An analysis of data collected from 2011 and 2013 has found that more than half of all opioid prescriptions in the United States are written for patients suffering from anxiety, depression and other mood disorders – despite their being at an increased risk of addiction.

The study questioned how pain in this vulnerable population is treated and found that they are prescribed opioids more than the rest of the population.

“We’re handing this stuff out like candy,” the paper’s senior author Dr Brian Sites, from the Dartmouth-Hitchcock Medical Centre, said.

Prescriptions have quadrupled within 16 years

In fact, opioid prescribing has quadrupled between 1999 and 2015 in the US, and led to the death of 183,000 people. Just on 23 June, a doctor in the state of Oklahoma was charged with second-degree murder following the death of at least five of her patients from the drugs she prescribed them.

The doctor, Regan Nichols, is actually among several doctors who have been sentenced to prison in the overdose deaths of their patients.

“Nichols prescribed patients, who entrusted their well-being to her, a horrifyingly excessive amount of opioid medications. Nichols’ blatant disregard for the lives of her patients is unconscionable,” the Oklahoma Attorney General Mike Hunter said.

The investigation found that between 2010 and 2014, Nichols prescribed more than three million doses. They were also usually a mix of muscle relaxants, anti-anxiety drugs and powerful painkillers, which are considered to be the “holy trinity” for addicts, the report said.

But why are doctors overprescribing?

The study, published in the Journal of the American Board of Family Medicine, also gathered data from opioid providers. It was discovered that 19% of Americans with mood disorders are prescribed opioids, compared to just 5% of the rest of the population. This difference remained even when researchers controlled for factors such as physical health, level of pain, age, sex and race.

It has not yet been ascertained why this difference exists, although Sites believes it may be because patients with mood disorders respond to pain differently – and this encourages doctors to prescribe them opioids more. Additionally, it is well-known that those with mood disorders are more likely to develop chronic pain conditions.

Doctors may also be more sympathetic to patients with pre-existing conditions whilst it is also possible that opioids have an anti-depressant effect, which spurs sufferers to request repeat prescriptions.

“We need to understand if this massive prescribing level is appropriate in actually providing benefit commensurate with the risk,” said Sites.

He also notes that currently doctors do not always have alternative treatments to offer such as cognitive behavioral therapy or physical therapy. “So, the easiest thing right now is to prescribe a pill,” he said.

Many are stepping forward to make a change

Dr Geoff Capraro is one such individual. Having seen far too many preventable overdose deaths, he is determined to make the antidote drug, Naloxone, more readily available in public places. An assistant professor of emergency medicine at Brown University, he is installing nearly 50 boxes of Naloxone at community organisations and treatment centres in his area.

“The biggest impact will be the message. This gives a bystander the best chance to save their neighbour,” Capraro said.

The city of Cambridge in the state of Massachusetts is also applying the idea by setting up locked, temperature-controlled boxes outdoors. The idea is that bystanders who witness an overdose can call the emergency services, which will provide a code to unlock the box and then make their way over to help revive the victim.

Others are looking at education. Assistant Dean, Dr Martin Klapheke, is changing the curriculum at the University of Central Florida’s College of Medicine to include substance abuse. Whilst studying paediatrics, the students observe how newborns born with opioids in their system suffer from tremors, seizures and wailing. They examine alternative treatments for addiction and learn how to use medication to treat addiction.

Drug manufacturers are also finally contributing to the fight. The US Food and Drug Administration (FDA) has asked companies to find a way to make it harder for addicts to cut, crush and grind the pills so they can be injected. Now, Inspirion Drugs is the first to market its “abuse-deterrent” pill. Called Roxybond, the pill has inactive ingredients that make it harder to manipulate.

Even if they are broken down, their “viscous material” makes it difficult to pass through a needle. It is hoped the tablet will provide doctors with a new way to treat pain and fight against potential abuse. MIMS

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