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Amid opioid crisis, Minnesota sees significant decline in painkiller prescriptions

Minnesota health care professionals dispensed about 9 percent fewer prescriptions for controlled opioid painkillers in 2016 than they did in 2015, according to the Minnesota Board of Pharmacy.

The data comes amid an opioid epidemic that continues to crescendo in Minnesota and the U.S. Between 2000 and 2015, opioid overdoses killed 2,273 Minnesotans, and nationally, they have contributed to more than 200,000 deaths since 1999.

For most drugs, the state wouldn’t expect to see a decline in prescriptions: Minnesota’s population is growing and getting older, which generally means a steady rise in drugs dispensed over time, said Cody Wiberg, the executive director of Minnesota’s Board of Pharmacy. But opioids are not most drugs. Among the most common versions of the drugs, Minnesota saw a decline in prescriptions of hydrocodone/acetaminophen (aka Vicodin) of 13 percent, while oxycodone (OxyContin) went down by one percent, tramadol (Ryzolt) by 6 percent  and oxycodone/acetaminophen (Percocet) by 13 percent.

Altogether, filled opioid prescriptions tracked by the state dropped from about 3.87 million in 2015 to 3.53 million in 2016. (The number of filled prescriptions for some opioid painkillers are not available prior to 2015.)

Prescriptions filled in Minnesota for common opioid painkillers
The number of prescriptions filled for Hydrocodone/Acetaminophen, Oxycodone/Acetainophen, Tramadol HCl and Oxycodone HCl/Acetaminophen — the most commonly prescribed opioids — declined in Minnesota in 2016.
Source: Minnesota Board of Pharmacy/Prescription Monitoring Program

The declines in Minnesota are consistent with declines reported nationally. IMS Health, an organization that tracks prescriptions, found a 12 percent drop in opioid prescriptions nationally from their peak in 2012 to 2016, according to The New York Times.

Raising awareness

With widespread media attention focused on deaths due to overdoses each year, awareness of the risks of opioid addiction has likely contributed to the drop-off in prescriptions, said Jason Varin, assistant professor in the Department of Pharmaceutical Care and Health Systems at the University of Minnesota’s College of Pharmacy.

Attitudes about prescribing opioids have also changed since the 1990s, when advocacy groups argued that their use was a more compassionate way to treat pain. Relying on a few small studies, they downplayed the risk of addiction to the drugs, said Dr. Bret Haake, a neurologist and clinical researcher at Health Partners.

Those risks were deemphasized by the pharmaceutical industry, too: Purdue Pharma, the company that manufactures OxyContin, once told doctors their extended-release formula carried less risk of addiction than shorter-acting opioid painkillers. (Purdue would eventually plead guilty to charges misleading the public on the claim, an admission that cost the company $600 million.)

Fewer downplay the risk of addiction now. “I would argue that there is very very limited pain diagnoses [they’re] appropriate for,” Haake said.

One reason opioid addiction can be so catastrophic is that some people who become hooked and can’t satisfy their addiction with prescription medication turn to heroin, often a cheaper fix than buying prescription opioids on the street. The number of deaths due to heroin in Minnesota has climbed in tandem with those due to opioids, according to Minnesota Department of Health data.

Opioid painkiller-related deaths in Minnesota, 2000-2015
The number of Minnesotans dying of overdoses related to opioid painkillers has increased since 2000.
Source: Minnesota Department of Health

Monitoring prescriptions

Changes in the rules for prescribing some opioids could also be changing prescribers’ behaviors, Varin said. Hydrocodone, for example, an ingredient in some prescription opioids, was reclassified in 2014 in a way that made it harder to prescribe and disallowed refills.

Wiberg says he’d like to think there’s another factor in the declining number of opioid prescriptions being dispensed in Minnesota: the state’s Prescription Monitoring Program.

That program, in use since 2010, tracks all controlled substance prescriptions for drug schedules II through V in Minnesota, and the number of queries to the system by medical providers has seen a steady increase.

Last year, in the hopes of preventing doctor shopping by opioid abusers, the Legislature passed a bill requiring all prescribers and pharmacists to establish accounts with the registry. The hope was that the professionals would use those accounts to check the prescription monitoring system for patients’ prescription histories, though prescribers are not required to do so under the law.

Legislating opioids

Rep. David Baker, R-Willmar, one of the most vocal legislators on the subject of opioids at the capitol, says he’s encouraged that the number of opioid painkiller prescriptions appear to be dropping. For him, the issue is personal. His son Dan was prescribed Vicodin for a back pain when he was a junior at St. Thomas University. He became addicted to painkillers and died of a heroin overdose in 2011 at age 25.

Baker and a group of legislators from both parties, including  Sen. Chris Eaton (DFL-Brooklyn Center), who lost her daughter to a heroin overdose in 2007, Rep. Debra Hilstrom (DFL-Brooklyn Center) and Sen. Julie Rosen (R-Vernon Center), have proposed legislation that Baker hopes could lead to further declines in opioid prescriptions in Minnesota.

Among other things, language included in the health and human services finance bill, debated in the House of Representatives Friday, would limit the terms of opioid prescriptions prescribed by dentists to four days, and propose requiring pharmacists to give patients information that explains the addictive potential of the drugs, as well as instructions on how to properly dispose of the drugs.

Baker said he’s optimistic that this session will bring about reforms, but said there’s still work to be done — especially in raising more awareness. “We’ve got more work to do, but this is a good starting point,” he said.

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Comments (3)

going to pot

In my non medical opinion many of these dangerous drugs could be replaced by a combination of pot and ibuprofen. Neither of which are as dangerous as opioids or acetaminophen.

Neither of which are as effective

Neither of which are as effective as opiates for severe pain, and ibuprofen is not without dangerous side effects (doctors won't prescribe it much for people past 60 for risks of bleeding). Probably pot and a strong counterirritant capsaicin cream or gel would do the job without any risk at all until we are talking about terribly severe pain.

If you have been shot, stabbed, had sciatica so severe you could not move much without shrieking, went through a bad delivery, broken a bone then maybe you have a more accurate way to really calibrate that 1 to 10 scale of pain health care folks are always asking you about. Sciatica was my new 9 or 10, but there may be worse pain ahead that will recalibrate my answers. If you live long enough and are unfortunate, someday you may have an accurate scale of pain severity; lets hope not, but be thankful we have opiates.

The fact is, when you need an opioid pain killer, nothing much else will do unless what is causing your pain magically disappears; but if you do have chronic pain that severe, you had better learn to deal with it some other way than opiates or you will live a miserable life, perhaps dying from that use.

Physicians have been handing out opioid prescriptions for pain equivalent to not much more than a moderately annoying hangnail. As they are seldom needed, prescriptions must decline; for the dozens of opioid prescriptions I have had, I only needed one along with whatever I was given post this surgery or that injury, and if I had been given just a dozen doses, healed or gotten the proper therapy, I would have any more.

If we had all those natural remedies like opium, marijuana, chamomile, instead of being prescribed, sold, and addicted to all the souped up versions of the same by various parties like physicians, drug pushers and the like, we'd have been much better off now as far as the societal problems related to opiate addiction. To get there, beyond physicians just using their knowledge and common sense, perhaps we need to calibrate everyones scale of pain, maybe at 13; we could probably produce that pain without injury, letting everyone determine what pain is to them, more accurately. I hope the lower prescription levels are symptomatic of that change.

Since we can never know, just that it feels better when you can visualize instantly transferring your level of pain to someone who deserves it (not quite opiate level relief, but it does give a little rush; maybe it is addictive as well), we really should have a baseline, something today's evidence based medicine often lacks perhaps making it less than useless, perhaps even damaging.

A physician friend of mine

...called acetaminophen "the most dangerous drug in your medicine cabinet". He was referring to common OTC nostrums usually found in the home.