Opioids Part 1 – The Jekyll and Hyde of the Story

Editor’s Note: In Part 1 of his articles on the two sides to the Opioid Crisis, Mitchell Vice President of Government Affairs Brian Allen looks at the initial positive outcomes and unanticipated consequences of the ongoing battle against opioid use.

The Good News: Efforts to Combat the Opioid Crisis is Seeing Positive Results

From 1997 to 2002, OxyContin prescriptions for non-cancer pain skyrocketed from 670,000 to 6.2 million. Looking back on these numbers with the knowledge we have now about the opioid crisis sparks many questions. How did this increase occur in such a short span of time? Why did opioid prescriptions continue to climb until 2012? What are we still learning about the extent of the opioid crisis? How can we best move forward with policies and proper pain management?

As the reasons for the start of the opioid crisis become clearer and we see more states taking action to stem the crisis, I am often reminded of the story of Jekyll and Hyde: one part bad and one part good.

One Jekyll and Hyde part of the story is that opioids, when used appropriately, can successfully relieve the effects of acute pain following an injury or surgery and will not, in most cases, have any lasting harmful effects. On the other hand, when over-prescribed or overused, or even sometimes when used as prescribed, they can be frighteningly addictive.

Let’s look at other opposing characteristics at play throughout the opioid crisis.

The Bad: Fueling the Opioid Crisis
Unfortunately, the over-prescribing, overuse and abuse of opioids has become all-too common, and many factors played into the spread of opioid prescriptions and, subsequently, opioid abuse and addiction in the United States.

Purdue Pharma introduced OxyContin into the U.S. market in 1996 and aggressively marketed the drug as an effective pain reliever with a “low-risk” of addiction. The company initially found success in marketing through pain management conferences and a paid speakers’ bureau staffed by medical professionals. The addictive side effects were not disclosed in the early stages of marketing the drug. Additionally, other opioid manufacturers engaged in similar campaigns.

Simultaneously, during the 1990’s, the American Pain Society, partly funded by drug companies, was opining that pain was being undertreated in the United States. They worked to have pain recognized as “the fifth vital sign” and urged the increased use of opioids to treat pain. In 2001, the Joint Commission, the hospital accreditation body, added the assessment and treatment of pain as one of the accreditation requirements; however, this was removed in 2009. As stated earlier, opioid prescribing increased dramatically after 1997.

The consequences have been dire: according to the Centers for Disease Control and Prevention (CDC), “from 1999 to 2017, almost 218,000 people died in the United States from overdoses related to prescription opioids.”

The Good: Efforts to Reduce Opioid Abuse
In 2017, the CDC declared a national emergency around the opioid crisis. For many of us who have been personally impacted by opioids, we recognized the crisis long before that announcement. Over the last several years, many state legislatures have passed legislation limiting the prescribing of opioids, and some state workers’ compensation regulators have adopted drug formulary rules and opioid prescribing guidelines. 

In 2019, several more states passed laws to limit opioid prescribing:

• Minnesota, Montana and Wyoming passed a law limiting opioids for acute pain to 7 days.
• Texas passed a law with a 10-day limit. 
• Indiana, Montana and Kentucky have implemented workers’ compensation drug formularies.
• •New York’s drug formulary will go into effect on December 5, 2019. 
• Other states are considering similar measures. 

These changes are having an impact.

The Workers’ Compensation Research Institute (WCRI) released a report in June 2019 that noted a significant reduction in opioid prescribing in all 27 states studied over the three-year period. The report finds that in the first quarter of 2015, opioids accounted for 22 percent of prescription payments in the typical state. During the first quarter of 2018, that percentage had decreased to 13 percent.  

The California Workers’ Compensation Institute (CWCI) reported in 2009 that opioids accounted for 30.5 percent of all prescriptions prescribed to injured workers in California. According to the report, in 2018, that percentage had decreased to 18 percent.

The CDC published data in October of 2018, indicating that national opioid prescribing peaked in 2012 at 81.3 prescriptions for every 100 persons and had declined to 58.7 prescriptions for every 100 persons in 2017.

As more states institute prescribing limits on opioids for acute pain and drug formularies in their workers’ compensation systems, and physicians receive better education on opioid prescribing and non-opioid alternatives to managing pain, these numbers will likely continue to improve.

By Brian Allen

Brian Allen is a nationally recognized policy expert for workers’ compensation and insurance issues across the country. Allen currently serves as Vice President of Government Affairs for Mitchell’s Pharmacy Solutions team. 

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