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A prescription for change in Delaware.
Prescription medications contribute to the opioid epidemic. You can change that.
The nation’s opioid epidemic reflects a complex set of circumstances. Patterns of opioid prescribing, including dose, duration, quantity, co-prescribing and patient risk factors, are major determinants of whether a person becomes dependent or addicted to opioids. The prescribing of opioids for pain, as well as the abundance of these dangerous drugs in our medicine cabinets and communities, is significantly driving the opioid epidemic. According to the Substance Abuse and Mental Health Service Administration (SAMHSA), nearly 10 million Americans age 12 or older have misused pain reliever medication within the past year (National Survey of Drug Use and Health, 2018).
The Centers for Disease Control and Prevention (CDC) found that over 20% of adults in the United States reported chronic pain (National Health Interview Survey, 2016). Studies show that the preferred method of treatment for chronic pain is non-pharmacological therapy and non-opioid pharmacological therapy. Each patient should be assessed to determine if opioid therapy will improve pain and function with limited risks. Opioids should be used in combination with alternative therapies (CDC, 2016).
In 2017, Delaware issued new regulations for safer opioid prescribing and better pain management practices. These support the “CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016“. Delaware responded with new regulations intended to support safer opioid prescribing and better pain management practices. The state’s Addiction Action Committee (AAC) guided the development of this page. Readers can find the following tools:
- What is expected of providers
- How to prescribe opioids safely
- How to use non-opioid treatments for pain management
- How to prevent substance use disorder
- How to identify and appropriately refer patients struggling with addiction
Delaware’s opioid death rate is on the rise.
Deaths due to opioid use continue to increase in Delaware. In 2018, 400 individuals died from drug overdose, according to preliminary data from the Delaware Division of Forensic Science. Although illicit fentanyl usage has led to an increase in deaths, nearly 100 individuals died from non-fentanyl-related opioid prescriptions in 2017. According to the National Institute on Drug Abuse, 80% of heroin users in the United States first misused prescription opioids. Also, the CDC estimates that 25% of individuals who use opioids to treat chronic pain develop an Opioid Use Disorder (OUD).
CDC ranks Delaware first in the nation for high-dose and long-acting/extended-release opioid prescriptions.
Recent studies show that patients with high-dosage opioid prescriptions have much higher rates of opioid use disorder than do patients with low-dose prescriptions — across both short- and long-duration regimens. For example, a recent analysis by Blue Cross Blue Shield found that an opioid use disorder diagnosis is more than 40 times as likely in patients with high-dose, short-duration regimens than it is for those with low-dose, short-duration regimens. An opioid use disorder diagnosis is seven times more likely in patients with high-dose, long-duration regimens than it is for those with low-dose, long-duration regimens. The CDC found that the risk of opioid overdose death is 10 times more likely in those with prescriptions of more than 90 MM per day, compared with prescriptions of 20 MME or less per day. Long-acting/extended-release opioid prescriptions are associated with greater risk of opioid use disorder. Studies show that there are no clear differences in pain or function with long-acting/extended-release opioids, and more importantly, there is a greater risk of nonfatal overdose when starting treatment with long-acting/extended-release opioids (CDC, 2016).
Delaware continues to prescribe the most opioids over 90 MME and the most long-acting/extended-release opioids in the United States. The figures below show high-dose and long-acting/extended-release prescribing trends continue to lead the Delaware. According to the CDC’s Annual Surveillance Report of Drug-Related Risks and Outcomes (2017), opioid prescribing rates, including high-dose and long-acting/extended-release, continue to improve. It is critical that we remain steadfast in our focus on decreasing high-dose opioid usage and offer short-term opioid prescriptions. If opioids are used, prescribe the lowest effective dose.