Painkiller Overdose Problems Linked to Doctors’ Prescribing Practices: CDC

The findings of a new report suggest that drug overdose is the leading cause of injury death in the U.S., and doctor’s prescribing habits often contribute to this growing trend. 

The death rate from drug overdose in the United States more than doubled from 1999 to 2013, researchers from the U.S. Centers of Disease Control and Prevention (CDC) found in a study published in the agency’s October 16 issue of the Morbidity and Mortality Weekly Report.

According to the findings, one-third of these deaths were caused by the opioid painkiller methadone. The increase is attributed to the misuse and abuse of prescription drugs, especially narcotic painkillers, sedatives and stimulants.

The report focused on the prescribing pattern of controlled substances across the country using the Prescription Behavior Surveillance System (PBSS), a public system that allows public health authorities to track the use and misuse of prescription controlled drugs. The data is compiled from state Prescription Drug Monitoring Programs (PDMPP)s established in 2012 and funded by the CDC and U.S. Food and Drug Administration (FDA).

A person’s risk of overdose is directly associated with the use of multiple prescribing doctors and a daily dosage of 100+ morphine milligram equivalents (MMEs) per day, according to the findings.

The PDMPP tracked opioid usage in eight states, California, Delaware, Florida, Idaho, Louisiana, Maine, Ohio and West Virginia. These eight states represent all four U.S. Census Bureau regions and comprise one-quarter of the U.S. population.

In all eight states opioid narcotic painkillers, such as Vicodin and OxyContin, were prescribed twice as often as other drugs, such as stimulants or benzodiazepines.

People who receive opioid prescriptions often also received benzodiazepine prescriptions, Adderal or Ritalin, despite the increased risk for drug interaction side effects. These drugs were prescribed four times more often in certain states.

Uniform Prescribing Practices Needed

The CDC report indicates that in most states, narcotic painkiller prescription rates peaked in either the 45 to 54 year old category or the 55 to 64 year old group. Benzodiazepine rates increased with age.

Among the states observed, Louisiana ranked first in opioid painkiller prescribing. Despite the recent change in FDA requirements concerning long-acting extended release opioid drugs, Delaware and Maine had high rates of use extended-release opioids. Both Delaware and Maine ranked highest in the average daily opioid dosage and the percentage of opioid prescriptions written for greater than 100 MMEs per day.

The study found a small number of doctors were heavy prescribers. One percent of doctors wrote 25% of narcotic painkiller prescriptions in Delaware, compared to 12% in Maine.

Receiving prescriptions from multiple doctors contributed to abuse and overdoses, and was most frequent in Ohio and lowest in Louisiana. Most prescriptions were written by general, family medicine, internal medicine and midlevel doctors.

In West Virginia, for one of every five days of treatment with an opioid, the patient also was taking a benzodiazepine. The increased use of benzodiazepines was not consistent with the fact that anxiety is most common among adults 30 to 44, not older adults, the researchers found.

Research published this month revealed less people nationwide are using opioid painkillers for non-medical uses, misusing, abusing or taking the painkillers not as directed, yet this has led to an epidemic of painkiller abuse and increased rates of overdose deaths involving prescription narcotic painkillers.

During 2004 to 2011, the number of people seen in the emergency room because of misuse or abuse of prescription drugs increased 153% for narcotic painkillers and 124 percent for anti-anxiety or insomnia medications, like Ativan or Xanax.

Prescribing practices varied widely among states even though the conditions the drugs are meant to treat occur at similar rates. The researchers said that the findings reveal an urgent need for improved and more uniform prescribing practices, especially for narcotic painkillers.

A 2014 CDC study indicated people are taking more prescription drugs than ever. Prescription drug spending increased by 11% from 1990 to 2000. Another study published in 2013 revealed the use of narcotic painkillers doubled over the past 10 years, while use of other pain relievers did not increase.