Prescription Medications are Contributing to the Opioid Epidemic—You Can Be Part of the Change

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. Both the direct prescribing of opioids for pain as well as the abundance of these dangerous drugs in our medicine cabinets and communities, were a significant driver of the opioid epidemic. According to the Centers for Disease Control and Prevention (CDC), nearly 2 million Americans, age 12 and older, either abused or were dependent on prescription opioids in 2014.

An estimated 11 percent of adults experience daily (chronic) pain. The evidence is mounting that chronic pain is often better managed through non-opioid treatment. When opioids are prescribed, it is important to ensure that it is done safely. In 2017, new regulations were put in place in Delaware that are intended to support safer opioid prescribing and better pain management practices. With guidance from the state’s Addiction Action Committee (AAC), we have developed tools to give you a clearer picture of what’s expected of prescribers; how to prescribe opioids safely; how to use non-opioid approaches to manage pain; and how to prevent, identify, and appropriately refer individuals with addiction.

Delaware’s opioid death rate is on the rise

Deaths due to opioid use continue to increase in Delaware. In 2017, 345 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 2016. According to the National Institute on Drug Abuse, 80 percent of heroin users in the United States first misused prescription opioids. Also, the Centers for Disease Control and Prevention (CDC) estimates that 25 percent of individuals who use opioids to treat chronic pain develop an Opioid Use Disorder (OUD).

Opioid-related overdose death rate per 100,000 persons, 1999-2016 (Age Adjusted)


Number of drug poisoning deaths in Delaware, 2007-2016

*2016 data are preliminary.

Source: Delaware Department of Health and Social Services, Division of Public Health, Delaware Health Statistics Center, 2017

CDC ranked Delaware first in the nation for high-dose opioid prescription

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 BCBS 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 more those who fill low-dose, long-duration regimens.

In 2012, Delaware was the leading state for the prescription of high-dose opioids. The figure below shows high dose prescribing trends in Delaware. According to CDC’s Annual Surveillance Report of Drug-Related Risks and Outcomes (2017), the high-dose opioid prescribing rates show improvements. Therefore, it is critical that we remain steadfast in our focus on decreasing high-dosage opioid usage — and if opioids are used, the lowest effective dose should be prescribed.

Annual High Dose (≥90MME/day) Prescribing Rates per 100 Persons

The Need for Change

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