Prescriptions Decline But Volumes Rise

According to the Milwaukee Journal Sentinel, IMS has reported that the number of prescriptions for opioids declined 5% in 2013 compared to 2012.  Although this could signal a positive step in combating opioid abuse, data suggest otherwise.  The decline in the number of prescriptions for opioids signals one thing only — a decline in the number of prescriptions.  Unfortunately, there is no convincing evidence that the use of opioids, both licit and illicit use, is declining.  The devil is in the details.  Let’s look at oxycodone, one of the popular opioid analgesics.  Oxycodone is an effective pain reliever for millions of Americans, but is also a drug that is widely abused and was the drug at the center of widely publicized trafficking and abuse issues in Florida in 2010 and 2011. According to information from the Drug Enforcement Administration (DEA), pharmacies in the United States filled 58.2 million prescriptions for oxycodone in 2010.  In 2013, pharmacies filled 58.8 million prescriptions for oxycodone.  Although this represents only a slight increase from 2010 (and a decrease from 2011 and 2012), there were fewer prescriptions for all opioids in 2013 than in 2010.  In other words, while prescriptions for opioids as whole have declined slightly, prescriptions for oxycodone, perhaps the most widely-abused opioid in the last 15 years, is bucking the trend. Even more telling is the aggregate production quota established by DEA.  The annual aggregate production quota for oxycodone in 2010 was 105,500 kilograms.  In 2013, the production quota for oxycodone was 153,750 kilogram.  Even if DEA held 25% of the 2013 quota in reserve — a new concept that DEA introduced in late 2012 — the amount allowed for production was 123,000 kilograms, a 17% increase over 2010.  You might also notice the significant increases in the aggregate production quota for hydrocodone, hydromorphone, methadone, morphine, and oxymorphone. Here are two observations from these data: 1) a decline in opioid prescriptions does not mean that the opioids that are being abused are being prescribed less or abused less; and 2) the number of prescriptions for a drug doesn’t necessarily represent the quantity of the drug being used — the number of dosage units per prescription and the strength of the drug prescribed are essential data points to make a meaningful assessment. The United States is producing (and likely using) a greater volume of narcotics today than it did in 2010.  So what do we make of the effort of regulators, law enforcement, and members of industry to reduce prescription drug abuse?  In the world of illicit drug trafficking, attacking supply while reducing demand is an effective two-pronged approach.  When it comes to prescription drug abuse, the issue is more complicated for law enforcement and members of industry.  Reducing supply impacts patients with legitimate medical needs.  And if reduction in supply could solve prescription drug abuse, DEA would have reduced the quotas.  Prescription drug abuse is a complex problem that calls for a thoughtful demand reduction strategy that explores effective alternatives to managing pain, consumer and prescriber education about the use of prescription opioids, and collaboration between public health officials, law enforcement officials, and the prescribers, pharmacists, wholesalers and manufacturers who make and deliver these drugs that are helpful to so many but are also harmful when misused. A decade after reducing prescription drug abuse became a national priority, the slight reduction in the number of prescriptions for opiates — after years of increasing supply and demand — is hollow.  Sometimes numbers lie.  It’s not time to celebrate.  It’s time to collaborate and forge a new approach to addressing prescription drug abuse.