States React to the Overdose Epidemic

(Summer 2018) American deaths related to opioids have now increased four-fold from 2000 to 2016. Currently, these drugs account for 115 deaths a day, with 46 of those being attributed to an overdose of prescription medications such as oxycodone, hydrocodone and methadone. Although opioid prescriptions can be effective in pain management, they also come with a high risk of misuse that often leads to addiction or death as well as high utilization of community resources. To address the growing problem, 28 states have taken steps to create opioid prescription limits.

The current epidemic is propelled by both prescription abuse and illicit drug use, but the root of the issue appears to be prescription opioids. Research shows that most illicit users started by misusing prescription medications first. Studies conducted by the Centers for Disease Control and Prevention (CDC) correlate this with the fact that opioid prescriptions for pain have increased dramatically since 1999, although Americans’ complaints of pain have not varied significantly. Even with a drop from 2010 to 2015, the number of opioids prescribed is now three times higher than 1999.

The CDC responded in 2016 by releasing its “Guideline for Prescribing Opioids for Chronic Pain” to primary care providers. This is a collection of recommendations to be considered on a voluntary basis when physicians are prescribing to patients 18 years or older. The focal point is chronic pain management and is not directed at patients in active cancer treatment, palliative care or end-of-life care. The guide also addresses acute pain, recommending that the quantity prescribed should not last longer than the pain is expected to continue, noting that three days is often enough and more than seven days should be rare.

Recent years have seen state legislatures also working to address this issue. In 2016, Massachusetts was the initial state to pass a law limiting first-time opioid prescriptions to seven days. By the end of the same year, another seven states had laws limiting these types of prescriptions as well. Similar laws were passed in 2017, and by the end of 2018’s first quarter, 28 states had laws on the books outlining opioid prescription parameters. Most of the legislation addresses quantity limits on first-time prescriptions, but some states set dosage limits as well. Almost half of the states make it clear that their restrictions are for acute situations and make allowances for chronic diagnoses, cancer and palliative care.

In addition, states are addressing the issue through other efforts. They are effectively utilizing prescription drug monitoring programs, and requirements for training and education of providers have been established in many states along with routine take-back campaigns. Meanwhile, the availability of naloxone, the opioid-overdose reversal medication, has greatly increased. As all of this has been taking place, some states are also focusing on passing laws related specifically to pain clinics.

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