According to a recent report commissioned by the Office of National Drug Control Policy, as many as 1.5 million Americans were chronic heroin users in 2010. Such statistics add further fuel to concerns about rising narcotics abuse and drug-related deaths.
Over the past five years alone, heroin deaths have increased by 45 percent--an increase that officials blame on the rise of addictive prescription drugs such as Vicodin, OxyContin, Percocet, codeine, and Fentora, all of which are opioids (derivatives of opium).
According to Gil Kerlikowske, director of the U.S. Office of National Drug Control Policy, approximately 100 Americans died from drug overdoses each day in 2010.
Prescription painkillers were responsible for 16,600 deaths that year, and heroin was involved in about 3,000 deaths. (Meanwhile, cocaine use decreased by about 50 percent between 2002 and 2010.)
The reason for the resurgence of heroin is in large part due to it being less expensive than its prescription counterparts, and US officials now warn that narcotic painkillers are a driving force in the rise of substance abuse and lethal overdoses. According to the US Justice Department, prescription opiates and heroin are two of the most lethal substances available.
Prescription Narcotics—A Driving Force in Rising Substance Abuse
This connection finally received some media attention following the death of Philip Seymour Hoffman, a 46-year-old Oscar-winning actor. He died from heroin overdose. Hoffman entered rehab when addiction to prescription painkillers led him to switch to heroin.
US Attorney General Eric Holder recently announced his office is taking steps to address the problem head-on. This effort includes but is not limited to tracking drug overdose trends, educating health care professionals and the public about prescription drug abuse, and promoting programs shown to prevent such abuse.
The federal government will also require manufacturers of extended-release and long-acting opioids to provide prescribers with educational programs explaining the risks and benefits of opioid therapy, and how to select appropriate candidates for such therapy. Also, as reported by Reuters:
“As part of that campaign, Holder reiterated the Obama administration’s call for more law enforcement agencies to train and equip personnel with an overdose-reversal medication called naloxone... Holder said 17 states and the District of Columbia have amended their laws to increase access to naloxone, a blocking agent that can reverse the effects of an overdose and help restore breathing.”
But such efforts have completely missed those at greatest risk for a drug overdose, i.e. those who use such drugs per doctor’s orders. Twenty-seven percent of the highest-risk users get their drugs from their doctor even when they’re using the drug nonmedically for 200 or more days per year... CDC Director Tom Frieden M.D., M.P.H recently echoed the study’s authors when he said that:
“Many abusers of opioid pain relievers are going directly to doctors for their drugs. Health care providers need to screen for abuse risk and prescribe judiciously by checking past records in state prescription drug monitoring programs. It’s time we stop the source and treat the troubled.”
Another JAMA study notes that, of the drug overdose deaths occurring in Tennessee between 2003 and 2010, more were caused by prescription drugs than heroin and cocaine combined. Incredibly, between 2007 and 2011, one-third of the population of Tennessee filled at least one prescription for an opioid each year... According to the authors:
“High-risk use of prescription opioids is frequent and increasing in Tennessee and is associated with increased overdose mortality. Use of prescription drug–monitoring program data to direct risk-reduction measures to the types of patients overrepresented among overdose deaths might reduce mortality associated with opioid abuse.”
Doctors Are Prescribing More Sedatives Than Ever
In related news, preliminary research presented at the 2014 meeting of the American Academy of Pain Medicine in Phoenix, Arizona found that 12.6 percent of all primary care visits made by Americans between 2002 and 2009 involved prescriptions for sedatives and/or narcotic painkillers (opioids). The study also found that:
- The number of prescriptions for sedative drugs rose by 12.5 percent a year
- Patients receiving a narcotic painkiller were 4.2 times more likely to receive a second prescription for a sedative
- The number of joint prescriptions of opioids and sedatives also increased by 12 percent a year in that time frame
- Prescription sedatives and narcotic painkillers are responsible for at least 30 percent of narcotic painkiller-related deaths
- Besides deaths caused by overdose, other risks associated with sedative use include falls in the elderly, emergency room visits, and drug dependence
According to co-author Dr. Ming-Chih Kao, a clinical assistant professor at Stanford University Medical Center: “Doctors need to be better educated about the risks of combining the two medications, and there needs to be better coordination between those who prescribe narcotic painkillers (often primary care doctors or pain specialists) and those who prescribe sedatives (often primary care doctors or psychiatrists).”
FDA Clamps Down on Painkiller Prescriptions, But Approves New Pure Hydrocodone Product
The US Food and Drug Administration (FDA) recently recommended tighter controls on painkiller prescriptions, and has announced its intention to reclassify hydrocodone-containing painkillers from a Schedule III to a Schedule II drug. The drug schedule system classifies medications based on their potential for abuse and addiction, as well as other medical criteria. The reclassification will affect how hydrocodone-containing drugs can be prescribed and refilled. Doctors will only be allowed to prescribe a 90-day supply of the drug per prescription, and they will no longer be permitted to phone in refills.
Rather, the patient has to bring the prescription with them to the pharmacy. The new regulations are expected to take effect sometime this year. Ironically enough, while talking about the need for stricter controls and less addictive painkillers, it recently approved the first drug containing pure hydrocodone for the US market, called Zohydro ER (Zogenix). All other hydrocodone-containing painkillers on the market are mixed with other non-addictive ingredients.
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