SOURCES: G. Caleb Alexander, M.D., M.S., co-director, John Hopkins Center of drug Safety and Effectiveness, Baltimore, Md.; Edward Michna, M.D., J.D., board of directors, American Pain Society, and director, Pain Trials Center, Brigham and Women's Hospital, and assistant professor, Harvard Medical School, Boston, Mass.; Aug. 17, 2015, JAMA Internal Medicine
MONDAY, Aug. 17, 2015 (HealthDay News) -- New legislation designed to rein in prescription narcotic abuse in the state of Florida has prompted a small, but quick decrease in narcotic painkiller prescriptions, a new investigation reveals.
About a year after the laws were enacted, Florida saw total prescriptions for the narcotic painkillers called opioids drop by 1.4 percent, the study found. Researchers also discovered a 2.5 percent decrease in the total of opioid volume that was dispensed. What's more, significant falloff was seen among patients and dispensaries that had been at the highest end of the prescribing spectrum, the study noted.
"There are no magic bullets when it comes to the opioid epidemic," acknowledged study lead author Dr. Caleb Alexander, co-director of the John Hopkins Center of Drug Safety and Effectiveness in Baltimore.
"The problem is huge. America is just 5 percent of the world's population, but we consume 80 percent of all opioids, and more Americans have died from opioid abuse than double the number who died in Iraq, Afghanistan and Vietnam combined," Alexander said.
"But these types of policies and programs," he added, "are one of the main tools states have to combat the problem. So it's very important that we evaluate their impact. And I do think these reductions are clinically important. Because even just a 2 percent reduction in opioid volume translates into hundreds of thousands of fewer pills dispensed per month."
Opioid-based painkillers include hydrocodone (Vicodin) and oxycodone (OxyContin, Percocet).
Alexander and his colleagues outline their findings in the Aug. 17 issue of JAMA Internal Medicine.
Though Florida is hardly the only state in the nation grappling with prescription narcotic abuse, the study team noted that it has become "the epicenter of this epidemic."
For example, fatalities among Floridians resulting from prescription drug overdoses skyrocketed by more than 80 percent between 2003 and 2009. And of the 100 American doctors cited for purchasing the highest amounts of the opioid oxycodone in 2010, 90 were based in Florida, according to the study.
Although opioids are an important and legal form of treatment for many pain sufferers, they are also extremely addictive. Some pain clinics across Florida and elsewhere are thought to be bogus dispensaries -- or "pill mills" -- that essentially dispense narcotics for profit rather than legitimate medical purpose, according to background information in the study.
To address these growing concerns, Florida passed new drug laws between 2010 and 2011. Florida's first law required that all pain management clinics be registered with the state and run by a physician owner. The second established a statewide prescription drug monitoring program that tracks all drugs sold in an electronic database.
The new analysis looked at the 2010 to 2012 prescription patterns among roughly 2.6 million patients across both Florida and neighboring Georgia. Georgia hadn't implemented any new curbs on pain clinic operations, the study said.
In all, 480 million prescription drugs were issued through more than 430,000 prescribers and 2,800 pharmacies across both states. Nearly 8 percent of the prescriptions were for opioids, the study found.
But compared to Georgia, post-legislation Florida saw a measurable drop in overall opioid dispensing.
For example, the average amount of opioid included in any one filled narcotic prescription dropped 6 percent in Florida.
"Of course, we're still losing far too many Americans to preventable deaths associated with this form of abuse and misuse," said Alexander. "But this is certainly a 'glass half-full' situation. Particularly because the bulk of this drop took place among the highest volume abusers and prescribers. So these policies will save lives."
But Dr. Edward Michna, director of the Pain Trials Center at Brigham and Women's Hospital in Boston, and assistant professor at Harvard Medical School, cautioned that such success can breed unintended consequences.
"Florida was out of control," he said. "It is the hotbed of the national problem. But with 49 states now implementing or about to implement similar programs, the risk is that we confuse criminal operations with the day-to-day practice of medicine. Because there is a large chronic pain problem in this country, and in many cases opioids may in fact be legitimately indicated.
"All this increased surveillance and decreased utilization raises the possibility that in the process some people who really need these meds may be affected. It's pretty clear something has to be done. But we need to find the right balance," Michna said.
There's more on opioid drug abuse at U.S. National Institute on Drug Abuse.