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New Hampshire ranks No. 3 in prescriptions for certain types of painkillers, CDC finds

Officials have renewed calls for action against prescription drug abuse after a recent study placed New Hampshire near the top in the country for prescription rates of certain types of opioid painkillers.

Nationwide, New Hampshire was 39th in the country for per capita prescriptions of opioid pain relievers in 2012 – 71.7 prescriptions per 100 people – according to an analysis by the Centers for Disease Control and Prevention.

But the statistic that caught lawmakers’ attention was the one concerning prescription rates for long-acting/extended release opioid pain relievers: New Hampshire had the third-highest prescribing rate in the nation in this category, with 19.6 prescriptions issued per 100 people. The state also ranked seventh for high-dose opioid pain relievers, at 6.1 prescriptions per 100 people. The CDC said the Northeast outranked other regions in its prescription rates for high-dose and long-acting opioids.

The CDC also examined the prescription rate for benzodiazepines (Xanax or Valium, for example), and found that New Hampshire was 21st in the nation with prescribers issuing these at a rate of 41.2 per 100 people.

The survey results, particularly the No. 3 ranking, were met with concern by New Hampshire policymakers when issued earlier this month.

“The rising rate of substance use in New Hampshire, especially for highly addictive opioids, is one of our most serious public health and safety challenges,” Gov. Maggie Hassan said in a statement, adding that she’s working with state and region officials to address the issue. “Prescription drug abuse, which is often linked to heroin use, remains high, and the Centers for Disease Control report reinforces this alarming trend.”

U.S. Sen. Kelly Ayotte, who introduced a law in June to provide more oversight for prescription drug practices, also said in a statement that the CDC report “underscores the urgent need for a comprehensive strategy on prescribing practices and pain management.” The law, co-sponsored by U.S. Sen. Joe Donnelly of Indiana, would create a “Pain Management Best Practices Inter-Agency Task Force” and authorize a grant program for states to put toward prescription drug monitoring programs.

Still, Dartmouth Center on Addiction Recovery and Education Director Seddon Savage cautioned against making direct comparisons between the states without additional context. Socioeconomic factors, she said, could shape whether someone uses short- versus long-acting painkillers, and a higher number of prescriptions doesn’t necessarily mean that a state has a higher number of people abusing those prescriptions.

“The problem here is not necessarily in the number of prescriptions, but also that they’re being misused,” said Savage, who also sits on the Governor’s Commission on Alcohol and Drug Abuse Prevention, Treatment, and Recovery. “If every patient who has received a prescription for opioid for the purposes of treating pain used the medication as prescribed and exclusively for the treatment of pain, we would see fewer opioid-associated problems – so the concern is that opioids that are out there are being diverted and misused for purposes other than pain relief.”

States urged to act

The CDC report recommends that states, among other things, expand the use of prescription drug monitoring programs and take steps to connect more people with substance abuse treatment programs, either through Medicaid or other programs.

New Hampshire was one of the last states – 49th – to establish a prescription drug monitoring program in 2012, but it’s still being implemented.

Joe Harding, director of the Bureau of Drug and Alcohol Services, said responding to prescription drug abuse requires a “multifaceted approach,” but a monitoring program is a critical part of making sure that patients are not “doctor shopping” for painkillers from multiple providers.

Harding said the New Hampshire Health Protection Program will also better allow the state to screen people for substance abuse disorders and to connect people with treatment programs. Not all of the substance abuse benefits will be available when the program starts in August – some rehabilitative services, peer support recovery support services and other services will be rolled out over a period of six months to a year, according to a timetable provided by Harding – because the state is still establishing the infrastructure needed to support the programs.

Screening programs to identify people who are at risk for developing an addiction to painkillers and those who are already addicted are also important tools for the state and the medical community to address opioid misuse, Harding said. Additionally, Harding said programs to retrieve unused prescriptions can prevent young people, in particular, from taking unauthorized painkillers that belonged to friends or family.

The role of prescribers

In a letter that predated the CDC survey, leaders from the New Hampshire Medical Society, the New Hampshire Division of Public Health Services and the New Hampshire Board of Medicine sent a letter to doctors across the state to make sure they “fully understand their responsibilities with respect to opioid prescribing.” The letter, dated June 25, referred physicians to the Federation of State Medical Boards Opioid guidelines and state standards, and it also warned that “significant deviation” from standards of care could result in a loss of credentials or other punishments.

Prescription painkillers can indeed be an important part of a patient’s treatment plan, but Savage said doctors should be careful to weigh whether opioids are absolutely necessary before prescribing them.

“They remain the most effective and potent pain relieving medicines we have available,” Savage said, “but unlike many medicines we prescribe, we have these unusual risks because people self-administer them for purposes other than what we intend.”

Doctors and nurses typically receive very little training on pain management as part of standard medical education programs, Savage said, and often don’t get adequate training in substance abuse, either. Making sure that prescribers better understand the complexities of the risks associated with prescription drugs and that they are aware of alternative treatment options could also help curb painkiller abuse, she said.

“It’s something all doctors see over the course of their careers,” Savage said. “It would help doctors be better prepared.”

(Casey McDermott can be reached at 369-3306 or or on Twitter @caseymcdermott.)

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