Colorado Medical Society

2017 CMS Annual Meeting - Opioid update

Wednesday, November 01, 2017

The final general session topic of the meeting focused on the opioid epidemic. Speaker Robert Valuck, PhD, RPh, FNAP, opened with sobering statistics on drug overdose mortality: In 2016, over 63,000 people died from drug overdoses in the United States, one every 10 minutes. Nearly two-thirds of those deaths involved prescription drugs, and opioids were involved in 75 percent of those deaths. In Colorado, there were 912 drug overdose deaths in 2016 and of these, 504 were opioid-involved.

“The good news is that prescription opioid deaths are down slightly but the bad news is heroin deaths, fentanyl deaths and methadone deaths are all up sharply,” Valuck said. “We know that the problem knows no bounds, whether that’s gender, age, income or other. It is truly an epidemic. Now it needs to be elevated to a public health concern.”

However, deaths are the tip of the iceberg, he explained. For every one death, there are 10 treatment admissions for abuse, 32 emergency department visits for misuse or abuse, 130 people who abuse or are dependent, and 825 nonmedical users.

According to two studies published in the Clinical Journal of Pain and Medical Care, the total cost of prescription drug abuse on the U.S. economy in 2013 was $78.5 billion. Medical complications comprised $1.2 billion, substance abuse treatment comprised $3.2 billion, and criminal justice comprised $12.1 billion. But the largest impact of prescription drug abuse is on productivity: $62 billion.

The current epidemic was fueled by a rapid increase in the amount of opioids being prescribed and dispensed due to increased recognition of pain and under-treatment of pain; recognition of pain as the “fifth vital sign;” drug company advertising and promotion; practitioners not specifically trained in opioid pharmacology, addiction or medication-assisted treatment; the highly addictive nature of the drug; and illegal activity, Valuck said.

“In Colorado we have been in the middle or lower percentile for prescriptions,” Valuck explained. “It’s not that we prescribe more. We prescribe fewer prescriptions than most. What we are in Colorado is among the highest in nonmedical users, and that includes prescribed opioids, alcohol and cannabis. In 2010-2011 we were No. 2 in nonmedical use of prescription drugs.”

“Where do people get these opioids that they non-medically use? Seventy percent obtain opioids from friends or relatives. It’s the leftover stuff in the medicine cabinet that gets people started. Storage and disposal is an indirect contribution to that part of the problem. If a patient ends up in the worst possible place – injection drugs – the vast majority started with prescribed opioids. That’s the most common spiral: prescription, medicine cabinet, doctor shopping, street.”

Much is being done on the federal level to address this issue. On the state level, the Colorado Consortium for Prescription Drug Abuse Prevention has nine different groups working on different aspects of the issue. “It’s a very complex problem so all the things we need to do about it are very complex,” Valuck said.

The General Assembly appointed the Opioid and Other Substance Use Disorders Interim Study Committee. “I’ve never seen a group of legislators come in so engaged,” he said. “They spent about 25 hours listening to people talking about what’s going on. There is a robust stakeholder process.”

Valuck closed with his advice for CMS-member physicians:

  1. In practice, follow the CMS 7 Strategies to Achieve Safe Opioid Prescribing (found on page 64 of the September/October Colorado Medicine).
  2. Voice your opinions on proposed legislation to CMS and the Prescription Drug Abuse Committee.
  3. Get involved with one of the Consortium’s work groups:

“If you’re not engaged, we’re leaving out the best brainpower in the state. We need you and encourage you to participate.”

Valuck is chair of the Colorado Consortium for Prescription Drug Abuse Prevention and a professor in the departments of Clinical Pharmacy, Epidemiology and Family Medicine at the University of Colorado Schools of Pharmacy, Public Health and Medicine at the Anschutz Medical Campus in Aurora.