The study conducted by researchers at the Utah Department of Health involved a randomized telephone survey in 2008 of more than 5,300 adults aged 18 years or older. It was published in the U.S. Center for Disease Control and Prevention's Morbidity and Mortality Weekly Report [Porucznik et al. 2010] and also reported in Healthday News [Reinberg 2010]. Here are highlights of the findings:
- Slightly more than 1 in 5 persons (20.8%) had been prescribed an opioid analgesic during the preceding 12 months; 71% for acute pain, 15% long-term pain, 14% both long- and short-term pain.
- Only about 3% of all respondents admitted to using their medication more frequently or in higher doses than had been prescribed, and 72% had leftover opioid medication. Roughly a quarter said that they disposed of leftover medication; however, 2.3% gave it away to someone else and 71% kept the excess opioids for themselves.
- Almost 2% of survey respondents said they had taken an opioid pain medicine not prescribed for them during the past year, and 97% of the time the drug came from a friend or relative. In most cases, roughly 85%, the medication was willingly shared, but 10% of the time the medication was pilfered and in 4% of cases it was purchased from a friend or relative.
- Importantly, the vast majority of persons who obtained opioids from a friend or relative did so to relieve pain (72.4%) and another 5.8% wanted to relieve anxiety or another physical symptom; about 15% abused diverted opioids “for fun.” Opioid misuse of any type was most common among person aged 45 to 54 years, although there were no statistically significant differences across age groups or by sex.
- Overdoses and associated deaths from opioids, largely due to drug misuse, have risen during the past 10 years and are of great concern, which prompted this study in Utah. Yet, as we noted in a recent blogpost [here], such cases are very complex and fatalities attributed to opioids may be inaccurate in many reports.
- The frequency of opioid prescribing noted in this Utah study (20.8%) seems quite high, and telephone surveys such as this, which covered only 0.2% of the population, can have wide margins of error. Extrapolating from study data, there were about 569,000 opioid prescriptions written during 2008 in a state with a population of only about 2.7 million persons that year. However, an editorial accompanying the study in MMWR noted that a nationwide U.S. study in 2002 similarly found an 18.4% rate of opioid prescribing among insured persons age 18 or over.
- It is interesting to note that only 3% of respondents admitted to misusing their opioids; that is, 97% were compliant with the prescribed dose and frequency. This could indicate a deficiency in the survey methodology, as other studies have found as many as 48% of patients are noncompliant, with most (34%) underusing their opioid analgesics [see our earlier blogpost]. This would better explain why so many persons in Utah have leftover medication.
- It is of further importance that in nearly 8 out of 10 cases of opioid “diversion” to a friend or relative it was for pain relief or other medical purpose rather than for recreational abuse. Clearly, this is “medical misuse” of the medication — use for a medicinal purpose other than intended and/or by a person other than for whom the drug was prescribed. Similarly, studies of opioid misuse among teenagers found that nearly half of them did so to relieve untreated pain [see earlier blogpost with data]. Such findings point to systemic problems in society, involving the undertreatment of pain along with casual attitudes toward the sharing and use of analgesics.
- Finally, as is usually the case, the mass media grossly slanted their reporting of the Utah study. For example, the Healthday News article focused on OxyContin® as a primary culprit, yet the study itself only noted oxycodone (not the long-acting ‘Contin’ formulation) and hydrocodone was the primary opioid in question — it was prescribed more than twice as often as oxycodone. Further, the article quotes a psychiatrist from North Carolina lamenting the Utah study as more evidence of increasing problems with opioids in the United States; he noted, “This problem is costing lives, including the lives of young healthy people." Yet, the study addressed neither opioid fatalities nor the impact on youth, and only relatively small proportions of opioids were non-prescribed (2%) or being abused for nonmedical purposes (15%). He also said, "Education of both physicians and the public is needed." With that, we heartily agree.
References:
> Porucznik CA, Sauer BC, Johnson EM. Adult use of prescription opioid pain medications — Utah, 2008. MMWR. 2010[Feb 19];59(6);153-157 [see article].
> Reinberg S. Oxycontin abusers often rely on 'leftover' meds from friends. Healthday News [online] February 18, 2010 [see article].
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2 comments:
There is a huge amount of confusion of what is the environmentally safe way of disposing of unused and unneeded opioid medications. The FDA publishes a list for the public to use. This information almost across the board recommends flushing medications down the toilet.
However, local governments at either the city or county level (at least in Ohio, who are charged with proper management of the disposal of waste and management of any possible water contamination) have events which occur very seldom where any prescriptions medications can be dropped off at a local government office (such as a city building or firehouse). The medication must be brought in using the original prescription bottle with label attached (which is used to identify the medication and then can be removed by the person dropping off the bottle -- although I don't think this is the best way to identify meds and there are other resources, but it does keep controlled substances "more" legal because carrying them outside of the bottle can cause issues at times with law enforcement, especially in large quantities) and then the medication will be handled by the local waste authorities in the manner they best determine for that medication. I've seen two in my area during the last year, but they have little announcement and they wouldn't even take my medications because I did not live in their jurisdictions.
This situation causes great confusion in the public because then they don't know who to listen to. The FDA says except for a short list of drugs (chemotherapeutic meds are most of them, if my memory serves correctly), you should flush all meds down the toilet. Then, the local environmental agency comes and promotes activities that say bring ALL of your unneeded prescription drugs to a disposal event so that they may be handled properly. How does the general population know who to follow?
Obviously, the FDA isn't probably calling the EPA and talking to them very much, because otherwise I think there would be a more extensive list of medications that need special handling. Whether it's risk of diversion, environmental contamination, or other risks, I would think that the list published by the FDA would include some items that say to contact your local governmental waste disposal organization to determine how to properly determine how to dispose of those meds.
Like I said, I don't think the FDA is talking to the EPA whatsoever, because all kinds of medications from A to Z are being found in trace levels in ground water throughout America. I think they need to look beyond their own little "box" and get proper information before making a master list of only a few drugs that should be disposed of in any other way than the old, "flush it" method, which is not appropriate in quite a few cases. Another method that I have seen recommended for disposing of opioid meds is to mix them with cat litter to make them less attractive or noticeable to drug seekers.
This is something the FDA does need to clarify because their current policy is not accurate and does not protect the water supply in the U.S. It will lead to continued contamination of the environment with pharmaceuticals. It's just a confusing mess right now.
Just my two cents...
As an update to my immediately previously posted comment, I ran across an interesting drug disposal program offered by a local city. They would take any prescription drugs except for "narcotics and controlled substances." They also listed a large number of other drugs, most of which were opiates, which were then mislabeled as to the drug's active ingredient, e.g. Daytrana had fentanyl listed as its active ingredient.
This is a further example of why guidelines need to be set up by the FDA to make it clear to local governments what they should and shouldn't be concerned with. It clearly appears after reading this posting about this different local drug drop-off activity that the confusion not only exists amongst the public, but inside the local governments and environmental agencies responsible for the water supply. Even these agencies have a fear of controlled substances and narcotics (and I truly believe they have no idea what the differences are between the two different terms are), but then they refuse to take them along with a number of other drugs that were mostly other opiates mislabeled and all covered under the category of controlled substances, even if their facts were correct as to the name-brand drug's active ingredients were listed correctly (and there were a number of errors).
Where does the responsibility lie: the FDA (who has knowledge of the drugs) or the EPA (who are the environmental protectors)? Why aren't they working together to form a list of how to dispose of various drugs properly, rather than just one of the agencies working without complete knowledge (namely the FDA) forming its own list. I don't think that's the best idea by any idea and I certainly wouldn't trust it whatsoever.
As a user of opiates for chronic pain, I now have no real source of valid information of how to properly dispose of unneeded controlled substances. I can't even trust the local government drop-off events to safely dispose of my controlled substances that I no longer need, so what is someone in my position who is trying to the right thing for the environment supposed to do? Who do I follow for guidance?
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