Study: Fewer pain patients, but number of days of medication per prescription up 8% over five years

ST. LOUIS — From 2009 to 2013, the number of Americans using prescription opiates declined 9.2%, yet both the number of opioid prescriptions filled and the number of days of medication per prescription rose more than 8% in that time period, according to a new report released Tuesday by Express Scripts.

 

The report, A Nation in Pain, provides an analysis of the use of prescription opioid medications — such as codeine, morphine, oxycodone and hydrocodone — in the United States between 2009 and 2013. 

 

 

Nearly half of patients who took opiate painkillers for more than 30 days in the first year continued to use them for three years or longer. And almost half of chronic opioid users took only short-acting medications rather than longer-acting formulations, thus increasing their risk for addiction, Express Scripts stated. Women were 30% more likely than men to use an opioid pain medication, but men tended to fill more frequent and potent opioid prescriptions.

 

And while the elderly had the highest prevalence rate of opioid use, younger adults tended to fill more frequent opioid prescriptions.

 

"Prescription opioids can provide patients with clinically safe and very effective pain management. However, their potential for misuse and addiction requires vigilance by all parties in a patient's care — doctors, nurses, caregivers, pharmacists and benefit providers," stated Lynne Nowak, medical director at Express Scripts. 

 

In addition to tracking opioid prescriptions, Express Scripts looked at users who prescribed opioids in combination with other medications. Nearly 1-in-3 patients were on both an opiate and an antianxiety benzodiazepine, a combination that is the most common cause of multiple drug overdose deaths, Express Scripts stated. Approximately 28% of opioid users were taking a muscle relaxant. As many as 8% were combining an opioid, muscle relaxant and a benzodiazepine. Additionally, 27% were taking multiple opiate pain treatments simultaneously.

 

All told, nearly 60% of patients on opioid pain treatments for long-term conditions were prescribed potentially dangerous mixtures of medications. Two-thirds of patients on these medication mixtures were prescribed the drugs by two or more physicians, and nearly 40% filled their prescriptions at more than one pharmacy.  

 

For the report, Express Scripts examined 36 million de-identified pharmacy claims of 6.8 million commercially insured Americans of all ages who filled at least one prescription for an opioid to treat acute or longer-term (nonacute) pain from 2009 through 2013. Prevalence, use and costs were evaluated during the five-year study period, including assessments of trends according to age, gender and geography.