Opioid prescription numbers see drop in region

Physicians have been prescribing opioids at a  decreasing rate in the region and throughout the country, according to data from the Centers for Medicare and Medicaid Services (CMS).

The data shows that physicians prescribed opioids to patients in the Medicare Part D program at a lower rate in 2015 than 2013 in Winchester and Shenandoah, Warren and Frederick counties. Michael Barnett, assistant professor of health policy and management at the Harvard T. H. Chan School of Public Health, said that the data is another sign that physicians are becoming more reluctant to prescribe opioids in the midst of an overdose epidemic.

“Physicians are shifting from the idea that, ‘Oh, opioids are the compassionate thing to prescribe and we need to prescribe them as often as reasonable’ toward the opposite extreme — that these are dangerous medications that we’re overusing and we should prescribe them as little as possible,” Barnett said.

The data only points to a fraction of the population: older people and people with disabilities. Those groups have more medical needs than the general population, meaning that they are likely prescribed opioids at a higher rate than the population as a whole.

But Barnett said that there is no reason to believe that changes in the rate of opioid prescriptions within this group would be any different than in the broader population.

“I think the overall changes are going to be similar,” Barnett said. “I think there probably are going to be important differences when you kind of peel into the details, but on a population level, I think we kind of see opioid prescribing rates falling kind of across the board.”

The data also follows a July report from the Centers for Disease Control and Prevention (CDC) that found that amount of opioids prescribed decreased between 2012 and 2015. Unlike the report from the Centers for Medicare and Medicaid Services, the CDC report looked at the quantity of opioids that were prescribed, and not just the number of opioid prescriptions.

But the decrease in opioid prescription rate, in both cases, was fairly small. Warren County had a 1 percent decrease in opioid prescription levels, according to the data from CMS; Winchester, Frederick and Shenandoah Counties all had opioid prescription decreases of between 0 and 1 percent.

According to the CDC’s report, opioids were prescribed at three times the rate that they were in 1999.

“Even though we’re down from the peak (prescribing levels), I think the peak was really, really, really high,” Barnett said.

The data from the Centers for Medicare and Medicaid Services also shows that physicians have been prescribing extended-release opioids more often, as a percentage of the number of opioids they prescribed. Physicians sometimes prescribe extended-release opioids for longer-term treatment, but Barnett said that the scientific consensus suggests the extended-release opioids are often overused.

“I think there’s a fairly uniform consensus out there — it’s not totally uniform — that extended-release opioids really need to be a last resort,” Barnett said.

In Frederick and Shenandoah counties and Winchester, extended-release opioid prescriptions increased between 2013 and 2015 as a rate of all opioid prescriptions, according to the Centers for Medicare and Medicaid Services data. Warren County had a drop in extended-release opioid prescriptions.

(In all four cases, the number of extended-release prescriptions was relatively small.)

Barnett said that he did not know why this change has been occurring, but he speculated that the shift might have to do with a change in how doctors are treating higher doses of opioids.

“It’s not uncommon that I’ll see patients who are receiving six Percocet a day and they get a prescription from their primary care doctor for 180 Percocet every month–six a day,” Barnett said. “And it’s possible that with the kind of increasing scare around opioid overdose and abuse, that physicians are becoming more comfortable giving their patients sort of an extended-release substitution for those big, short-acting prescriptions.”