A newly published study of opioid use in the U.S. finds patients prescribed potentially addictive painkillers are taking more of them for longer – usually in the form of dangerous cocktail combinations. The increase is so stark that the number of prescriptions has risen, even as the total number of Americans filling these prescriptions has declined.

Photo Credit: Tom Walker via flickr | CC BY-NC 2.0

The results of the study are described in a report issued yesterday by pharmacy benefits manager Express Scripts. The investigation examined more than 36-million pharmacy claims from from 6.8-million Americans who had filled at least one opioid prescription for the treatment of pain, during a five-year period spanning 2009 through 2013. Here are the key findings:

Fewer Patients, Increasing Number of Prescriptions: The number of Americans filling prescriptions for opioids declined 9.2% between 2009 and 2013, but both the number of prescriptions filled and the number of days of medication per prescription rose approximately 8.4%.

Short-Term Use of Prescription Opiates Declined: The number of longer-term opioid users remained fairly constant over the five years studied; the number of short-term users declined 11.1% between 2009 and 2013.

Patients Likely to Use Prescription Opiates Long-Term: Nearly one half of patients who took opiate painkillers for more than 30 days in the first year of use continued to use them for three years or longer. Almost 50% of those patients were taking only short-acting opioids, putting them at higher risk of addiction.

Younger Adults Use More Opioid Medications: The elderly have the highest prevalence of opioid use, but younger adults (age 20-44) filled more opioid prescriptions and had the greatest increase in the number of days of medication prescribed, per prescription, of any age group over the five year period.

Opioid Use More Prevalent Among Women: 30% more women than men took prescription opiates in 2013; however, men are more likely to fill more prescriptions and take higher doses of these medications.

Pain Prescriptions Most Prevalent in Southeastern Small Cities: The greatest concentration of opioid use is found in small cities in the Southeastern region of the U.S., with the vast majority of these cities located in four states: Kentucky, Alabama, Georgia and Arkansas.

Most Long-Term Opioid Users Take Dangerous Drug Combinations: Nearly 60% of patients using opioids were taking a combination of drugs that are dangerous and potentially fatal; among these mixtures, almost one in three patients were prescribed anti-anxiety drugs known as benzodiazepines along with an opioid – the most common cause of overdose deaths involving multiple drugs.

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The U.S. accounts for less than 5% of the world's population, yet consumes about 80% of the world's opioid supply. Taken in combination with the results of this investigation, statistics like this point to an urgent medical issue. The report goes on to summarize discouraging findings from three recent studies that examine the rise and societal cost of opioid abuse in the United States:

Opioids have a valuable role in pain treatment but these medications also expose users to a high risk of overdose and addiction. Opiate pain medication abuse has become a significant public health problem in the U.S. Since 1999, there has been a four-fold increase in deaths from unintended opioid overdoses. The nonmedical use of opiate painkillers costs the country $53.4 billion yearly, including $42 billion in lost productivity; and opioid abusers have healthcare costs that are nearly nine times higher than nonabusers. Prescription opioids are also a known gateway drug for heroin, with one study showing that as many as 80% of heroin users first took prescription opioids before they started on heroin.

"It suggests that we still have a lot more work to do in better informing the medical community that opioids may not be safe or effective for long-term chronic pain," said Dr. Andrew J. Kolodny, chief medical official of the drug treatment organization Phoenix House, in an interview with The New York Times.

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"It's just not the proper way to manage chronic pain," echoed Dr. Glen Stettin, a senior vice president at Express Scripts and co-author of the report issued Tuesday. "That's a red flag that they are either not being managed correctly, or something else is going on."

[Express Scripts via NYT]