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Despite Decrease in Prescription Opioid Abuse, ‘Use Disorders’ Rise

New evidence corroborates opioid crisis

Although the number of people reporting the use of prescription opioids for nonmedical reasons fell between 2003 and 2012, use disorders and overdose deaths increased during the same period, according to a new study published in the Journal of the American Medical Association. The finding was based on survey data from 472,000 individuals.

As reported by Reuters, the rate of nonmedical use of opioids –– i.e., not using a prescription as directed, or using a prescription that was written for someone else –– fell from 5.4% to 4.9% over the 10-year period, but the rate of use disorders rose from 0.6% to 0.9% percent. The number of people reporting opioid use for more than 200 days also increased.

The increase in use disorders in the new study suggests that “more patients are experiencing an inexorable progression from initial opioid use to frequent use,” the authors noted.

The Centers for Disease Control and Prevention recently granted 16 states a total of $20 million to study safe prescribing practices and to reduce the availability of prescription opioids.

According to national statistics, drug overdose deaths involving prescription opioids increased from 4.5 to 7.8 per 100,000 people between 2003 and 2013. The proportion of prescription opioid users with use disorders also increased, from 12.7% to 16.9%. These numbers could come down if clinicians reduce inappropriate opioid prescribing and develop new, safer treatments for pain, lead author Dr. Beth Han of the New York University School of Medicine said.

In a letter published in the same issue of JAMA, other researchers found that from 2004 to 2013, the use of treatment options for opioid use disorders in inpatient, outpatient, hospital, office, emergency room, jail, or self-help center settings did not change relative to the number of opioid users. The number of settings treating patients for opioid use disorders did increase, but medication-assisted treatment may not be available in inpatient settings, the authors reported.

“Not everybody is going to want or need the same treatment,” said Brendan Saloner of the Johns Hopkins Bloomberg School of Public Health in Baltimore, who coauthored the letter. But access to appropriate treatments, such as methadone maintenance programs, is important, Saloner commented. Opioid addiction is a chronic condition, like diabetes, and medications can help manage it, he told Reuters Health by phone.

“The last decade has been a time of rapidly growing numbers of people dying from opioid overdoses,” he said, but “the ability of the health system to detect and provide timely access to treatment does not seem to be improving much.”

“There still are 17 states that don’t cover methadone maintenance” under Medicaid, despite the fact that methadone maintenance has the strongest evidence base of increasing recovery rates, he added.

Source: Reuters, October 13, 2015

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