According to Penn Med study, opioids most-prescribed drug

The number two cause of accidental death is now also the most commonly prescribed type of medication, according to two School of Medicine studies showing a dramatic increase in the amount of opioids prescribed.

Opioids are effective at reducing pain, but also have a high rate of abuse. This abuse is especially prevalent among 18- to 25- year-olds, said Thomas McLellan — an author of the studies and director of the Center for Substance Abuse Solutions at the Medical School.

Prescriptions for opioids are drastically increasing while prescriptions for nonsteroidal anti-inflammatory drugs, such as ibuprofen, have decreased.

This increase in opioid prescriptions has gone hand-in-hand with an increase in opioid-related overdose deaths, which rose from about 3,000 to 12,000 between 1999 and 2007. Moreover, the number of opioid-related emergency department visits reached 305,088 in 2008. The number of people admitted to opioid abuse programs has also increased sixfold — rising from 19,941 to 121,091 between 1998 and 2008.

Opioid overdose occurs when prescriptions are not used by their intended recipients or for their intended use, McLellan said. More than 60 percent of those who die from opioid overdose do not have a prescription, and doctors often prescribe 30 days of opioids for pain that will only last a couple of days, McLellan added. These extra pills get stored in medicine cabinets and often allow children to access opioids.

The report recommends examining possibilities to lower the percentage of opioids prescribed to adolescents. In 2009, 11.7 percent of the 202 million prescriptions were intended for 11- to 29-year-olds. Opioid misuse is especially prevalent among college students who may take them because they can provide energy in addition to relieving pain, according to McLellan.

“My own son died of alcohol and opioid overdose, the day he took his last final at Penn,” McLellan said. “I’m not exactly impartial. This is a very significant problem.”

“Kids think, ‘opioids, they come from a pharmacy, they’re being prescribed by a doctor, they’ve got to be safe,’” McLellan added. “Well, the fact of the matter is that some of your high potency prescribed opioids have more of exactly the same ingredient in them than street heroin does.”

According to Julie Lyzinski, director of Penn’s Office of Alcohol and Other Drug Program Initiatives, “both here at Penn and on college campuses nationwide, prescription drug abuse has increased and is an ongoing concern.” Lyzinski explained that young adults use them to get high and “to keep them going through the day” if they are regular users.

A college junior who wished to remain anonymous because of the issue’s sensitivity said, “I have never used them, but I have several friends who use Percocet recreationally.”

Of prescription drugs, “opioids are arguably the most addictive,” said Neta Zach, who teaches a class at Penn called “Drugs, Brain and Mind.” Zach explained that, like other drugs, opiate users develop a tolerance so that in order to achieve the same effect, they must constantly increase their dosages. As a result, they can experience withdrawal effects like pain and higher blood pressure.

“The treatment [for addiction] often involves some form of drug replacement to assist in the brain’s recalibration. These are highly addictive drugs, highly addictive,” Lyzinski wrote in an email.

McLellan believes the increase in opioid prescriptions stems from the fact that nonsteroidal anti-inflammatory drugs “have fallen from favor with the FDA and with physicians” because of their side effects like liver damage. “There are fewer things that physicians are comfortable with prescribing, and so that leaves opioids.”

Despite the effectiveness of opioids in reducing pain, McLellan believes that it is possible to reduce opioid overdose death while still protecting doctors and making sure “that patients get the relief they need.”

In an accompanying commentary to the study, the researchers outline ways to help reduce opioid prescriptions, including screening patients more thoroughly, shortening the length of the prescription and educating the families of patients.

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