Opioid Prescribing On The Decline for Both Cancer and Non-Cancer Patients: Study

Amid efforts to reduce opioid prescribing in the U.S., more patients began choosing non-opioids for pain relief

Following efforts in recent years to address the nationwide opioid abuse pandemic, and widespread concerns about overprescription of the powerful and addictive pain medication, a new study suggests that the rates of opioid prescriptions have dropped in the U.S., both among cancer and non-cancer patients.

A number of healthcare interventions have been implemented to increase the use of pain management treatments that do not involve narcotic painkillers, and those efforts appear to be working, according to findings published last week in the medical journal PLOS One.

Researchers from Johns Hopkins Bloomberg School of Public Health and the University of Michigan used administrative claims data from the IBM MarketScan Research Databases, which included information for privately insured adults who were continuously enrolled in insurance for at least one calendar year from 2012 to 2019, covering 26.1 to 53.1 million patients covered by 100 insurance companies in the US.

The study compared patients diagnosed with cancer and those with pain from other conditions, such as arthritis, headaches, low back injuries and or neuropathic pain. Overall, researchers found that fewer patients are taking opioids to treat pain, while the rates of non-opioid painkiller use remain steady.

Patients Starting to Prefer Non-Opioids

According to researchers, the number of patients who received opioid painkiller prescriptions dropped. Among those with non-cancer pain, opioid prescriptions decreased from 85% to 79%. For those with cancer, prescriptions decreased from 50% to 31%.

At the same time, slightly more cancer patients began using non-opioid pain medications. In fact, rates of non-opioid pain medication use held steady. For those with non-cancer pain, rates changed from 67% to 66%. For those with cancer, use rates went from 74% to 79%.

Among patients who were prescribed opioids, including patients treated for both cancer and non-cancer pain, fewer patients received extremely high doses of the narcotic drugs. There was also a decrease in patients who received greater than 90 morphine milligram equivalents per day from 14% in 2012 to 5% in 2019 among non-cancer pain patients and from 26% in 2012 to 8% in 2019 among cancer patients.

The average morphine milligram equivalent use dropped among non-cancer patients from 50 to 38% of patients and among cancer patients from 62 to 45% of patients.

The number of patients with a greater than seven-day supply of high doses of opioids decreased from 56% to 31% among those with non-cancer pain and decreased from 48% to 23% for those with cancer pain.

The average number of opioid prescriptions also dropped from five to four for non-cancer pain patients and from four to three for cancer patients.

Additionally, more patients with non-cancer pain began using non-pharmacologic therapies, and treatments like applying heat or ice, massage therapy, transcutaneous electrical nerve stimulation (TENS) unit therapy, physical therapy, spinal cord stimulation, acupuncture, and meditation. However, the increases were moderate, rising from 62% of patients to 66%.

“Overall, from 2012–2019, opioid prescribing declined for non-cancer pain and cancer, with larger reductions for patients with non-cancer pain. For both groups, reductions in prescribed opioids outpaced increases in non-opioid alternatives,” wrote study authors.

Opioid Overuse Has Caused Nationwide Addiction Problems

Recent research has indicated opioids should no longer be used to treat back pain, spurring new guidelines that only recommend the use of opioids for cancer pain. However, according to a study involving 2019 data, nearly one-quarter of US adults with chronic pain admitted to using opioids in the last three months.

Other research indicates long-term opioid prescriptions and high-doses increase the risk of abuse and adverse events, including overdoses. Furthermore, many children are given high risk opioid prescriptions that can lead to misuse and abuse later.

In recent years, the opioid epidemic has worsened, ultimately accounting for nearly 70% of all overdose deaths, according to a 2018 study.

The crisis has largely been spurred by the use of synthetic opioids, like fentanyl which is 50 to 100 times more powerful than morphine. Fentanyl deaths increased more than 1,000% in recent years.