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Fatal opioid overdoses down dramatically since 2010

Key clinical point: Two changes in the pharmaceutical market dramatically reversed fatal opioid overdoses, along with opioid dispensing, in late 2010.

Major finding: “Sudden, substantial, and sustained decreases” in the dispensing of prescription opioids at the end of 2010 was associated with parallel declines in fatal overdoses of 19% in 2011 and 20% in 2012.

Data source: A retrospective cohort study analyzing opioid dispensing and overdose patterns among 31,316,598 privately insured adults during a 10-year period.

Disclosures: This study was supported by the Harvard Pilgrim Health Care Institute, the U.S. Health Resources and Services Administration, and the Ryoichi Sasakawa Fellowship Fund. Dr. Larochelle and his associates reported having no relevant financial disclosures.

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Public health ‘levers’ work

The findings by Larochelle et al highlight the critical importance of one public health lever: controlling the market supply of opioids.

Another effective intervention is to promote judicious opioid prescribing: favoring nonopioid or nonpharmacologic approaches to pain management and, when opioids are necessary, prescribing the lowest possible dose for the shortest amount of time necessary to control pain. Oher promising public health strategies include prescription drug monitoring programs and the regulation of pain clinics.

Dr. Hillary V. Kunins is in the New York City Department of Health and Mental Hygiene, Queens. She reported having no relevant financial disclosures. Dr. Kunins made these remarks in an Invited Commentary (JAMA Intern. Med. 2015 April 20 [doi:10.1001/jamaintrnmed. 2015.0939]).


 

References

Two changes in the pharmaceutical market in late 2010 dramatically reversed the alarming rise in fatal opioid overdoses that occurred during the preceding decade, according to a report published online April 20 in JAMA Internal Medicine.

Overdose deaths attributed to prescription opioids quadrupled in the U.S. between 1999 and 2010, in parallel with rapidly expanding sales of the drugs. Two changes in the pharmaceutical market were undertaken to address these unrelenting increases: replacing the standard formulation of OxyContin with an abuse-deterrent formulation (resistant to crushing and dissolving the tablets for ingestion, snorting, or injection) and withdrawing propoxyphene from sale, wrote Dr. Marc R. Larochelle of Harvard Pilgrim Health Care Institute and the department of population medicine, Harvard, both in Boston, and his associates.

To assess the impact of these 2 interventions, the investigators examined hospitalizations for prescription opioids as well as dispensing patterns using an insurance database covering adults in all 50 states. The data comprised 31,316,598 patients aged 18-64 who were enrolled in a commercial health plan between 2003 and 2012. There were 12,164 overdoses attributed to prescription opioids during the study period.

The “sudden, substantial, and sustained decreases” in the dispensing of prescription opioids at the end of 2010 was associated with parallel declines in fatal overdoses, which dropped by 19% in 2011 and by a further 20% in 2012. “Extrapolating our estimates at 2 years to the 124 million commercially insured U.S. residents aged 18-64 years, there would be 5,456 fewer prescription opioid overdoses . . . annually,” Dr. Larochelle and his associates said (JAMA Intern. Med. 2015 April 20 [doi:10.1001/jamainternmed.2015.0914]).

“This is the first study to demonstrate that a decrease in opioid supply is associated with a decrease in overall prescription opioid overdose,” they noted. “Our results have significant implications for policymakers and health care professionals grappling with the epidemic of opioid abuse and overdose.”

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