The Opioid Paradox: Prescription Opioid Use Declines as Heroin Use Increases

by Phil Walls, RPh
Chief Clinical Officer

I am blogging from Maine today as I attend the Maine Comp Summit. My presentation on Sunday, August 28, 2016 was “Understand the Problem First: Why Does Heroin Abuse Matter to a Claims Professional?” The short answer to that question is because, among other things, the Centers for Disease Control now recognize that addiction to prescription opioids makes an individual 40 times more likely to become addicted to heroin. The key takeaways from the session was that:

1. We can’t legislate our way out of this epidemic;
2. We can’t cure an addict by giving them another addictive drug; and
3. We can all be part of the solution.

Maine cracked down on the prescribing of opioids for patients enrolled in its MaineCare system in 2012 resulting in a 45% decrease in opioid prescriptions by 2014 — an outstanding result, although one that many fear may directly or indirectly contribute to the state’s increased heroin use. As the number of patients in state-sponsored addiction treatment programs declined from a peak of 5,132 in 2012 to 3,391 in 2014, the number admitted for heroin treatment increased from about a 1000 per year to 3,102 by 2014. As the graph below indicates, the number being treated for heroin addiction in state programs nearly matched people being treated for prescription opioids.

myMatrixx- take on Opioid Paradox

However, in spite of these concerns, the police chief of Sanford, Maine got it right when he stated, “We can’t not do it because we’re afraid of what might happen. We can’t continue to have these drugs be overprescribed.”

And according to the Center for Disease Control (CDC), the first step in combating heroin addiction is to decrease the overprescribing of opioids. Although that will not take care of all the heroin addicts currently needing treatment, it will at least hopefully stem the tide of new addicts currently being created on a daily basis.

Maine has also become the second state to mandate the electronic prescribing of controlled substances (EPCS) with an effective date of July 1, 2017. This mandate is part of their new statute, “An Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program.”
In addition, it also:

-Requires that prescribers receive continuing medical education on addiction, according to a bulletin from the Maine Medical Association (MMA);
-Mandates a limit on opioid scripts to seven days for acute pain and 30 days for chronic pain, with no limits on renewals; and
-Limits the morphine milligram equivalent (MME, aka MED or morphine equivalent dose) to 100mg effective 90 days after the law’s passage for new prescriptions. But patients who are already receiving drugs in excess of that limit can take up to 300 mg until July 1, 2017.

Again, as the police chief of Sanford stated: “We can’t not do it.”