New data provide more evidence that individuals who abuse or are addicted to prescription opioids are switching to heroin and synthetic opioids, such as fentanyl, because they are cheaper and easier to get.
Conducted by researchers at the Stanford University School of Medicine in California, the study suggests that hospital discharges related to prescription opioids have declined in recent years, while heroin-related discharges have soared.
The decrease in prescription opioid discharges corresponds to national, state, and local initiatives that targeted opioid prescribing, fueled by President Barack Obama's 2010 National Drug Control Strategy, which was designed to combat the growing opioid epidemic, the authors note.
In contrast, the trends in heroin-related discharges are "alarming for public health stakeholders," they write.
The data suggest that "expanded availability of lethal illicit drugs are being used to replace prescription opioids in some cases," senior author Tina Hernandez-Boussard, PhD, said in a news release. The decrease in hospital discharges due to prescribed opioids may signal that initiatives to curb their overprescription are beginning to work, she noted.
The study was published online October 2 in Health Affairs.
Using publicly available data, the researchers analyzed national trends in hospital inpatient and emergency department (ED) discharges for opioid abuse and poisoning from 1997 to 2014.
Overall, opioid-related ED discharges increased by 10.5% annually from 2006 to 2014 and by 4.9% annually from 1997 to 2014 in the inpatient setting, the authors report.
In both settings, discharge rates for prescription opioid poisonings began to decline around 2010, whereas discharge rates for heroin poisonings started to increase around 2008.
Discharge rates for prescription opioid poisoning increased by a significant 8.0% annually from 1997 to 2010 in the inpatient setting and by 5.0% annually from 2006 to 2010 in the ED. However, in both settings, discharge rates for prescription opioid poisoning fell significantly from 2010 to 2014 ― decreasing annually by about 5.0%.
For heroin poisoning, ED discharge rates rose significantly after 2008, at an annual rate of 31.4%.
"The trends in ED and inpatient discharges likely underestimate the severity of the epidemic because the use of naloxone, which may prevent ED or inpatient admissions, has become more readily accessible. In addition, lethal illicit opioids may lead to death before hospitalization, and the common dosage of naloxone might not be effective in rescuing people from fentanyl overdose," the investigators write.
"Further research on prescribing patterns and the indirect costs of the shift to heroin for the legal system ― as well as on the implementation of safety strategies, such as law enforcement overdose response programs ― could guide policies directed at curbing and managing the epidemic," they add.
Anna Lembke, MD, associate professor of psychiatry at Stanford, has no doubt that many of those addicted to prescription opioids have switched to heroin or synthetic opioids, such as fentanyl. "My patients have told me that's exactly what they did. Heroin was cheaper and easier to get," Dr Lembke, who was not involved in the study, said in the news release.
Dr Lembke is the author of Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It's So Hard to Stop (Johns Hopkins University Press, 2016).
She said she is cautiously optimistic that the tide may be turning with respect to prescription opioids, but "there is still a long way to go, and doctors are still prescribing way too many opioids ― four times as many as in the 1990s and far more than other developed countries in the world."
The study was supported by the Agency for Healthcare Research and Quality and the Department of Medicine at Stanford University.
Health Affairs. Published online October 2, 2017. Abstract
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