Doctors are writing fewer prescriptions for powerful painkillers than they did a year ago, and fewer Virginians are dying and overdosing from opioids, according to reports filed by the state Department of Health.
If the fatal overdose trend holds through the final quarter, 2018 could mark a turning point in Virginia’s opioid epidemic. Overdose deaths have been on the rise since 2013, when, for the first time, more Virginians died from drugs than from guns and automobile wrecks.
Overprescribing of powerful painkillers in large doses and for long periods of time has been blamed as one of the causes leading to the opioid epidemic. Virginia lawmakers and public health officials adopted a number of changes that limit how much, and for what conditions, opioids can be prescribed, and requires doctors, nurse practitioners and physician assistants to check patients’ usage through an electronic database.
Ralph Orr, director of the Prescription Monitoring Program, in an annual report to the Joint Commission on Health Care filed earlier this month, said that its use has nearly doubled since the beginning of 2017, and that more than a million prescriptions a month are filled through the program.
From that data, the Prescription Monitoring Program is finding that fewer doctors are prescribing opioids, fewer patients are taking them — and when they are, the dosages are smaller and are available for fewer days, he said.
Other Virginia Department of Health reports filed in recent weeks also indicate that there are efforts working to combat the rise in recent years of opioid overdoses and deaths. Fewer Virginians than last year are turning up in emergency rooms and morgues from drug overdoses.
The most recent quarterly report filed by the Office of the Chief Medical Examiner projects 1,444 deaths from drugs this year, a drop from 1,538 in 2017. Of those deaths, 508 came from prescription opioids alone.
And the health department’s monthly report tracking overdose visits to hospital emergency rooms notes that cases are 12 percent lower from January to September when compared to last year, and 11 percent lower than 2016.
Still, more than 700 people were treated for drug overdoses during September. That figure does not include all hospitals, nor people who were revived outside of a hospital and refused further treatment.
A sharp increase in overdoses began in 2016 when fentanyl began to be mixed with heroin.
Fentanyl is a powerful painkiller that until two years ago mostly was found in pain patches prescribed to cancer patients. It is now manufactured illicitly and mixed with street drugs, and it has been implicated as the cause of the substantial rise in drug deaths, first mixed with heroin and now with cocaine and meth.
Lawmakers and public health officials have instituted a number of measures, including making the fast-acting antidote to opioid overdoses, naloxone, available to anyone without a prescription; designing an addiction treatment plan through Medicaid to get more people into effective treatment programs; and discouraging physicians from prescribing opioids for more than a few days.
Though the state has had the Prescription Monitoring Program for more than a decade — its creation was part of the effort to first address oxycodone addiction in the far southwest part of the state — few prescribers and dispensers were using it. Two years ago, Virginia automatically registered prescribers as their licenses came up for renewal.
The database is also being integrated into electronic health records, making it easier to use, and changes to laws have mandated its use.
The program’s annual report said, “Requests for a patient’s prescription history have grown exponentially in recent years.” Quarterly use nearly quadrupled by mid-2018 when compared to early 2017. Requests are projected to exceed 33 million in 2018, or double last year’s total.
Last year, the Prescription Monitoring Program began to generate reports to let doctors know how often they prescribe controlled substances, how their data compare with peers with similar medical practices and whether they prescribed dangerous combinations of medications.
The data are also being used to identify unusual patterns. Lawmakers last year gave the program the authority to disclose data to the Department of Health Professions’ enforcement division.
Since July 2017, the division reviewed practices by 34 prescribers and 28 dispensers, and initiated investigations as appropriate, the annual report said.
The Prescription Monitoring Program advisory panel in September adopted new guidelines that will trigger investigations by flagging the top opioid prescribers and dispensers.
The program is also used to identify possible criminal activity by people seeking drugs and then diverting them to the street market.