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Painkiller Prescriptions Vary Widely Among States

Death toll can be reduced with better oversight, agency says, citing success in Florida

WebMD News from HealthDay

By Dennis Thompson

HealthDay Reporter

TUESDAY, July 1, 2014 (HealthDay News) -- Doctors in some states seem to wield a freer hand issuing prescriptions for powerful narcotic medications, leading to wide variations in narcotic drug use among states, U.S. health officials reported Tuesday.

Physicians in Alabama -- the state with the highest number of narcotic painkiller prescriptions -- issued nearly three times as many of those prescriptions as doctors in Hawaii -- the lowest prescribing state, according to researchers with the Centers for Disease Control and Prevention.

"The bottom line is we're not seeing consistent, effective, appropriate prescribing of painkillers across the nation, and this is a problem because of the deaths that result," Dr. Tom Frieden, director of the CDC, said at a news conference.

Frieden added that every day 46 people die from an overdose of prescription painkillers.

Overall, health-care providers wrote 259 million prescriptions for powerful painkillers in 2012, based on prescription data gathered from retail pharmacies by a commercial vendor, the CDC reported.

"That's enough for every American adult to have their own bottle of pills," Frieden said.

The CDC analysis of prescription trends also found that:

  • Ten of the highest prescribing states for narcotic painkillers are in the South, with Alabama, Tennessee and West Virginia leading the nation.
  • The Northeast, especially Maine and New Hampshire, had the most prescriptions per person for long-acting/extended-release painkillers and for high-dose painkillers.
  • Prescriptions for oxymorphone varied the most between states, out of all narcotic medications. Nearly 22 times as many prescriptions were written for oxymorphone in Tennessee as were written in Minnesota.

But, the CDC analysis also found that states that crack down on narcotic painkiller prescriptions can dramatically limit the number of overdose deaths. The CDC pointed to Florida as a major success story.

"Florida shows that policy and enforcement matter. When you take serious action, you get encouraging results," Frieden said.

The death rate from prescription drug overdoses in Florida decreased 23 percent between 2010 and 2012, after legislators and law enforcement took actions to crack down on the widespread availability of narcotic painkillers, the CDC said.

The declines in Florida deaths linked to specific prescription painkillers -- oxycodone, methadone, and hydrocodone -- paralleled declines in prescribing rates for those drugs, the researchers said.

Florida officials took action after drug overdose deaths surged 61 percent between 2003 and 2009, the CDC reported.

The prescription drug epidemic in Florida became so rampant that other states were drawn into the drama, said Dr. M. Fahad Khan, assistant professor in the Department of Anesthesiology at NYU Langone Medical Center in New York City.

"Practicing pain medicine all the way up here in New York did not mean you were immune to the problems going on in Florida, as many of our patients here in the state often had their opioid prescriptions started for them by doctors in the Sunshine State," Khan said. "As a pain medicine specialist, your ears automatically perked up when you saw the patient's state of residence listed as Florida on your clinic intake form."

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