In 2015, Harvard Medical School reported that “four times as many prescription painkillers are provided each year now compared with the 1990s.” In 2017, the U.S. Department of Health and Human Services (HHS) implemented a public health emergency, and developed a campaign to focus on specifically reducing opioid dependency. In its research, HHS cited the following statistics from the Centers for Disease Control and Prevention:

• In 2016, approximately 115 people died each day in the U.S. from opioid overdoses.
• In that same year, reports indicated the number of deaths from fentanyl and prescription/illegal opiates was five times greater than in 1999.
• Also in 2016, more than 63,000 deaths occurred—over 65 percent were due to opioids.

Why People Abuse Painkillers

The Substance Abuse and Mental Health Services Administration (SAMHSA) reported in July 2017 that prescription drug misuse is second only to marijuana as the most commonly-used illegal drug.

SAMHSA indicated that more than 90 percent of Americans surveyed in 2015 used prescribed pain relievers in the previous year. Of that number:

• Nearly 64 percent misused these medications in order to alleviate pain.
• Approximately 6 percent misused tranquilizers issued by medical professionals, usually to relax or to sleep more efficiently.

In some respects, prescribers are responsible for controlling access to painkillers. Their scope of knowledge regarding painkiller alternatives is more extensive than what the average person might know, especially when it involves medication.

But when patients approach healthcare providers with complaints of pain, it’s difficult for medical professionals to evaluate, as each individual’s perception of pain—particularly chronic pain—is subjective. There’s no universal aspect of measurement that can be applied.

Because every person has different pain receptors, various prescription medications may be offered to help reduce the severity of symptoms.

Some recommended drugs—such as anti-inflammatories or NSAIDs more powerful than over-the-counter varieties—have what’s called a “ceiling effect” where an increased dose doesn’t provide greater pain relief. With different types of opioids—narcotic analgesics such as Percocet, hydrocodone, Tylenol with codeine, methadone, OxyContin, Lortab, fentanyl, and others—some people develop a tolerance to a certain dose, even if pain hasn’t subsided, so dosing is increased without limitation. This is the start of addiction.

Additionally, some physicians think we have a “prescription culture.” Researcher Marcia Meldrum of the University of California studied the history of pain care applications and shared her findings in a variety of medical journals. “Too many people see drugs as the answer to not only pain, but to improve their lives,” she’s quoted as saying in the Canadian Medical Association Journal. “If the solution also means they may become somewhat dependent on a drug, they probably think, ‘Well, that would be better than this.'”

Consequently, many medical professionals seek to alleviate symptomatic problems with painkillers, even when causation isn’t clearly identified.

Overprescribing Painkillers May Contribute to Epidemic Increase

Unfortunately, the medical community isn’t completely without fault in the painkiller epidemic, and more lawsuits are coming to light. Here are just a few:

• In March 2018, NBC News reported five physicians accepted bribes to prescribe more fentanyl than medically necessary.
• A story in Rheumatology News discussed the details of several lawsuits brought against physicians for excessive prescribing of painkillers—including a Oklahoma doctor who “prescribed three million doses over five years,” often in combination with anti-anxiety medication and muscle relaxers.
• Another March 2018 story from CNN outlined the particular conflicts with the “pay to prescribe” incentive systems of some pharmaceutical companies. For example, one lawsuit described how a doctor would only prescribe a certain manufacturer’s drug to patients, regardless of how serious side effects impacted them, and how much money he received as a result. The Drug Enforcement Administration investigated this doctor and discovered he prescribed buprenorphine, another type of opiate, “for non-legitimate medical reasons” and received bonuses from the drug company.
• Fortune magazine revealed in a June 2018 feature that the HHS and the Department of Justice issued charges in a massive class action lawsuit against 601 defendants—including physicians, nurses, clinics, and pharmacies—because of a reported $2 billion in healthcare fraud involving opioids.
• Owners of Purdue Pharma—the manufacturer of OxyContin—and many of the company’s board members and executives are embroiled in a multi-district case worth billions of dollars with other painkiller drug manufacturers and distributors. The primary reason for the lawsuit: “an illegal business model leading to addiction and deception to enrich a few while leaving a path of devastation and destruction in its wake.”

What’s Being Done Now

The Washington Post reported in August 2017 that as of that time, 17 states had enacted rules to limit the number of painkillers doctors can prescribe. Some restrictions were by number of days allowed for a prescription; others by type of drug and dosage.

Arizona is one of those states. Effective April 2018, state lawmakers:

• Limited initial opioid prescriptions to a five-day supply, unless post-surgical—then a 14-day supply is allowed in most circumstances
• Restricted dosage of initial opioid prescriptions to under 90 MME per day, or morphine milligram equivalents
• Required that schedule II opioids—which are many of the narcotic analgesics mentions above—can no longer be prescribed without a doctor’s visit, with extremely few exceptions
• Mandated that pharmacies dispense schedule II drugs with red caps and labels warning of “potential addiction”

Additionally, in 2019, a gradual rollout throughout the state enforces mandatory electronic prescription tracking for schedule II opioids.

For full details about changes to protect Arizona residents, review the Turning the Tide Controlled Prescription Monitoring Program. You can also follow real time statistics on the painkiller epidemic on a special site updated by the Arizona Department of Health Services.

Comprehensive Care at Cottonwood Tucson

If you or someone you love is struggling with painkiller addiction, please reach out to our staff right away. We can be reached at 888-727-0441 or you can fill out our contact form.

By Tracey L. Kelley