July 6, 2017

Abby Goodnough

WASHINGTON — The amount of opioid painkillers prescribed in the United States peaked in 2010, a new federal analysis has found, with prescriptions for higher, more dangerous doses dropping most sharply — by 41 percent — since then.

But the analysis, by the federal Centers for Disease Control and Prevention, also found that the prescribing rate in 2015 remained three times as high as in 1999, when the nation’s problem with opioid addiction was just getting started. And there is still tremendous regional variation in how many opioids doctors dole out, with far more prescribed per capita in parts of Maine, Nevada and Tennessee, for example, than in most of Iowa, Minnesota and Texas.

Over all, the analysis found that the amount of opioids prescribed fell 18 percent from 2010 to 2015, though it increased in 23 percent of counties.

“We still have too many people getting medicine at too high a level and for too long,” said Dr. Anne Schuchat, the acting director of the C.D.C. She noted that the quantity of opioids prescribed in 2015 would be enough to provide every American with round-the-clock painkillers for three weeks.

A flurry of recent attempts to tamp down opioid prescribing — including C.D.C. guidelines issued last year on prescribing the drugs for chronic pain and new state and insurer limits on how many pills doctors can prescribe — is not reflected in the analysis, which did not look beyond 2015.

But earlier actions, like state crackdowns on pain clinics and prescribing guidelines released by the Department of Veterans Affairs in 2010, may have contributed to the declines. The quantity of prescribed opioids fell in 85 percent of Ohio counties from 2010 to 2015, for example, as the state tightened regulations for pain clinics and started requiring clinicians to check databases to see whether patients were getting opioid prescriptions elsewhere.

The decline documented in the analysis also coincided with the federal government’s tightening of prescribing rules in 2014 for one of the most common painkillers: hydrocodone combined with a second analgesic, like acetaminophen.

In many states, including Ohio, restrictions on prescribing have coincided with staggering increases in overdose deaths from heroin and its far more powerful, synthetic relative, fentanyl. But Dr. Schuchat, pointing to several studies, said the C.D.C. had found no clear-cut evidence that tighter prescribing played a role in the rising use of illicit opioids.

“We do know that when you start people on prescription opioids, the risk of unintended consequences and illicit use goes up,” Dr. Schuchat said. “But our staff has done intensive analyses to see whether changing policies for prescription drugs shifts people into illicit use, and the answer is no.”

While the analysis found that the amount of opioids prescribed per capita remained extremely high in many counties in 2015, some experts warned that averages could be misleading.

“An enormous amount of opioid volume is driven by a very small number of prescribers,” said Dr. Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. “They need to be intervened upon, targeted with educational outreach and, if necessary, professional or regulatory sanction. My sense is that’s not yet happening enough.”

Attempts to restrict opioid prescribing have upset many patients with chronic pain, who say their needs are being ignored in the rush to stamp out the addiction epidemic.

Read the full story on The New York Times.

Abby Goodnough is a health care reporter for The New York Times.