Photo: John Angelillo/UPI
Opioid abuse may still be at crisis levels across the United States, but legislative efforts designed to place limits on use of prescription painkillers driving the problem appear to be working, a new analysis has revealed.
In an article published Friday in the Journal of the American Medical Association, researchers comparing opioid prescribing levels among surgeons before and after new laws in Massachusetts and Connecticut -- two states where use of the drugs has reached epidemic proportions -- found that they were at least somewhat successful at reducing use of the medications.
However, they also noted that the surgeons who often prescribe these drugs still need to be educated about the dangers associated with them and when it is appropriate to use them. Additionally, in general, the laws appear to be having a limited impact in Connecticut.
"Our team was interested in understanding the opioid crisis further by examining the effect of these limits and postoperative opioid prescribing on surgical patients in Massachusetts and Connecticut," study co-author Sunil Agarwal, of the Michigan Opioid Prescribing Engagement Network in Ann Arbor, told UPI. "Excess opioid prescribing after surgery often leads to misuse and diversion into the community."
As a result, "millions of Americans continue to be affected by the opioid crisis across the country," Agarwal added.
The Centers for Disease Control and Prevention first published its opioid prescribing guidelines in 2016, and Massachusetts and Connecticut were the first two states to enact legislation restricting the amount and duration of painkiller treatment based on the agency's recommendations. Since then, 29 other states have followed suit.
According to Agarwal, many people use opioid analgesics like oxycodone and morphine for the first time during and after surgery to treat post-operative pain. If not properly educated and monitored, some of them may become addicted to the medications and ultimately turn to illegal "street" drugs like heroin.
The U.S. Department of Health and Human Services estimates that more than 10 million Americans misuse opioids, and nearly 50,000 die annually from overdose-related causes. The problem has been referred to as an epidemic.
In response, Massachusetts and Connecticut implemented seven-day limits on initial opioid prescriptions in 2016, although both states allow exceptions for those with cancer-related pain, palliative care needs and chronic pain management needs. In addition, clinicians may override the limits according to their medical judgment.
Using the 2014 to 2017 IBM MarketScan Research Database, Agarwal and his colleagues identified 16,281 first-time opioid users in both states who filled a prescription within three days of surgery between July 1, 2014, and November 30, 2017 -- covering a period before and after new laws were put on the books.
In Massachusetts, they found that prescription limits led to a reduction in the amount of opioids prescribed, the number of days prescribed -- by a mean of 0.4 days -- and a nearly 6 percent decline in the proportion of prescriptions exceeding a seven-day supply.
However, similar changes were not seen in Connecticut.
"Opioid misuse and abuse are at the forefront of discussion within the medical community as we try to better understand and intervene on these problems," Agarwal said.
"Given the complexity of the opioid crisis, physicians and the medical community are working towards addressing it using a multifaceted approach," she said. "This includes developing evidence-based pain management recommendations for providers, educating patients about the safe use and disposal of opioids, reducing the excess opioid pills within communities and understanding legislation and initiatives that intend to address the opioid crisis."
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