Prescription Opioids: Risk Management and Strategies for Safe Use _ _________________________________ Between 1992 and 2003, the U.S. population increased 14%, while persons abusing opioid analge- sics increased 94% and first-time nonmedical opioid analgesic users 12 to 17 years of age increased 542% [47]. To assist in monitoring the public health prob- lem associated with prescribed opioids, numerous governmental, nonprofit, and private sector agencies and organizations are involved in collecting, report- ing, and analyzing data on the abuse, addiction, fatal overdose, and treatment admissions related to opioid analgesics ( Table 7 ) [62]. remained significant. ARCOS indicated that 9.7 bil- lion dosage units of opioid controlled prescription drugs were manufactured and distributed in 2019. Of that number, approximately 78% were oxycodone and hydrocodone products [64].
Prescribing rates are down overall, but they vary widely between states, particularly at the county level. The nationwide prescribing rate for 2018 was 51.4 prescriptions per 100 persons, yet some coun- ties had rates that were seven times higher than the national average. For example, Alabama and Arkansas had the highest prescription rates (just under 100 prescriptions for 100 people), while New York and Hawaii had the lowest rates at 34.0 and 33.4 prescriptions per 100 people, respectively [64]. FACTORS THAT INFLUENCE OPIOID ANALGESIC PRESCRIBING A decision to prescribe opioids is based on clini- cian knowledge and judgment and also on patient preference, availability of non-opioid pain treatment approaches, the complexities and bias in third-party reimbursement, aggressive pharmaceutical market- ing, and medico-legal concerns. These and other factors have tended to skew the standard of care toward reliance on opioids for long-term chronic pain management in the past few decades [8]. The use of patient satisfaction as a barometer of clinician skill may also influence opioid analgesic prescribing. Satisfaction with clinical care can be obtained from patient surveys, commonly includ- ing questions about how adequately their pain was addressed by the provider. Numerous for-profit provider-grading websites offer patients a forum to broadcast their opinions of care received from physicians. Healthcare professionals are likely to get a poor rating from patients who were refused opioids over abuse concerns, and reimbursement and job security can be adversely impacted by nega- tive patient survey ratings in some institutions [65]. The financial structure of many managed care firms and third-party carriers incentivizes pain treatment and discourages substance abuse or addiction treat- ment. From a financial reimbursement perspective, the time spent providing patient education and counseling related to addiction issues has become
As of April 2020, 40 states have passed laws that address opioid analgesic prescribing. State-specific legislation, medical and pharmacy boards, Medicaid programs, department of workforce services, and workers’ compensation programs have adopted policies, guidelines, and regulations that place limits on prescribing opioid analgesic medications and/or require monitoring of opioid prescriptions. Many insurance companies and managed healthcare organizations have also implemented policies related to limitations on opioid analgesic prescriptions. This has led to a general downward trend in total daily doses of opioids used, use of ER/LA opioid analgesics, and use of high-dose opioids. This trend began even before the release of the 2016 CDC guidelines for opioid prescribing. The use of ER/ LA opioid analgesics for chronic pain continues to decline year-over-year. As of 2023, more than 90% of opioid prescriptions have been for immediate-release opioids or short-acting opioids [63]. In 2020, the Drug Enforcement Agency’s Automa- tion of Reports and Consolidated Orders System (ARCOS) reported that the number of dosage units distributed nationwide at the retail level (i.e., hospi- tals, pharmacies, practitioners, treatment programs, and teaching institutions) was down from 2018. However, opioids continued to rank as fifth out of the seventh most distributed controlled prescrip- tion drugs. Hydrocodone and oxycodone products were dispensed at more than twice the rate of any other controlled prescription drug, which remains a steady trend [64]. Although the amount of pre- scription opioids available on the legitimate market has declined each year since peaking in 2011, the number of prescription opioids available in 2020
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MDMS1526
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