And when unused opioids are available, “they are easily diverted for personal use or financial benefit,” Gallagher said.
The opioid epidemic has been developing over the last 20 to 30 years and there aren’t any short-term fixes to eradicate it.
Pennsylvania Physician General Rachel Levine
He estimates the opioid death rate will increase 20 to 30 percent over the next several years. Starrels, the professor at Albert Einstein College of Medicine, believes it will likely be several years before the rate of the thousands of deaths connected to opioids begins to drop.
Federal statistics also show a slowing of opioid prescriptions in Pennsylvania, although the state’s percentage of opioid prescriptions per 100 patients was higher than the national average in 2016, according to the CDC.
Pennsylvania’s rate in 2016 was 69.5 percent of retail opioid prescriptions per 100 patients, a decrease from the previous year’s rate of 75.5 percent, according to the CDC.
In 2016, the national rate was 66.5 percent, the agency’s website shows.
Although opioid prescriptions are falling in some areas, the prescribing rates continue to be “very high” in areas across the country, according to the CDC. Some counties — mostly in the South — have rates seven times higher than the national overall prescribing rate.
Parts of the Lehigh Valley region had a lower overall prescribing rate than that national average of 66.5 percent. They include Lehigh County (48 percent), Northampton (66.4 percent), Montgomery (59.4 percent), Bucks (66.4 percent) and Berks (59.2 percent).
Despite those counties ranking lower than the national average, several were still noted as “emerging hotspots” by the CDC, including Northampton, Montgomery and Berks counties.
Several counties surrounding the Lehigh Valley have prescribing rates higher than the national average, including Carbon (74 percent) and Schuylkill (79.2 percent). The closest Pennsylvania county labeled as a “hotspot” by the CDC is Northumberland County (95.2 percent).
Similar to the state monitoring program that saw a 12 percent drop in opioid prescriptions, Geisinger Health System also uses an electronic health record that targets specific sites that may be distributing large number of opioid prescriptions, according to spokesman Mark Gilger.
The system has helped Geisinger reduce the number of opioid prescriptions in the last three years from an average of 60,000 prescriptions a month to 31,000, Gilger said. The company serves customers in Pennsylvania and New Jersey.
Highmark insurance company has also seen a drop in opioid prescriptions, spokeswoman Leilyn Perri said. She said opioid prescriptions per 1,000 commercially insured adults were down 15 percent in 2017 compared with the previous year. Highmark could provide no specifics on the number of opioid prescriptions, and that drop is based on customers in Pennsylvania, West Virginia and Delaware.
Some states — New Jersey, Maryland, Florida and Illinois — also noted drops in opioid prescriptions in 2016 from the previous year, according to the most recent figures available from the CDC.
Not all experts share the grim belief that opioid deaths will continue to climb.
Dr. Priya Mammen, director of public health programs and an emergency room doctor at Thomas Jefferson University Hospital in Philadelphia, said she hopes this is the year the death toll may begin to show signs of reversal. She said in the last few months of 2017, there was a drop in opioid overdose patients at her hospital’s emergency room.
“It’s never too little, too late,” Mammen said. “People are dying and we must do everything we can to prevent that.”
States with the highest rate of prescribing opioids in 2016
Numbers are based on per 100 patients: Ranged from 32.5 in the District of Columbia to 121 in Alabama.
Source: Centers for Disease Control and Prevention