Nearly six million fewer adults received an opioid prescription from 2014 to 2016, according to a new analysis that found larger declines among patients who reported having more severe pain.
The annual share of adults who were prescribed opioids fell from 12.9% in 2014 to 10.3% in 2016, with heavier declines in shorter-term prescriptions. The analysis of data from the Agency for Healthcare Research and Quality were published Monday in Health Affairs.
Surprisingly, the most dramatic decline in opioid prescriptions affected patients who reported having more severe levels of pain. Nearly 4 million fewer adults who reported having moderate or severe pain received an opioid prescription during the study period compared to 2.2 million fewer adults who reported having less-than-moderate pain.
Study lead author Dr. Mark Olfson, a professor of psychiatry, medicine and law at Columbia University's Irving Medical Center, said the study did not examine factors that contributed to the decline. Some factors likely included increased public awareness of the opioid epidemic and efforts to limit its effects, such as state prescription drug monitoring programs, improved prescribing practices by hospitals and state laws limiting the number of days' supply of opioid prescription.
Olfson called the decline in opioid prescriptions "encouraging" as it means there are fewer drugs for people to potentially misuse. But he said the findings also raise concerns that strategies intended to reduce the overall volume of opioid prescriptions may hurt the patients most in need of the treatment. The strategies also may fail to give patients with with less severe pain non-opioid pain therapy alternatives.
"Because of risks of transition from medical to nonmedical use, the fewer people exposed to medically prescribed opioids can be expected to lead to fewer Americans developing nonmedical opioid use," Olfson said. "If, however, opioid prescriptions are decreasing in a manner that leaves more people with unbearable pain, a reduction in opioid prescribing could have some offsetting adverse effects."
A total of 31 states have implemented laws restricting the duration of opioid prescriptions for acute pain since the Centers for Disease Control and Prevention issued its opioid prescribing guidelines in 2016.
But a recent study published in December in the journal JAMA Network Open found those laws have varied results in reducing opioid prescriptions.
While reductions in opioid prescription sizes occurred in Massachusetts after the state implemented its opioid limits in 2016, Connecticut didn't experience a similar drop with its law, according to the JAMA study.
The number of opioid prescriptions written in the U.S. has fallen steadily since it peaked at more than 255 million in 2012. It dropped to 191 million in 2017, according to CDC figures.
Olfson said the Health Affairs study suggests the focus on reducing the absolute number of opioid prescriptions may have missed the opportunity for clinicians to more thoroughly evaluate the effectiveness of pain management practices.
"Efforts to restrain opioid prescribing may have been applied in a somewhat crude manner that is not sensitive to the severity of each individual patient's level of pain," Olfson said. "The extent to which these broad prescribing patterns represent the effects of changes in opioid prescribing control policies, clinical challenges in evaluating pain severity, or both will require further study."