Painkiller prescriptions decline in Kentucky, but health care providers still wildly inconsistent

The number of prescriptions for a class of painkillers that inflamed drug abuse in Kentucky for years has gone down since 2010, according to a federal study.

However, several counties remained near the top nationally in 2015 in the amount of the drugs, called opioids, that doctors authorized, according to the Centers for Disease Control and Prevention.

And despite a decline in opioid prescribing across the country, the amount prescribed nationally per capita in 2015 was still three times higher than in 1999, and almost four times higher than the amount distributed in Europe, the CDC said.

“There’s still a lot of pills out there,” said Van Ingram, head of the Kentucky Office of Drug Control Policy.

It is also clear that overdose deaths have not gone down in Kentucky, even as deaths from oxycodone and hydrocodone have tapered off. Rising abuse of heroin and a far more powerful drug called fentanyl — which also are opioids — has caused even more deaths.

The number of overdose deaths in Kentucky last year in which oxycodone was detected went down 4 percent from 2015, while the number with hyrdocodone present dropped 5 percent.

However, the total number of deaths went up from 1,248 in 2015 to 1,404 in 2016 because of overdoses of heroin and fentanyl, according to the state Office of Drug Control Policy.

A report from the agency said fentanyl was involved in 47 percent of overdose deaths, either alone or with heroin, which was up from 34 percent in 2015. The number of deaths where heroin was detected also went up.

Ingram said the state is making progress in tackling its drug problem, but has a long way to go.

“It is tremendously frustrating,” Ingram said of the continued high number of overdose deaths.

The CDC report illustrates how the nation’s drug problem evolved over more than a decade.

It said overdose deaths related to prescription opioids rose sharply between 1999 and 2010. That paralleled an increase in prescriptions for opioids as doctors began to use them to treat chronic pain not associated with cancer.

Before that, opioids were used mostly for severe, acute pain; postsurgical pain; and end-of-life care, the CDC said.

The spread of a powerful opioid called OxyContin in Kentucky and elsewhere beginning in the late 1990s was a key factor in the evolution of opioids in the state, helping create new addicts.

The drug was a boon to people suffering from cancer and chronic pain, with a time-release function that provided steady relief over a longer period. However, drug abusers quickly learned to crush the pills and snort or inject the powder for a heroin-like high.

Doctors — many unaware of the potential for abuse and addiction, others misinformed about it, and some acting out of greed — wrote prescriptions for a flood of the pills.

The number of OxyContin pills dispensed to state residents jumped from 4.86 million in 1999 to 9.36 million in 2000, according to the Appalachia High Intensity Drug Trafficking Area.

Rising abuse of opioids helped drive up the number of overdose deaths in Kentucky a staggering 296 percent from 2000 to 2010, with the highest rates concentrated in Eastern Kentucky, according to a 2012 study by the Kentucky Injury Prevention and Research Center at the University of Kentucky.

There were 52,404 drug-overdose deaths in the nation in 2015, the CDC said. That was the last year with available nationwide numbers.

Annual opioid prescribing rates went up in the country from 72.4 prescriptions per 100 people in 2006 to 81.2 in 2010, then leveled off before going down to 70.6 prescriptions for each 100 people in 2015, the CDC said.

Half the counties in the nation saw reductions in opioid prescriptions from 2010 to 2015. The reduction was even greater in Kentucky, where the amount of opioids prescribed per capita went down in 62 percent of the counties, the CDC said.

The state’s prescription-monitoring system has more recent data that show the trend continued into 2016.

There were 5.56 million opioid prescriptions issued in the state in 2011, the peak year, according to data from the Kentucky All Schedule Prescription Electronic Reporting, or KASPER, system. The state has 4.3 million residents.

The number of prescriptions dropped to 4.23 million in 2016.

The CDC report pointed to a number of factors in declining opioid prescriptions in many places, including mandates for providers to run monitoring reports on patients to prevent “doctor-shopping” and laws to crack down on overprescribing at pain clinics.

In Kentucky, lawmakers approved tougher standards on pain clinics, and there was wider use of the state’s prescription-monitoring system and continued education on prescribing for health care providers. This year, the legislature approved a law limiting opioid prescriptions for acute pain to a three-day supply.

As a result, attitudes among prescribers have shifted, Ingram said.

“That’s the whole goal — to be more judicious as a state and as a country with prescribing these medications,” Ingram said.

Research shows patients are unlikely to stop taking opioids if they receive them for more than 90 days, the CDC said. The agency said doctors should consider non-opioid therapy for treatment of chronic pain treatment.

Although opioid prescriptions have declined in recent years, there are indications of continuing inconsistencies in how health care providers prescribe them, the CDC report said.

It found big differences among counties in the amount of opioids prescribed per person. The per capita amount prescribed in the top counties averaged six times the amount in the lowest counties, the report said.

Some Kentucky counties were in the top category nationally.

Some of that difference could be explained by having a large number of people with conditions such as arthritis, but that would account for only a fraction of the disparity, the report said.

The variations suggest “inconsistent practice patterns” and a lack of consensus about appropriate opioid use, and shows the need for better use of guidance and standards on prescribing the powerful medication, the CDC said.

“Changes in opioid prescribing can save lives,” the report said. “The findings of this report demonstrate that substantial changes are possible and that more are needed.”