Medicaid Opioid Drug Utilization Review Workgroup

​Opioid Overdose Landscape

According to recent data from the Centers for Disease Control and Prevention, two distinct but inter-connected trends are driving the opioid overdose epidemic in the United States:

  1. A 15-year increase in deaths from opioid overdoses; and
  2. A recent surge in illicit opioid overdose, driven mainly by heroin and illegally-made fentanyl.

 

Prescription Opioid Overdose

According to the Johns Hopkins Bloomberg School of Public Health, an estimated one in five patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings. Between 2007 and 2012, the rate of opioid prescriptions increased steadily among specialists more likely to manage acute and chronic pain. Prescription rates are highest among pain medicine, surgery, and physical medicine or rehabilitation; however, primary care providers account for about half of opioid pain relievers dispensed.

According to the Centers for Disease Control and Prevention, both opioid prescription drug sales and overdose deaths involving prescription opioids have quadrupled since 1999 without a concurrent increase in the amount of pain reported by Americans.

Today, at least half of all opioid overdose deaths in the United States involve a prescription opioid.

 

Source: National Vital Statistics, 2013  

Illicit Opioid Overdose

Maryland mirrors national data in that opioid overdose is driving increases in overall drug- and alcohol-related overdose. Historically, Baltimore City has driven the umber of heroin-related overdose deaths in the State; today, that is no longer the case.

Between 2008 and 2014, four of six jurisdictions with the highest heroin-related emergency room department admission rates were predominantly rural counties.

Between 2008 and 2013, the proportion of all heroin-related substance use disorder treatment admission attributed to rural and suburban counties rose from 11 percent to 24 percent and 25 percent to 28 percent, respectively, while the proportion of admission for Baltimore City residents fell from 64 percent to 48 percent.

 

Additional Risk

Overdose is not the only risk related to prescription opioids: misuse, abuse, and opioid use disorder (addiction) are also potential dangers.

According to the Centers for Disease Control and Prevention, almost two million Americans abused or were dependent upon prescription opioids in 2014. As many as one in four people who receive prescription opioids long-term for non-cancer pain in primary care settings struggle with addiction.

There is also indication that prescription opioid abuse is a major risk factor in heroin use. In many cases, heroin is cheaper and more widely available than prescription opioids. The use of fentanyl--a substance 100 times more potent than morphine and 50 times more potent than heroin--is also increasingly added as a cutting agent or being sold as a standalone drug, in place of heroin.