Excessive, High-Dose Opioid Prescriptions: Alarming PA Study

Authored by Elliott Redwine, | Medically Reviewed by Dr. Elizabeth Drew, MD
Last Updated: August 22, 2021

Covid-19 may be changing the world as we know it, but the U.S. opioid epidemic never went away, and never let up. Now, a recent study by medical researchers at the University of Pennsylvania has uncovered the alarming rate at which excessive and high-dose opioid prescriptions are being routinely written post-surgery for patients after a common outpatient procedure.

Worryingly, between 2015 and 2019, more than one-third of patients received opioid prescriptions that are above the risk threshold established by the Centers for Disease Control & Prevention (CDC), which are provided to prevent an increased risk of fatal overdose in those taking them – one of the primary reasons the U.S. is still in the grip of the opioid crisis.

“We found massive levels of variation in… patients who are prescribed opioids… We’ve also seen that the average number of pills prescribed was extremely high for outpatient procedures of this type, particularly for patients who had not been taking opioids prior to surgery. – Dr. M. Kit Delgado, epidemiologist and researcher, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA

These excessive, high-dose opioid prescriptions were written for patients who had just undergone a simple, often non-invasive procedure – arthroscopic knee surgery, one of the three most common outpatient procedures in the U.S.

Penn Study in Detail: Opioid Doses = 50 Milligrams of Morphine Daily

The objective of the study researched by Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, was to analyze state-level variations in opioid prescriptions written for so-called “opioid-naïve” patients after common knee arthroscopy procedures.

It had previously been established that the majority of patients prescribed opioids after minor surgery had tablets leftover, as these patients reported using less than 10 tablets during their recovery. It was hoped that the study would be highly useful in efforts to reduce the overprescribing of opioids by better understanding any variations, including the dose that patients had been prescribed.

The study, published in the British Medical Journal this year and using data from 2015-19, found that prescription levels varied widely depending on the state in which the individual received the outpatient arthroscopy procedure. For example, only 40% of patients in South Dakota were given opioids, but 85% received them in Nebraska. Additionally, patients were prescribed 24 tablets in Vermont, compared to 45 tablets in Oklahoma. 

However, it was the actual strength of the opioid prescriptions that triggered alarm among the study’s researchers. The average prescription was high – 250 milligrams of morphine over a five-day period, equal to 50 mgs per day. This equates to the threshold set by the CDC as a significant marker for increased risk of opioid overdose death, yet it was prescribed to approximately 36% of the patients studied.

There are direct links (known to the medical profession) between first-time opioid users and high-dose prescriptions, such as:

  • The transition to long-term opioid use
  • The high number of tablets remaining within the community, and 
  • The higher rate of overdose among family members
opioid prescriptions in Pennsylvania

Opioid-Related Addiction & Fatal Overdoses

The opioid crisis first came to widespread attention in 2015 when something dramatic happened – for the first time in almost a century, life expectancy in the U.S. dropped, and then entered a period of decline.

According to the data collected by the World Bank Group, the nation’s average life expectancy fell from 78.8 years in 2014 to 78.7 years in 2015. It then went on to drop down to 78.5 years in both 2016 and 2017. It’s dramatic because, in high-income countries like the U.S., life expectancy has been increasing steadily for decades. In fact, the last time that U.S. life expectancy declined in a similar way, it was because of military deaths in the First World War and the 1918 influenza pandemic, way back in 1915-18.

And the cause of this recent decline? Opioid prescriptions, written out by doctors who were handing out a drug that had been extensively misbranded, and then criminally marketed by pharmaceutical companies for over a 20-year period. This dangerous plethora of legal opioids resulted in widespread addiction, followed by a serious surge in rates of addiction, then fatal overdoses and suicides, both of which were directly linked to the use of opioid drugs. 

The fatality rate from drug overdoses more than tripled between 1999 and 2017; those from opioid overdoses increased by almost a staggering 600% during the same period. More U.S. citizens died from opioid overdoses in 2017 than from either HIV- or AIDS-related illnesses at the very peak of the AIDS epidemic.

At the end of 2016, CDC Director, Dr. Thomas Frieden, wrote “America is awash in opioids; urgent action is critical.” On October 26, 2017, the U.S. government formally (and finally) declared the national crisis as an “Opioid Epidemic.”

Now, in the midst of both a global pandemic and a national opioid epidemic, and with fatal opioid-related overdoses once again rising, the University of Pennsylvania has published a study revealing that excessive, high-dose opioids had been prescribed freely during the period 2015-19 – the likelihood is that is still the case.

The Impact of Two Epidemics: Addiction and COVID-19

Covid-19 Effect: Fatal Opioid Overdoses Now Rising Again

As previously mentioned, the Covid-19 pandemic continues to plague the U.S., while the opioid epidemic has never left. The effect of focusing the nation’s efforts on controlling the virus has been to the utter detriment of evidence-based opioid addiction treatment.

Facilities who offer these vital rehab services for opioid addicts have had hours reduced, staff furloughed, and many have not survived the financial strain placed on businesses by social distancing regulations. Sadly, many rehabs have foreclosed.

Additionally, although telehealth has proven highly effective in providing healthcare services online, virtual addiction treatment is proving to be significantly less successful. Coupled with lockdowns, social distancing and isolation increasing the anxiety and depression of active opioid addicts and abusers, and Covid-19’s effect on illegal drug supply, meaning that addicts will take anything and everything offered with absolutely no idea what’s in it, the result has been a dramatic spike in fatal drug overdoses, involving opioids, cocaine, and methamphetamine.

The work that is enabled by this declaration is vital to saving the lives of so many Pennsylvanians, providing education and treatment, and advancing initiatives across the state to continue to battle this epidemic.” – Tom Wolf, Governor of Pennsylvania, 11th Renewal of Opioid Disaster Declaration (August 19, 2020)

This September, the American Medical Association released a shocking report from its own findings during the first part of this year. Using data compiled from 40 U.S. states through the U.S. Overdose Detection Mapping Application Program (ODMAP), which collects real-time overdose numbers, suspected drug overdoses across the nation have risen by almost a fifth (18%) from the middle of March, when compared with data from before the coronavirus arrived here.

Fatal Drug Overdose Statistics in the U.S. / Pennsylvania, 2020

In the U.S., suspected fatal drug overdoses have spiked by 18% this year during the months of March to July. Additionally, in a CDC survey of U.S. adults, 13% of respondents in June reported they had either started or increased their substance use to self-medicate from the effects of the coronavirus pandemic, such as increased stress or negative emotions, like depression.

One particularly shocking revelation has been in Milwaukee County, Wisconsin, where 911 calls for overdoses increased by more than 50% in March and April compared to the same period last year.

Here in Pennsylvania, the picture appears to be less dramatic, but equally concerning.

In western Pennsylvania, overdoses and overdose deaths are now happening at a rate not witnessed since the height of the opioid epidemic in 2017. The state’s doctors, law enforcement, and drug and alcohol experts are all reaching the same conclusion: Covid-19’s seriously negative effect on addiction treatment.

In Beaver County, PA., for example, the effect has been devastating – fatal overdoses are up a frightening 30% from the first 3 months of the year. As of June 3, it’s a similar story in Cumberland County, where the unemployment rate went from 4% in March to more than 12% in April. More than 30 people have died this year from a drug overdose, and the county is sadly now well on its way to eclipsing the peak of opioid deaths in 2017.

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