‘Remarkable Increase’ in Opioid Prescribing in U.S.

‘Remarkable Increase’ in Opioid Prescribing in U.S.

The prescribing of opioid painkillers by doctors in the United States has nearly doubled over the past decade, according to a large new study that also found the use of safer alternatives for pain treatment was flat or declining.

Researchers at the Johns Hopkins Bloomberg School of Public Health analyzed a nationwide database of outpatient visits to doctors’ offices from 2000 to 2010. About 20% of the visits involved a primary diagnosis of pain.

bigstock-Doctor-writing-patient-notes-o-16554509“The overall prevalence of patient-reported pain has not changed during the past decade, although providers’ diagnoses of pain as a primary complaint nearly doubled,” said G. Caleb Alexander, MD, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness.

“Despite greater recognition of pain by providers and a remarkable increase in opioid prescribing, there was no commensurate increase in the prescribing of non-opioid therapies. This is particularly important because of the variety of alternative pharmacologic treatments available to treat nonmalignant pain.”

Researchers found that 11.3% of the visits in 2000 ended with the prescribing of an opioid pain medicine such as OxyContin or hydrocodone.  A decade later the prescribing rate for opioids had grown to 19.6% of visits – a 73% increase.

Over the same period, the prescribing rate for non-opioid analgesics such as acetaminophen, aspirin, and non-steroidal anti-inflammatory medicines (NSAIDs) remained flat at about 29% of visits.

For new cases of musculoskeletal pain, the prescribing rate for non-opioid analgesics fell from 38% in 2000 to 29% in 2010.

“Despite large increases in opioid use, there were not similar increases in the prescribing of alternative analgesics, such as NSAIDs, acetaminophen, and other therapies that may serve as alternatives to prescription opioids. These results are important given the epidemic rates of prescription opioid abuse that have occurred in the context of efforts to improve the identification and treatment of nonmalignant pain,” said Alexander.

“There is little evidence to support any greater safety or effectiveness of opioids over many of these alternative analgesics, particularly with respect to functional outcomes and longer term use.”

The study by Alexander and his colleagues is one of the first to focus on trends in pain treatment in outpatient office and clinic visits.

“The majority of pain medications are prescribed by primary care physicians, who treat over half of the chronic pain patients in the United States. Pain specialists only treat a fraction of these patients,” said Matthew Daubresse, MHS, who is lead author of the study being published in the October issue of the journal Medical Care.

About 100 million adult Americans suffer from chronic pain.  In recent years there has been a growing awareness in the medical community about the prevalence of pain. That awareness has coincided with a sharp increase in opioid use and abuse. By 2010, over 5 million people aged 12 years and older reported the non-medical use of pain relievers.

“We found that not only have the rates of treated pain not improved, but in many cases, use of safer alternatives to opioids, such as medicines like ibuprofen and acetaminophen, have either stayed flat or declined,” says Alexander. “This suggests that efforts to improve the identification and treatment of pain may have backfired, due to an over-reliance on prescription opioids that have caused incredible morbidity and mortality among patients young and old alike.”

“Policy-makers, professional organizations, and providers should re-evaluate prior efforts to improve the identification, treatment and management of non-malignant pain and promote approaches that adequately reflect the importance of non-opioid and non-pharmacologic treatments.”

Authored by: Pat Anson, Editor

There are 4 comments for this article
  1. Peter at 10:57 am

    Opioids are being over-prescribed at an ever increasing rate. Doctors, at the urging of big pharma, prescribe more pills than are necessary to effectively treat pain and at times prescribe them needlessly. Adolescent athletes are being prescribed opioids for injuries. As a result, more youth are getting their hands on opioids, abusing them and in many cases becoming addicted. When the cost of obtaining painkillers on the street becomes prohibitive they begin to use heroin which is much less expensive. Heroin and opioid use is an epidemic in this country. I know this because I work with adolescent addicts. It is time to put pressure on big pharma and the medical industry to stop over-prescribing opioids. I cringe when I hear of someone being prescribed 30 percocets for a tooth abscess. (true story)

  2. Trudy McGee at 4:12 pm

    Funny, but if aspirin were presented to the FDA today, it would not be approved. NSAID’s and their very close cousin acetaminophen cause more harm in long term usage than any opioid. Opioids have been in use for over 2,000 years, and although can be addicting to those with addicting personalities, are extremely useful and much safer than the antidepressants, antipsychotics, and myriad of drugs pushed by Big Pharma for their profits, and trust me, their PROFITS alone! As long as they can keep “helping” people by inventing, or redesigning new drugs with more and more side effects that have a synergistic effect when used in combination with more pills to “help” people, they will. It’s time to STOP this insanity that opioids are bad. More people are using them, because more people are getting hurt in industrial accidents, car accidents etc, than ever. More people have these helpful medications available to them than any other time in history because they can. Ever since it was declared that people have the right NOT to suffer from pain, then the amount of opioid prescriptions increased. At least when you are siting studies, site what else went on at the time also. Don’t just quote one piece of history. When the 1-10 pain chart was insisted upon in hospitals, and doctors realized how many people were suffering in silence, or behind the alcohol, or illegal drugs, THAT is when the prescriptions increased.

  3. Julie Anna Bloodworth at 3:59 pm

    I believe that it is IMPOSSIBLE to know how many Chronic Pain Patients are using Ibubrofen, Acetaminophen, and even NSAIDS due to the fact that they are available OVER THE COUNTER!!! I can virtually guarantee that Chronic Pain Patients have used all of these medications, often to the point of damaging their Liver and Kidneys to keep from having to go to the doctor. This war on prescription meds is just a glorified WITCH HUNT! Junkies that are abusing these medications are still going to be able to find their fix while the people that are genuinely in agony are going to be suffering even more.

  4. Candice Cutlip at 12:35 pm

    Doctors aren’t actually prescribing NSAIDS probably because they are OVER THE COUNTER… Duh! I would dare say MOST people will try acetaminophen ibuprofen and aspirin BEFORE they go running to the doctor to ascertain what further remedies need to be tried or considered. Thats what I do! I’m not going to pay $100+bucks for a doctors visit for a sprained ankle to get an invisible prescription for Tylenol… It is OTC therefore doesn’t require my doctor even knowing I’ve taken some! If my ankle was broken… well i would have probably taken tylenol at home first, THEN gone to the ER if it didn’t help.

    Maybe we need to be comparing apples to apples instead of screwing valid data comparing apples to oranges. That seems like simple logic to me…