Late last week, the Centers for Disease Control and Prevention released yet another disturbing report about how the prescribing of pain medications known as opioids has gotten terribly — and, all too often, tragically — out of control.
After analyzing prescription claims data for 2008-2012, the CDC researchers found that 39 percent of women aged 15 to 44 on Medicaid and 28 percent of those on private insurance were given — and filled — prescriptions for opioids by their physicians during those years.
Most commonly prescribed were the painkillers hydrocodone, codeine and oxycodone.
Those percentages are concerning because opioid use by pregnant women can double the risk of birth defects, including spina bifida, congenital heart defects and gastroschisis, a condition in which the baby is born with his or her intestines protruding from a hole near the navel.
“Many women of reproductive age are taking these medicines and may not know they are pregnant and therefore may be unknowingly exposing their unborn child,” CDC Director Dr. Tom Frieden, said in a statement released with the report.
Indeed, a study published last year in the journal Obstetrics and Gynecology reported that in 2007 almost one-quarter of pregnant women on Medicaid had been given — and filled — prescriptions for opioids during their pregnancy.
As the new CDC report points out, its Medicaid findings are particularly worrisome because half of all births in the United States occur among Medicaid enrollees.
And not only were women on Medicaid in the study more likely to be prescribed opioids, they were also more likely to receive multiple prescriptions for the drugs. Women with private insurance who were prescribed opioids filled an average of 2.6 prescriptions each, while those on Medicaid filled an average of 4.3 prescriptions.
That finding may be explained, the report says, by differences in what the two types of insurance cover, or in the way that women use each system’s health-care services, or, perhaps, in the underlying health conditions of the two groups of women.
The study also found that, among privately insured reproductive-aged women, opioid prescription rates were highest for those living in the South and lowest for those living in the Northeast. Racial/ethnicity data was available for the Medicaid data, and it showed that opioid prescriptions were almost 1.5 times higher among non-Hispanic white women than among non-Hispanic black or Hispanic women.
Billions at stake
The CDC report calls for “more targeted interventions and communications strategies … to reduce unnecessary prescribing and use of opioid-containing medications, particularly among women who might become pregnant.”
It urges health-care providers to talk with women about the risks of prenatal opioid exposure.
But a much more forceful effort than that will be needed. Prescription opioids are a multibillion-dollar-a-year industry. The pharmaceutical industry, aided in the past by patient-advocacy pain organizations with strong financial ties to opioid manufacturers, has been remarkably successful in pushing for a widening of the use of prescription opioids over the last 15 years or so — despite the lack of evidence that these drugs are safe or even effective for chronic, noncancer pain.
The result has been deadly. Since the late 1990s, when pharmaceutical lobbyists began persuading states to no longer restrict the use of opioids to cancer or conditions that cause short-term pain (less than three months), more than 100,000 Americans have died from prescription opioid overdoses.
Here’s how quickly the danger grew: Within just 12 years, the number of people dying from such overdoses quadrupled, from around 4,000 in 1999 to more than 16,000 in 2010.
Getting the message?
Doctors may, finally, be getting the message, however. Last fall, the American Academy of Neurology (AAN) issued the first position paper on prescription opioids by a major American medical specialty society. As I reported at the time, the AAN recommended to its members that they not prescribe opioids to people with headache, lower back pain, fibromyalgia or other noncancer conditions because the risks far outweigh the benefits.
The AAN paper also stressed that “reversing current opioid overdose epidemic trends will not be easily accomplished by informal or even mandatory education alone” — or, I might add, by suggesting, as the CDC does in its new report, that doctors simply discuss the dangers of prescription opioids with their patients.
Those tactics have been tried, with little effect. What’s required now — as the AAN paper underscored — is a revision of state and federal laws and policies. Lawmakers and policymakers need to start taking this prescription opioid epidemic seriously.
The CDC report was published last Friday in the agency’s publication Morbidity and Mortality Weekly Report (MMWR), where it can be read in full.