Rate plateaus as doctors are urged to recommend nondrug pain treatments
By Amy Norton
MONDAY, Oct. 23, 2017 (HealthDay News) -- The number of Americans abusing prescription painkillers has leveled off in recent years, but there is no apparent decline yet.
That's the finding of a new study tracking the U.S. opioid abuse problem. Researchers found that after a large spike in the early 2000s, Americans' misuse of prescription opioid painkillers has plateaued in recent years.
Still, the issue isn't going away: By 2014, the most recent survey year, close to 14 percent of U.S. adults and teenagers had ever abused the drugs -- which include Vicodin (hydrocodone), OxyContin (oxycodone) and morphine.
The findings underscore the importance of giving patients alternative ways to manage pain, said lead researcher Dr. Asokumar Buvanendran, vice chair of anesthesiology at Rush University Medical Center in Chicago.
There are times when people need short-term pain relief with opioids.
But for most long-term pain (unrelated to cancer), opioids are generally no better than a placebo, Buvanendran said.
And the risks of opioids -- including addiction and overdose -- are well-known.
A recent government study found that Americans' death rate from opioid overdoses more than tripled between 2000 and 2015. That included deaths from prescription painkillers and heroin.
Many experts blame loose prescribing practices for getting people hooked on painkillers. Various medical organizations have come out with guidelines aimed at reining in opioid prescriptions.
The U.S. Centers for Disease Control and Prevention says the first-line treatments for chronic pain should be nonopioid medications and nondrug options, such as physical therapy and cognitive behavioral therapy.
And when opioids are prescribed short-term, patients should only be given a few days' worth of pills, at the lowest dose, the CDC says.
But it takes time for guidelines to be put into practice and show effects in the real world, Buvanendran said.
"I don't have a crystal ball," he said. But, he added, the plateau in Americans' prescription opioid abuse might turn into a decline in the next few years.
Buvanendran was scheduled to present the findings Sunday at the annual meeting of the American Society of Anesthesiologists, in Boston.
Another study presented at the meeting suggested that progress is being made in opioid prescribing. Looking at more than 1 million patients who had hip or knee replacements, researchers found that 1 in 4 were given opioids alone after surgery in 2006.
By 2014, only 1 in 12 got just an opioid painkiller. Instead, more patients were getting additional pain treatments such as anti-inflammatories and nerve block injections -- and lower opioid doses.
Buvanendran's findings come from a government survey done between 2000 and 2014.
From 2000 to 2002, there was a sharp rise in the number of Americans who'd ever abused prescription opioids -- from less than 9 percent, to more than 13 percent.
That figure held fairly steady over subsequent years, standing at 13.6 percent in 2014.
What's needed to get that number down?
For one, people who already have an opioid problem need treatment, said Alexandra Duncan. She is a senior officer with the substance use prevention and treatment initiative at the nonprofit Pew Charitable Trusts.
"Medication-assisted treatment" is considered most effective for opioid dependence, Duncan said. That means counseling along with any of three approved drugs: buprenorphine, methadone or naltrexone.
The medications work by blocking the effects of opioids or by easing withdrawal symptoms.
Yet many people with opioid dependence don't have access to the medications, according to Pew. Studies show that only a minority of public and private drug-abuse treatment programs offer the medications, for example.
Adequate funding for opioid treatment should be a priority, Duncan said.
Then there's the issue of stigma, she added. "We need to ensure that people feel comfortable seeking help," Duncan said.
As for preventing opioid abuse, she said, one way is through state-run prescription drug monitoring programs.
The programs electronically track prescriptions for controlled substances, and doctors can check them before prescribing opioids. That can help catch "doctor shoppers" -- people who go from one provider to the next, seeking a new opioid prescription.
According to Buvanendran, patients can do their part by disposing of unused prescriptions properly. Extra pills left sitting around can be misused by someone else.
But don't simply drop the pills in the garbage, he said. The safest route is to return the drugs to the pharmacy, if possible, or to a drug "take-back" program at a local police station.
Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.
The U.S. National Institute on Drug Abuse has more on opioids.
SOURCES: Asokumar Buvanendran, M.D., vice chair, anesthesiology, Rush University Medical Center, Chicago; Alexandra Duncan, Dr.P.H., M.P.H., senior officer, substance use prevention and treatment initiative, Pew Charitable Trusts, Washington, D.C.; Oct. 22, 2017 presentation, American Society of Anesthesiologists annual meeting, Boston
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