Some states are still prescribing more than they were ten years ago.
The U.S. has entered a frightening new phase of the opioid epidemic. According to the Centers for Disease Control and Prevention (CDC), fentanyl and other synthetic opioids have replaced prescription opioids as the leading cause of drug overdose deaths in the country. The pharmaceutical version of fentanyl—anywhere between 50-100 times more potent than morphine—is typically reserved for patients with terminal illnesses, like late-stage cancer.
In recent years though, overdose deaths tied to illicitly-made fentanyl have risen a shocking 72 percent.
The number of deaths attributed to synthetic opioids isn’t just historic—the opioid epidemic is already the deadliest drug epidemic in the United States—it’s also the result of the way we, as a culture, have learned to manage pain. Prescribing practices condoned by some of the most powerful healthcare organizations in the country have contributed to a dangerous trend. And though prescription practices are improving in many parts of the country, they’re still rising in hotbed regions for overdoses. Read on to learn more about how we got here—and where pill mills continue to profit.
Quick, Not Painless: The Roots of Overprescribing
From 1999 to 2010, the number of prescription opioids sold to pharmacies, hospitals, and doctors’ offices nearly quadrupled.
“While pain is very difficult, we found ourselves in a situation where we were taking much more powerful medication than we necessarily needed,” said Ronne Ostby, a vice president at ICF. “Because those medications were being prescribed by a doctor, people felt that they were safe.”
Ostby—who previously led strategy development for the White House National Youth Anti-Drug Media Campaign—and ICF Senior Manager Rosanne Hoffman work with the CDC to develop opioid misuse research, communication campaigns, and educational resources. They say that our overbearing approach to pain management, despite the fact that Americans aren’t actually experiencing more pain than they were a few decades ago, is one of the most powerful catalysts of the crisis.
The emergence of pain as the “fifth vital sign” (following temperature, pulse, breath, and blood pressure) in 1995 encouraged more lenient prescribing practices. Suddenly, it became easier than ever to simply take a pill as a quick and painless means of treating even minor discomfort. Because these medications were sanctioned by doctors, people also felt more comfortable sharing them with family members and loved ones—a practice that further undermined their power and increased the likelihood that anyone could become dependent.
“People don’t realize just how addictive and dangerous these medications are,” said Hoffman. “It’s not the same as giving ibuprofen to a friend who has a headache.”
Prescription Opioids and the Transition to Illegal Substances
In response to the worsening crisis, the American Medical Association (AMA) has since recommended that pain no longer be designated as a vital sign. But our cultural response to pain has changed and our expectations of pain management—both the speed and comprehensiveness with which it’s treated—are higher.
Most people who are using and addicted to heroin, says Ostby, started using opioids through prescriptions. Over time, those taking the drugs find it incredibly difficult to wean themselves off without experiencing painful withdrawal symptoms, or “dope sickness.” From there, it’s a slippery slope, as the cost of procuring expensive (and often regulated) prescription opioids increases. In some cases, even patients who don’t want to be taking opioids find that alternatives aren’t covered by their insurance provider and treatment isn’t readily accessible.
It’s usually at this point that many people make the transition to cheaper, illicit, and even more powerful substances like fentanyl and heroin.
“Once you’re at the point where you’re crushing your prescription opioids into fine dust so that you can sniff them,” said Ostby, “heroin use is like a lock to follow on behind that.”
Mapping State-by-State Prescription Trends
Although the national average has decreased and more counties now report prescribing data — meaning we have a clearer picture than ever before of where prescription rates are rising — many areas of the country are still prescribing more opioids than they were ten years ago. We created the below infographic to illustrate where those increases have occurred.
Reflecting on Critical Errors and Mapping the Path Forward
Regardless of its roots, the nuanced and swift evolution of the opioid crisis has made it exponentially more difficult to understand and treat. According to public health officials and clinical professionals like Scott Gottlieb, Food and Drug Administration (FDA) Chief and Physician, a range of stakeholders made critical mistakes in the early days of the epidemic by failing to recognize its virulence or scope.
“We didn’t get ahead of it. Nobody got ahead of it,” said Gottlieb, at a recent National Academy of Medicine conference. "The type of action we need to take to finally (address) this crisis is going to be far more dramatic than we would have had to do had we made certain decisions years ago."
Knowing where we’ve missed the mark has helped experts better understand what can move us forward, including prescription limits, better access to treatment, prevention-focused awareness campaigns, and improved provider education. How have you seen the opioid addiction manifest in your community? What should we be doing to help patients, providers, and communities develop better approaches? Tell us what you think on Facebook, Twitter, or LinkedIn.