Massachusetts physicians rank among the top 10 nationally in prescribing OxyContin and other long-acting painkillers, according to a government report released Tuesday that highlighted wide state-by-state variation in the rates of use of addictive opioid medications.
But the state ranked low, 41st nationally, for overall prescribing of opioids, which have become a major concern because of rising rates of abuse and overdose deaths. Long-
acting pain medications such as OxyContin are only one of several types of opioids, which also include methadone, codeine, and hydrocodone.
Addiction specialists said the Massachusetts figures were encouraging. Long-acting painkillers, often used for chronic pain by cancer patients and others, tend to be less addictive than short-acting pain pills when taken appropriately, said Dr. Jane Liebschutz, a general internal medicine physician at Boston Medical Center and an addiction researcher at Boston University.
OxyContin was once notorious because it was easily abused by addicts, but it and similar long-acting pain medications have been reformulated to keep users from crushing them to circumvent the time-release action. That may have led more doctors to prescribe them, Liebschutz said.
“It’s more advanced, a better practice that patients with chronic pain get extended relief,” Liebschutz said. “Massachusetts is doing well, and that’s the take-home message.”
Governor Deval Patrick declared a public health emergency in March in response to rising opioid addictions and overdose deaths.
Many victims first become addicted to prescription medications and then switch to heroin, which is cheaper but riskier, Dr. Tom Frieden, director of the federal Centers for Disease Control and Prevention, said during a conference call.
The CDC report, based on 2012 data, could shed light on why deaths have surged in several pockets of the country, the researchers said.
In some states, opioids were prescribed at rates up to three times higher than in others, which probably is not attributable to differences in the health of each state’s population, Frieden said. “The type of pain treatment you get shouldn’t depend on where you live,” he said. Opioids “are not the answer every time someone has pain,” he added.
In 2012, physicians wrote 259 million prescriptions for opioids, enough for every American adult to have his or her own bottle of pills, Frieden said.
He said researchers cannot explain the variation in opioid prescribing patterns, but he noted states with higher prescribing rates tend to have more problems with opioid addiction and overdoses, including many Southern states. Alabama had the highest rate of opioid prescriptions, with a large swath of Southern states ranking in the top 10. Hawaii ranked lowest.
Massachusetts ranked eighth in long-acting painkiller prescription rates and ninth in the use of a kind of sedative known as benzodiazepines.
The CDC is urging states to identify physicians who may overprescribe opioids by using their prescription drug monitoring programs. Currently, these online databases are primarily used to allow physicians to track a patient’s past prescriptions and spot those who are abusing them. The data would also allow the CDC to examine variations in prescribing patterns nationwide.
Last month, the Patrick administration proposed strenghtening the state’s Prescription Monitoring Program by giving more health workers access to the database, such as nurse practitioners and physician’s assistants, and requiring doctors to record prescriptions for commonly abused drugs every time they are prescribed, rather than only recording a patient’s first prescription.
The state Department of Public Health issued a statement Tuesday, noting that a state opioid task force has “recognized safe prescribing and dispensing as one of the critical actions needed to address this public health emergency in Massachusetts.” It also noted that it had accelerated the time frame for all physicians to use the Prescription Monitoring Program, to the end of this year, a step in line with the CDC’s recommendation. DPH did not make any official available for an interview.
Frieden also recommended states work together to monitor patients’ prescriptions. Last month, Patrick met with four other New England governors to discuss sharing prescription data and making it easier for patients to seek treatment across state lines.
Dr. Richard S. Pieters, president of the Massachusetts Medical Society, said the new data do not warrant changing prescribing practices. In fact, he said, patients often complain that their pain is not adequately controlled.
“I am really concerned that it is becoming more and more difficult to adequately manage a patient’s acute and terminal pain, which is often undertreated,” Pieters said. “We need to evaluate why rates are where they are before modifications are made.”
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