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Opioid overdose deaths are skyrocketing

Monday, Mar 20, 2017

* From the latest edition of the Annals of Surgery, which has been published since 1885

We are running out of ways to emphasize how dire the opioid overdose crisis has become. In 2015, United States drug overdose deaths exceeded 50,000; 30,000 involved opioids. There were more deaths from opioid overdose than not only from motor vehicle accidents, but also than from HIV/AIDS at the peak of the epidemic in 1995.

The role of surgeons is important for 2 reasons. First, we are likely to encounter many patients on chronic opioids. Older estimates suggest 5% of the general population use opioids chronically. Cron et al found that patients seeing surgeons may have significantly higher rates of use, with 21% of general surgery patients at the University of Michigan Medical Center using opioids at home prior to surgery.

Second, emerging evidence suggests that surgeons are unwittingly enablers of addiction, abuse, and overdosage. Waljee et al5 cite administrative data suggesting that 3% to 10% of opioid-naive patients who receive narcotic prescriptions for low-risk surgery continue to take narcotics up to a year later. Moreover, the vast majority of prescription opiate abusers receive the drugs they use through diversion, most often from family members who have excess pills. And, as Hill et al document, surgeons frequently supply a large excess of pills, with 72% of narcotics prescribed for 5 outpatient procedures going unused. One hundred seventeen of 127 patients they tracked had excess pills; three-quarters retained the pills instead of disposing them. Cauley et al also found, in data from the National Inpatient Sample, that rates of postoperative opioid overdosage among patients undergoing inpatient surgery doubled over the last decade. Surgeons are proving to likely be a significant source of the opioid supply fueling the current epidemic.

* One way to address the problem

In 2010, however, the U.S. Drug Enforcement Agency issued regulations permitting electronic prescribing for controlled substances.11 Such systems have numerous advantages: they prevent duplicate and forged prescriptions by using 2-factor authentication; reduce dosing errors; cross-reference prescription monitoring program databases; and simplify the prescription process for doctors and patients. Electronic prescribing would make it far easier for surgeons to write smaller prescriptions that meet the needs of 80% of patients, or even 50%, knowing they could remotely order an additional supply if a patient needed it.

The technology is widely available, but few doctors use it. Although 81% of pharmacies are enabled to receive computerized opioid prescriptions; more than 90% of physicians have electronic medical record systems; and most can be enabled for controlled substances—only 8% of physicians are in practices that have enabled that capability and use it.

Doing so is clearly feasible. In March, 2016, New York promulgated stringent opioid prescription requirements, including mandatory use of electronic prescriptions. By then, half of the state’s doctors were already prescribing controlled substances electronically.

* Related…

* Opioid epidemic: Another drug war failure: Pot, in fact, appears to be saving lives. A 2014 study published in JAMA Internal Medicine found that states allowing medical marijuana had 25 percent fewer deaths from prescription drug overdoses than states forbidding it… Crackdowns have other unhealthy side effects. “When the police shut down a local pill mill, they rarely identify the users and help them get treatment, and heroin and fentanyl dealers are quick to move in to exploit the new business opportunity,” writes New York University professor Mark A.R. Kleiman in the March/April issue of Foreign Affairs. “In 2014, deaths from overdosing on prescription opioids fell, but deaths from fentanyl overdoses almost doubled.”

* Hearing continued for McHenry doctor accused of overprescribing pain pills

- Posted by Rich Miller        

20 Comments
  1. - wordslinger - Monday, Mar 20, 17 @ 12:18 pm:

    People are getting rich pushing prescription junk — often paid for by taxpayers — and they ain’t from south of the Rio Grande or banging in the hood.

    They’re the very best people — docs, corporate execs, their lobbyists, their marketers — pillars of the community.

    But now AG Sessions is promising a return to
    Reefer Madness law enforcement, claiming marijuana is just as dangerous as opiods. That’s a breathtaking combination of deadly ignorant and stupid.

    AL, by the way, where Sessions is big heat, leads the nation in opiod ODs per capita.

    The next death from a marijuana OD will be the first.


  2. - Lucci - Monday, Mar 20, 17 @ 12:18 pm:

    Illinois’ workers’ comp laws make the opioid problem worse

    https://www.illinoispolicy.org/illinois-employers-forced-to-subsidize-opioid-over-prescribing/


  3. - Amalia - Monday, Mar 20, 17 @ 1:06 pm:

    ah prescriptions that are dispensed for the use of people as needed. it is different with some drugs. for example, you must take all the antibiotics if prescribed (but please don’t keep asking for them as antibiotics in food and elsewhere are a problem.). you must do all of a course of steroid treatment, often a descending course of treatment, if prescribed. you may take vicodin/oxy if prescribed. one pill, two pills, more, or none. there are plenty of people who are in pain and actually need the drugs and get hooked. then there are people I know and love who just say it’s prescribed, I’m taking it because the doctor gave it to me. that is foolish. if you truly need meds, take them. if not, don’t. a wide discussion of the dispensing of prescription meds is needed.


  4. - The Real Just Me - Monday, Mar 20, 17 @ 1:07 pm:

    The IPI article referred to seems to blame doctors in the WC system for making the opioid problem worse. In fact, under the IL WC law, the fee for physician-dispensed medication including all opioids is just $4.18. It does not seem reasonable that a doctor would put her license on the line and make the “opioid problem worse” for an incentive of $4.18. Now if you want to say that big pharma and big pharma retail are gaming the IL WC system because there is absolutely no restriction on what they get reimbursed, then maybe you’re on to something.


  5. - Way Way Down Here - Monday, Mar 20, 17 @ 1:14 pm:

    I’ve attended three OD funerals in the past year. Two children of friends and the brother of another. Another friend’s thirtyish daughter badly broke a toe. The first MD, unsolicited, gave her a prescription for 10 Oxy. The follow-up MD gave her an unsolicited prescription for 50 Oxy. Just sayin’


  6. - Springfieldish - Monday, Mar 20, 17 @ 1:15 pm:

    If the IPI says it’s Monday, check a calendar.


  7. - Anonymous - Monday, Mar 20, 17 @ 1:20 pm:

    ’states allowing medical marijuana had 25 percent fewer deaths from prescription drug overdoses than states forbidding it’

    In Illinois, that would mean 350 people who wouldn’t have died of opioid overdoses in 2015.

    – MrJM


  8. - Lucci - Monday, Mar 20, 17 @ 1:23 pm:

    The Real Just Me:

    The IPI blog references the loophole that was used to skirt the $4.18 reg in the 2011 law.

    “For example, a January 2015 study from WCRI found that after the new rules took effect, doctors began prescribing hydrocodone-acetaminophen, commonly known as Vicodin, in a previously rare dosage at $3.04 a pill – double to quadruple the prices paid to physicians for the same drug of other existing strengths.”

    Johns Hopkins researchers chalked it up to some physicians who play this game responding to financial incentives. Workers’ Comp Research Institute has also identified the financial incentives as the key driver.

    https://www.researchgate.net/profile/Xuguang_Tao/publication/262148290_Effect_of_Physician-Dispensed_Medication_on_Workers%27_Compensation_Claim_Outcomes_in_the_State_of_Illinois/links/0deec53c3c7327d02e000000/Effect-of-Physician-Dispensed-Medication-on-Workers-Compensation-Claim-Outcomes-in-the-State-of-Illinois.pdf


  9. - Arthur Andersen - Monday, Mar 20, 17 @ 1:25 pm:

    To their credit, my doc’s practice group has cut way back on prescribing opioids. My sense is they’re among the minority so far here in the ‘Patch.


  10. - The Real Just Me - Monday, Mar 20, 17 @ 1:38 pm:

    Lucci, whether the pill costs $3 or $300, under IL WC law the doctor gets only $4.18 for dispensing it. The Average Wholesale Price of the pill is not set by the doctor. Like I said, you want to blame someone, blame big pharma, but that might include some IL manufactures.


  11. - Moby - Monday, Mar 20, 17 @ 1:47 pm:

    = In Illinois, that would mean 350 people who wouldn’t have died of opioid overdoses in 2015. =

    That report has been updated with provisional 2016 data, and the opioid od death numbers are even higher.


  12. - Lucci - Monday, Mar 20, 17 @ 1:49 pm:

    The Real Just Me:

    I don’t disagree that there is blame to go around, and it is not a good thing that manufacturers are immediately creating new drug amounts to get around the regulation. But it takes two to tango.

    It is not the $4.18 dispensing fee that is the source of the profits, it is the new dosage amounts with new wholesale prices that are being created to make the $4.18 dispensing fee regulation meaningless.

    And to that end, there are physicians involved in this who are choosing to prescribe new dosage amounts that have no medical benefits in order to capture the profit from the new “wholesale” price. Here is the full quote:

    “Illinois has tried to end repackaging abuse before. In 2011, a bipartisan effort sought to limit the financial incentives to physicians by limiting the price they could charge to the average wholesale price of the drug, plus a dispensing fee. But doctors and pharmaceutical companies were able to circumvent the rules by inventing new doses and assigning them significantly higher prices.

    For example, a January 2015 study from WCRI found that after the new rules took effect, doctors began prescribing hydrocodone-acetaminophen, commonly known as Vicodin, in a previously rare dosage at $3.04 a pill – double to quadruple the prices paid to physicians for the same drug of other existing strengths.

    Separate studies by WCRI and by researchers at Johns Hopkins University found no medical reason for doctors to prescribe the new doses.”


  13. - Collect Call From Rod.... - Monday, Mar 20, 17 @ 2:05 pm:

    The CDC says that those who are addicted to prescription opioids are 40x more likely to be addicted to heroin.

    The Governor could address the crisis by adding intractable pain or opioid dependence as qualifying conditions under the medical cannabis program.

    Instead, the administration removed intractable pain and opioid dependence as qualifying conditions in SB 10 last spring when they offered their deal.


  14. - don the legend - Monday, Mar 20, 17 @ 2:25 pm:

    This appears as another example of how politics trumps science and good public health policies. The evidence (medical marijuana) is pretty clear but our elected officials fear the backlash from opportunistic and hair on fire political opponents.


  15. - wordslinger - Monday, Mar 20, 17 @ 3:05 pm:

    –Like I said, you want to blame someone, blame big pharma, but that might include some IL manufactures.–

    Big Pharma created the market and are to blame. Purdue funded the whole “study” into “pain management.”

    But there are plenty of docs who took the swag — cruises, “honariums” for “speeches” and such to push the smack. And you can use the google and discover plenty of pill-pushing factories around the country where docs are writing scripts like robots.

    The WSJ and NYT have been on it for years. This New Yorker article is a good primer.

    http://www.newyorker.com/business/currency/who-is-responsible-for-the-pain-pill-epidemic


  16. - Jake From Elwood - Monday, Mar 20, 17 @ 3:28 pm:

    Most on this blog probably know someone who has died from an opiate OD. Prescription painkillers are being abused so often and when the doctors finally cut off the meds, the users then turn to street drugs. Fentanyl is a big problem in Will County.
    Sad but true reality.


  17. - wordslinger - Monday, Mar 20, 17 @ 4:04 pm:

    –Fentanyl is a big problem in Will County.–

    Fentanyl is stone-cold terrifying. We can’t get a handle on the Oxy epidemic, and here comes something 50 to 100 times more powerful than morphine.

    I’m not sure the Clown College that is Congress is capable of a national response to this emergency. Last year, Congress refused to fund emergency funding for opioid treatment because some GOP lawmakers like to pretend they’re fiscally prudent.

    The ask from Obama was $600M. No go.


  18. - The Real Just Me - Monday, Mar 20, 17 @ 4:11 pm:

    Lucci, please immediately report doctors who are prescribing unnecessary dosages and medicines to the Dept. of Professional Regulation. The vast majority of doctors who dispense medicine to their patients do so because they think in their sound medical judgment that their patients need it for one medical reason or another. It was not the doctors who “invented new dosages and assigned them significantly higher prices.” It was the big pharma manufacturers who did that, competing with each other in a free market. Maybe stricter regulation of the manufacturers’ pricing is the answer.


  19. - Retired ISP - Monday, Mar 20, 17 @ 4:58 pm:

    Not one comment has indicated any responsibility on the part of the patient…..there may be problems with big pharma, doctors, etc……but……..


  20. - Rabid - Tuesday, Mar 21, 17 @ 5:15 am:

    Treat it like cannabis, you need a background check and card before you can get it


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