Change in opioid prescriptions varies around NH, says CDC

Staff and wire reports
Friday, July 07, 2017

If New Hampshire wants to cut the number of opioid prescriptions issued as a step in finding the drug epidemic, it may need to figure out what Belknap County is doing.

That county, which covers the Lakes Region, saw per-capita opioid prescriptions fall by one-quarter between 2010 and 2015, according to data recently released by the Centers for Disease Control. It was more of a decrease than any other of New Hampshire’s 10 counties, six of which saw prescriptions levels stay the same or increase over the same period.

The data was released as part of a CDC study called “Vital Signs: Changes in Opioid Prescribing in the United States” that reported a small decrease in total opioid prescriptions issued throughout the country, with great variation among counties.

Anne Schuchat, the CDC’s acting director, expressed optimism about the findings during a conference call with reporters Thursday but said the prescription rate is triple the level of 1999 and four times the level in some European countries.

“It looks a little bit better, but you really have to put that in context,” Schuchat said in an interview. “We’re still seeing too many people get too much for too long.”

Enough opioids were ordered in 2015 to keep every American medicated round-the-clock for three weeks, she said.

According to the data, Merrimack County, which includes Concord, saw virtually no change over the 2010-15 period.

The biggest increase came in Carroll County, which includes Conway; prescriptions there rose 25 percent during those years.

In absolute figures, Coos County and Carroll County had the highest prescription rate in 2015. Each saw more than 1,100 morphine milligram equivalents or MMEs, a measure of opioid amount, per person. By contrast, Sullivan County in the Connecticut River Valley had barely 700 MMEs.

Belknap County had just 739 MME in 2015, down from 995 in 2010.

Merrimack County was in the middle, with 921 MMEs in 2015.

The over-prescribing of legal opioids is a contributing factor to the current opioid addiction crisis. However, some drug users eventually move to cheaper or stronger drugs, especially if they run into difficulty obtaining prescription opioids.

In recent years, the overdose death rate from illicit drugs, such as heroin and fentanyl, has risen much faster than the rate of overdoses from medical narcotics.

Gary Mendell, founder of the anti-drug advocacy group Shatterproof, argues that prescribing practices should be measured and responded to in real time. The CDC process of collecting data from states and counties is cumbersome and inefficient, he said.

“Can you imagine being on a conference call with a company and they announce data that’s two years old?” said Mendell, a former hotel executive. “There’s a simple saying in business: What doesn’t get measured doesn’t get done.”

Prescription opioids alone killed nearly 180,000 people from 2000 to 2015 while overdoses, drug misuse and dependence on medical narcotics created an annual “economic burden” estimated at $78.5 billion, according to the new report.

In 2015, the latest year for which the CDC has released data, more than 33,000 people died of overdoses that involved an opioid, including more than 15,000 who had taken a prescription narcotic. Nearly 13,000 more were killed by overdoses of heroin.

In New Hampshire, drug overdose deaths were expected to reach 479 in 2016; a precise number will not be available until December.

The CDC report found that doctors in some counties in hard-hit parts of Appalachia, the Southwest and New England prescribed as much as 5,543 milligrams of morphine per capita in 2015.

In the past few years, medical and public health authorities, including the CDC, have been urging doctors to cut back on the number of pills, the dose and the duration of the prescriptions they offer – a turnaround from recent years, when a nationwide movement urged physicians to more aggressively treat their patients’ pain.