This week I have two articles to share about opioids. The first article reports on a study of prescribing patterns in the U.S. The second article is about how Australia seems to be following in the United States’ footsteps when it comes to opioid use. Below are these articles and my thoughts on their implications.
Disclaimer: The views and opinions expressed below are those of Mark Pew, Senior Vice President of Product Development and Marketing, and do not necessarily reflect the views of Preferred Medical.
Based on a research study published by BMJ, one percent of providers were responsible for 49% of all opioid doses and 27% of all opioid prescriptions in the United States. The study evaluated claims from a national insurance provider from 2003 to 2017. While it is recommended that opioid doses be less than 50 MMEs per day and taken for less than seven days, 42 to 49 percent of prescriptions were over the recommended dose and 81 to 98 percent were for over seven days. While this may look like shocking numbers, it is important to point out that most providers prescribed opioids with the correct amount and duration (“Among the bottom 99% of providers, at least 86% of opioid prescriptions were less than 50 MMEs and at least 71% were for fewer than 7 days”).
You’ve heard about the 80/20 rule? Well, at least in 2017, with Rx opioids it’s more the 99/1 rule. The good news is that increasingly ER doctors are not in that one percent…”ER Opioid Prescriptions Drop By 31 Percent.” Why is that important? “Research has shown that 17 percent of patients who filled their first opioid prescription for a minor (MP: note – “minor”) painful condition were still using the drugs one year later (MP: 365 days for “minor” pain?).” The one-percenters by medical specialty were family medicine (24%), physical or pain medicine and rehabilitation (14%), anesthesiology (14%), and internal medicine (13%). Obviously, education on “Appropriate, Not Zero, Opioid” use is still required for that one percent.
It is widely known there is an opioid epidemic in the United States, but what most people don’t know is that the same issue with opioids is happening in Australia. It’s also interesting to note that the same companies that have been linked to the U.S. problem are using a similar strategy to reach Australians. Mundipharma, owned by the same Sackler family that owns Purdue Pharma, is engaged in Australia but has also extended their reach to China and other countries / continents with the same claims that OxyContin is less addictive than other opioids.
Just in case you thought the opioid epidemic was solely a U.S. problem, read how the same scourge is happening in Australia. There were 8,421 opioid-related deaths from 2010 thru 2016, but “today at least three people die from opioid harm in Australia a day, while 150 more are hospitalized.” And history is repeating itself—”the same companies that have been linked to – and are being sued over – the US crisis, including Purdue Pharma (thru Mundipharma), are using similar marketing tactics to promote their products in Australia.” Thanks to my friend on the front lines there, Rosemary McKenzie-Ferguson, for sharing this story with me so I could share it with you. On 5/7/17 I documented (“Congressional representatives warn WHO of OxyContin maker’s global push“) that the U.S. Congress had warned the WHO (World Health Organization) about Mundipharma. Unfortunately, what they warned about has come to be. Via conversation with another friend of mine on the front lines, Kathy Hubble, Australia also has a significant struggle with benzodiazepines, gabapentin and pregablin. Unfortunately, the U.S. and Australia are eerily similar in the scope and source of the problem. Because Australia is a few years behind the U.S. in trajectory of this debacle, hopefully they can learn from our mistakes – and progress – to lessen the overall societal impact.
To read everything on my mind this past week, please visit me on LinkedIn at https://www.linkedin.com/pulse/marks-musings-february-10-mark-rxprofessor-pew/.
Until Next Week,