Abrupt Slowing in Painkiller Deaths Linked to 2 Factors

A team of American researchers reports that two factors—a switch to a tamper-resistant form of the medication OxyContin and discontinuation of a medication called propoxyphene—help explain a drop in prescription opioid-related fatalities that began in late 2010.

Prescription opioid-related deaths began to drop across the U.S. in the second decade of the 21st century after increasing rapidly over the preceding decade. In a study published in April 2015 in the American Medical Association journal JAMA Internal Medicine, researchers from two U.S. universities investigated the reasons for this abrupt trend reversal. The researchers concluded that a ban on the sale of propoxyphene and a reformulation of frequently misused OxyContin largely account for the lowered rate of prescription opioid mortality.

Prescription Opioids, Overdose and Death

Despite their closely regulated production and medical usefulness, prescription opioids are highly similar in many ways to heroin and other illegal/illicit opioid street drugs. Regardless of their status as a medication or drug, all opioid substances can trigger physical dependence and addiction when consumed repeatedly and excessively over time. In addition, all opioid substances can overwhelm the normal function of the central nervous system (brain and spinal cord) and produce an overdose when consumed in excessive amounts. Population segments particularly likely to overdose on an opioid medication include people with ready access to prescription opioids, people who manipulate prescription opioids in order to intensify their effects, people who fail to seek appropriate treatment for opioid addiction, people who combine opioid medications with other substances that suppress central nervous system function and people who return to opioid intake after establishing a substantial period of abstinence.

In the first decade of the 21st century, opioid medication-related overdose fatalities increased in America by an astounding 300 percent. Factors associated with this steep increase in lethal outcomes include a marked increase in the writing of opioid prescriptions, the availability of particularly powerful opioid medications and an increasing tendency among opioid misusers to inhale, smoke or inject prescription opioids rather than consume them orally. The rate of opioid medication-related death began to subside in 2011. Despite this fact, approximately 46 Americans still die from prescription opioid overdoses every day.

OxyContin and Propoxyphene

OxyContin is an oxycodone-based opioid medication designed to produce its pain-relieving effects slowly over a number of hours. Unfortunately, in its original form, the medication was highly susceptible to crushing and other forms of manipulation that allowed misusers to experience its drug effects very rapidly. In August 2010, the manufacturer of OxyContin withdrew the original form of the medication from the U.S. market and introduced a new tamper-resistant formulation. Propoxyphene is a powerful opioid medication found in discontinued products that include Darvon and PC-CAP. In response to ongoing concerns about overdoses and other harmful outcomes associated with use of the medication, the U.S. Food and Drug Administration ordered all propoxyphene-containing products off the U.S. market in November 2010.

Impact on Prescription Opioid-Related Death

In the study published in JAMA Internal Medicine, researchers from Harvard Medical School and the Boston University School of Medicine used data from a nationwide insurance company to explore the reasons why the rate of opioid medication-related fatality started dropping in late 2010 and 2011. Specifically, the researchers sought to gauge the impact of the reformulation of OxyContin and the removal of propoxyphene-containing products from the marketplace. In addition to looking at the rate of prescription opioid-related death, they looked at the rate of opioid prescribing among American doctors. In addition, the researchers looked at the rate of heroin-related death.

The researchers concluded that the introduction of tamper-resistant OxyContin played an important role in reversing the trend of prescription opioid-related fatality at the beginning of the second decade of the 21st century. They also concluded that the banning of propoxyphene played a similarly important role. Within 24 months of the two changes under consideration, the rate of fatal opioid medication overdose declined by fully 20 percent throughout the U.S. The rate of opioid medication prescribing also fell by a substantial amount.

The study’s authors note that the rate of heroin-related fatality rose by fully 23 percent in the two-year timeframe under analysis. Fatal opioid medication overdoses still occur more often than fatal heroin overdoses, but the current trend underscores the increasing prominence of cheaper, more readily available heroin throughout much of America.

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