Opioid Prescriptions On the Decline, But Is That Actually Good News?

Although the nationwide opioid crisis has been making front page news for quite some time, some headlines are proclaiming a positive development: last year, the number of prescriptions for opioid painkillers fell drastically, representing the biggest drop in 25 years. The increased public awareness pertaining to addiction and the potential for fatal overdoses has certainly made an impact — and it’s also led to an increase in medical treatments to combat opioid addiction. But the dip in opioid prescriptions could have some unintended consequences that might take the epidemic even further.

Currently, the U.S. is responsible for 30% of worldwide opioid consumption. Since the 1990s, opioids have seen a major resurgence, prescribed frequently by doctors and sought after by those wanting to feel high. Considering that over 1.5 billion people worldwide suffer from chronic pain, medical professionals were quick to offer opioids like oxycodone to provide relief.

Unfortunately, drugs like this come with an incredibly high risk of addiction. Not only are prescription opioids meant to be taken for around-the-clock pain management (rather than on an as-needed basis), but these drugs literally change the way someone’s body responds to pain. And when a patient takes these drugs in high doses or fails to do so in the way it was intended, the high they feel has been compared to that of heroin (another opioid).

It’s also proven to be just as deadly. Opioid-driven drug overdoses were the leading cause of accidental death in the U.S. in 2015, with 20,101 fatal overdoses being attributed to prescription painkillers. Opioids kill more than 115 people every day and it’s estimated that roughly 2.6 million people are currently suffering from opioid use disorder.

Recently, efforts have been made to curb the epidemic. The CDC released the first-ever national guidelines for prescribing opioids two years ago, which recommended that doctors recommend conventional pain relievers first and prescribe only a few days’ worth of opioids when necessary. Opioid prescriptions have actually been declining since 2011, but the drop has become more pronounced since 2016.

According to a report from IQVIA’s Institute for Human Data Science, nationwide opioid prescriptions filled by retail and mail-order pharmacies dropped by an average 8.9% from 2016 to 2017. In 18 states, opioid prescriptions declined by 10%, but all 50 states and the District of Columbia saw declines of at least 5%. The trend continued in 2017, with a 12% decrease in total dosage of opioid prescriptions from the previous year. The drop can be at least partially attributed to prescriptions of shorter durations and lower doses, as well as a 7.8% decrease in new patients starting opioid prescriptions.

Furthermore, the unintended consequences of opioid prescription reductions are becoming evident. Many people who once relied on prescription painkillers now find themselves turning to alternative methods of managing their pain, but without proper guidance, these alternatives could be just as harmful. Some patients, especially those with chronic pain, have reported feeling abandoned by healthcare providers after these restrictions are put in place, making them more vulnerable to seeking out illicit substances as a means to cope. Without sufficient support, this gap could leave many struggling individuals without the necessary tools to manage their pain safely and effectively. This highlights the need for better access to opioid addiction treatment and more comprehensive care that addresses both pain management and the underlying issues that contribute to addiction.

Legal ramifications play a role, of course, but many experts highlight increased public awareness about addiction and overdoses as another reason for the decline. And over the past two years, the number of new monthly prescriptions for opioid addiction treatment medications has nearly doubled. While the federal government estimates that only 20% of those struggling with opioid addiction are currently receiving treatment (and only one-third of that 20% are being treated with the three medications actually approved by the FDA), it’s possible that more patients are realizing that they have a problem and need to seek help.

That said, some experts believe that restrictions on opioid prescriptions could have the exact opposite effect that was intended. It’s possible that because prescription opioids are more difficult to get in the long-term, this could be to blame for the spike in heroin and fentanyl overdose fatalities. Another recent study suggests that opioid deaths are barely impeded by opioid prescription monitoring programs — partially because they’re inconsistent from state-to-state and partially due to what’s called the “substitution effect,” when those addicted to prescription opioids will switch to something else (e.g., heroin) when they can’t access their original drug of choice. Because heroin and other non-prescription opioids have an unknown purity and quality, they carry an increased risk of accidental overdose and death.

Researchers ultimately concluded that restricting the supply of prescription opioids had very little effect on the demand, which often represents a total waste of resources with little to show for it. Increased access to mental health treatment and evidence-based substance use treatments may make a real difference, considering that many of those who struggle with addiction end up self-medicating with their drug of choice. Around 15% of adults over the age of 60 suffer from mental health disorders, which doesn’t even include statistics from the rest of the adult population. Additional community support and social services, researchers add, may also make a more substantial dent in the number of addicted individuals and overdoses.

So while some may rejoice at the thought that prescription opioids aren’t being prescribed as readily as they once were, it’s important to look at the real picture. Prescription drugs are only one piece of a complex puzzle — and the nation is not even close to solving it yet.