Tighter Opioid Laws in U.S. Haven't Eased Misuse
U.S. laws designed to curb abuse of opioid painkillers haven't reduced misuse or overdoses by disabled Medicare beneficiaries, a new study suggests.
Between 2006 and 2012, states enacted 81 laws to control use of powerful opioids such as Oxycontin and Vicodin. But even with these new prescription-drug monitoring programs and other regulations, researchers found that 45 percent of disabled Medicare beneficiaries were still using opioids in 2012.
And 8 percent got their opioids from four or more doctors.
"There is no evidence yet that these laws prevent misuse of prescription opioids," said lead researcher Ellen Meara, a professor at the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.
"In this vulnerable population of disabled workers, legal remedies to the opioid epidemic are too weak and too slow," she added.
Disabled workers are at risk of opioid abuse, she said, because they "have complex medical and social needs, high rates of poverty, and they are more likely to have diagnoses of mental illness like depression compared with other Americans."
Widespread availability of powerful painkillers has caused an epidemic of addiction, injury and death, said Dr. G. Caleb Alexander, co-director of the John Hopkins Center of Drug Safety and Effectiveness.
"The United States accounts for 5 percent of the world's population, but consumes 80 percent of the opioids -- you know we've got a problem," said Alexander, who wasn't involved in the study.
According to the U.S. Centers for Disease Control and Prevention, 78 Americans die every day from an overdose of opioids, including heroin.
Tighter regulations have a role in curbing the epidemic, Alexander said.
The problem with the laws enacted between 2006 and 2012 is that none addressed the "underlying pain and disenfranchisement that has led so many Americans to seek relief of pain with opioids," Meara said.
Eventually, though, Meara believes new and/or tougher legislation will start to turn the epidemic around.
"Over a five-year horizon, I am optimistic that legal remedies may help slow the misuse, abuse and overdose deaths related to prescription opioids," Meara said. "Unfortunately, the epidemic is spreading and changing rapidly, while the legal response is slow and blunt."
Progress has been made since 2012, when the study ended, she noted. For instance, it's now easier to gain access to naloxone, a prescription drug that can reverse opioid overdose. Addicts have greater access to medication-assisted treatment for addiction, and newer laws help prevent fraudulent prescribing, Meara said.
For the study, Meara and her colleagues used Medicare data to assess the volume of opioid painkiller use among disabled beneficiaries, aged 21 to 64, from 2006 to 2012.
They found no discernible difference in opioid use or overdose as a result of tighter regulations. For example, 5 percent still had prescriptions for high doses of opioid painkillers -- more than 120 milligrams -- in 2012.
They found that 0.3 percent of these patients were treated for a nonfatal overdose in 2012, about the same as before tougher laws were enacted, Meara said.
Alexander is cautious about drawing broad conclusions from a single study, however. "A lot has happened since 2012, this is a rapidly evolving area," he said.
He also stressed that limiting use of opioid painkillers doesn't mean shortchanging patients in pain as some have feared, he added. There are many non-narcotic painkillers and non-drug treatments for chronic pain, he said.
These drugs do have a role for people in acute pain and those suffering at the end of life, Alexander said. "But that's not where we've seen the soaring increase. In the past two decades, it's been in the treatment of chronic, non-cancer pain," he said.
The report appears in the June 23 issue of the New England Journal of Medicine.