The use of potent, long-acting opioid analgesics among U.S. adults continues to rise, despite alarming data concerning their abuse and misuse, as well as overdose-related deaths, according to a report by the Centers for Disease Control and Prevention. The report, however, has received strong criticism for confusing terminology and not taking into account distinguishing pharmacologic factors between drugs.
According to a data brief developed by the National Center for Health Statistics (NCHS) based on new trends from the National Health and Nutrition Examination Survey, the percentage of opioid analgesic users who used an opioid analgesic stronger than morphine increased from 17% to 37% between 1999 and 2011-2012, the most recent period for which data are available. Over the same period, the percentage of survey respondents who used only a “weaker than morphine” opioid in the past 30 days declined from 42.4% to 20%.
“I think the two trends taken together are consistent with what we are seeing in the various reports on opioid-related adverse events and overdose-related deaths,” said Leonard J. Paulozzi, MD, MPH, medical epidemiologist, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, and one of the co-authors of the NCHS data brief. Dr. Paulozzi added that the data brief is a “simple report that just asks people what they’re taking,” and should not be seen an indicator of opioid overprescribing among pain management practitioners.
Indeed, the overall use of prescription opioids among U.S. adults over the age of 20 years has remained “relatively stable” since 2006, the NCHS reported. Nearly 7% of all U.S. adults over age 20 reported using a prescription opioid analgesic in the past 30 days in 2011-2012. The rate of opioid analgesic use was higher among older adults (8.1% for those between ages 40 and 59 years and 7.9% for those aged 60 years and older) than among younger adults (4.7% for those between the ages of 20 and 39 years), and among women (7.2% vs. 6.3% in men). Additionally, the NCHS data brief noted that use of opioid analgesics was lower among Hispanic adults (4.9%) than non-Hispanic white (7.5%) and non-Hispanic black (6.5%) adults.
Wayne B. Jonas, MD, president and CEO, Samueli Institute, a nonprofit research organization based in Alexandria, Va., and a general practitioner who treats pain and who has devoted much of his research to pain management, described the NCHS findings as “discouraging” and as an indication that general practitioners have not changed their “prescribing procedures” with regard to “opioids as a class” despite recommendations against their use (or at least their overuse) by the Institute of Medicine and others. However, he said he does not expect to see significant changes in prescribing patterns until there is a “cultural shift”—in other words, until nonpharmacologic, holistic and/or complementary approaches are truly recognized as viable options and provided and reimbursed for (by insurance providers)—accordingly within the health care system.
“If anything, these numbers show that reaching for the prescription pad and writing a script for an opioid or nonopioid drug remains the easiest thing for practitioners to do,” Dr. Jonas told Pain Medicine News. “If we want to see shifts in opioid prescribing, and we are serious about it, we need to set up incentives to change. The amount of money spent on research and reimbursement for nonpharmacologic and self-care approaches for pain is miniscule compared with the amount spent on drugs. Until that balance shifts, you’re not going to see change, and [the finding of this data brief] supports that.”
The NCHS survey study has received criticism, however, from medical experts such as Lynn Webster, MD, and June Dahl, PhD, who point out that the “scientifically vague” nature of the “stronger than morphine opioid” verbiage with little consideration given to formulation, mechanisms of action and other pharmacologic factors. Dr. Dahl summed up her frustration with the study in a Medpage Today editorial entitled “What Makes an Opioid Weaker or Stronger Than Morphine?” by stating, “It is extremely concerning that a distinguished agency such as the CDC should use confusing terminology to classify the drugs whose use they reported.”