Dr. Benjamin Rathert explains why doctors need proper training on prescribing opioids
Editor’s note: This story is part of a continuing series about the opioid epidemic in Illinois.
A proposal by the federal Drug Enforcement Agency to limit the production of prescription painkillers in 2018 has some drug and addiction experts worried that it could be a sign of more addiction and heroin use in Illinois and other states.
Due to declining opioid prescribing by doctors, the DEA announced Aug. 4 that it is considering lowering the quota of Schedule I and II opioids — the most potent and addictive types — by 20 percent for 2018, compared to 2017 levels.
However, as the country scales back on opioid prescriptions, it is the scarcity of addiction treatment that could more negatively affect people, said Gary Tennis, president of the National Alliance for Model State Drug Laws, which works on drug law policy. He estimated that treatment funding is at 10 percent of what it needs to be, and, as more patients are denied opioid prescriptions, they could turn to heroin.
“Heroin has never been more dangerous, and that’s why we have an exploding overdose problem,” Tennis said. “If they don’t go to treatment, it could be a death sentence.”
Overall, fewer opioid prescriptions is a good sign, as doctors realize they’re overprescribing, Tennis said. According to the Centers for Disease Control and Prevention, opioid prescribing quadrupled over the past 20 years, but “we didn’t have a quadrupling of pain,” he said.
Still, he warned, “(doctors) just can’t cut the person off.”
Angela Manns, a registered nurse and the Medical Services Director at Centerstone, a healthcare provider that also treats addiction in Southern Illinois, agreed with Tennis’ concerns about the lack of treatment options.
“Reducing the availability of legitimate pain medication can lead patients to seek pain control other ways as their dependence grows,” she said. “Heroin and heroin substitutes are often cheaper and easier to get than prescribed pain medication.”
“Given the current crisis with heroin, it may mean even more people seeking very limited addiction treatment resources, especially in Southern Illinois,” Manns said.
Heroin has never been more dangerous, and that’s why we have an exploding overdose problem. If they don’t go to treatment, it could be a death sentence.
Gary Tennis, president of the National Alliance for Model State Drug Laws
Illinois is among the majority states with declining prescription trends, according to data collected by the state’s Prescription Monitoring Program:
▪ In 2016, patients received about 1.9 million grams of hydrocodone in short-acting tablets, down from an average of 2.4 million grams from 2012 through 2015.
▪ Patients also received about 490,000 grams oxycodone in short-acting tablets, the first decline recorded by the PMP after years of consistent increases, from 384,000 grams in 2012 to 523,000 grams in 2015.
After nearly two decades of opioid quota increases, 2017 will be the second time in two years the DEA will likely decide to lower the threshold. The agency proposed to reduce the 2018 hydrocodone quota by about 41 percent from its 2016 level, and the oxycodone quota is set to decline 31 percent over the same period.
Despite the DEA’s plans, the 2018 production supply isn’t set in stone just yet. Currently, it is open for a comment period, which is scheduled to close Sept. 6. The DEA may also hold a hearing on the issue. The agency is expected to issue final quotas for individual drugs later this year.
The DEA, instructed by law to provide a supply of medicine for the medical, scientific and research needs of the country, sets opioid quotas every year based on a variety of factors, including retail consumption levels, past quotas and forecasts from manufacturers, explained Scott Collier, the Diversion Program Manager at the DEA in St. Louis.
“This is a normal, natural thing that DEA does,” he said.
Collier believes the 20-percent reduction is “significant,” but it isn’t a move designed to create a scarcity of painkillers. That’s because it is a reaction to prescribing trends, not something that influences them. In fact, the opioid supply runs a little high because the DEA doesn’t want shortages in case of war or natural disasters, he said, adding that there has never been an opioid shortage.
Both Collier and Tennis think patients won’t really feel the new quotas; however, they may notice as doctors prescribe fewer painkillers in the future.
The new limits could shield the next generation of patients from opioid exposure, but for the one coming down from the crisis, it’s critical even for patients with legitimate prescriptions for opioid pills be assessed for addiction, Tennis said.
“It could be the difference between life and death.”