Rates of opioid dispensing, overdose drop following market changes

Dispensing of prescription opioid pain relievers and prescription opioid overdoses both dropped substantially after abuse-deterrent extended-release oxycodone hydrochloride was introduced on the pharmaceutical market and the narcotic drug propoxyphene was withdrawn from the U.S. market in 2010, according to an article published online by JAMA Internal Medicine.

The abuse-deterrent OxyContin formulation is resistant to crushing and dissolving, actions that have been used to bypass the extended-release mechanism to get a quicker and more intense high. Propoxyphene (also known as Darvon) was approved in 1957 for the treatment of pain; reports of abuse were reported soon after and, by 1977, propoxyphene was the second leading agent in prescription drug-induced deaths. Propoxyphene was voluntarily withdrawn from the U.S. market in response to emerging data about cardiac toxic effects. Some speculated reducing the supply of prescription opioids would lead those individuals already addicted to substitute with alternative prescription opioids or heroin, according to the study background.

Marc R. Larochelle, M.D., M.P.H., of the Harvard Medical School and Boston University School of Medicine, and coauthors examined the association between these two supply-based interventions on opioid dispensing and overdose. The authors analyzed claims from a large national U.S. health insurer with data on 31.3 million insured members from 2003 through 2012.

Study results indicate total opioid dispensing decreased by 19 percent from the expected rate two years after the opioid pharmaceutical market changes and the estimated overdose rate dropped by 20 percent However, the authors found heroin overdose increased by 23 percent.

"Our results have significant implications for policymakers and health care professions grappling with the epidemic of opioid abuse and overdose. Changes imposed through regulatory mandates or voluntary company actions may be a viable approach to stemming prescription abuse. However, identifying interventions that reduce opioid supply without affecting access to individuals who benefit from opioid therapy remains a challenge. ... Finally, although restricted opioid supplies might decrease new-onset addiction in the future, it will not cure existing addiction. Regardless of the mediating mechanism, a transition from prescription opioid to heroin abuse has been well documented and further efforts are needed to improve identification and treatment of these individuals," the study concludes.

(JAMA Intern Med. Published online April 13, 2015. doi:10.1001/jamainternmed.2015.0914. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: An author made funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

In a related commentary, Hillary V. Kunins, M.D., M.P.H., M.S., of the New York City Department of Health and Mental Hygiene, writes: "Recasting the often-maligned 'doctor-shopper' instead as a patient with a substance use disorder reminds us that using public health strategies to promote judicious opioid prescribing, including via pharmaceutical market change to reduce overdose risk, needs to be accompanied by similar policy approaches to provide accessible and effective services for people who use drugs. Policy and public health interventions that both prevent opioid use disorders and overdose and provide access to treatment and other services to address consequences of opioid use disorder once it occurs are the two prongs of a comprehensive public health approach to address the opioid epidemic."

(JAMA Intern Med. Published online April 13, 2015. doi:10.1001/jamainternmed.2015.0939. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Media Advisory: To contact corresponding author Marc R. Larochelle, M.D., M.P.H., call Jenny Eriksen Leary at 617-638-6841 or email jenny.eriksen@bmc.org. To contact corresponding commentary author Hillary V. Kunins, M.D., M.P.H., M.S., call Christopher Miller at 347-396-4177 or email pressoffice@health.nyc.gov.