Prescription Overdose Deaths in Florida Plunge After Tougher Measures, Report Says
By SABRINA TAVERNISE JULY 1, 2014
Prescription drug overdose deaths in Florida fell sharply after the state began strengthening its prescribing laws and stepping up enforcement. Federal researchers said Tuesday that it was one of the first significant documented declines in the nation since the epidemic of prescription drug abuse took hold more than a decade ago.
The death rate from prescription drug overdoses in Florida fell by 23 percent from 2010 to 2012, according to a report by the Centers for Disease Control and Prevention, and by more than half in the same period for oxycodone, one of the most widely abused drugs and one that has been at the heart of the health crisis.
Florida began making legal and regulatory changes in 2010, for example requiring pain clinics to register with the state. At the same time, the authorities conducted statewide raids that resulted in drug seizures and the closing of pain clinics. Federal researchers who wrote the report said that the decline in deaths might not be exclusively attributable to the reduction in prescribing, but that the timing suggested it had been an important factor.
Drug overdose deaths in Florida have fallen since 2010, when the state began stricter regulation of pain medication prescriptions.
Per 100,000 people
JULY 1, 2014
By The New York Times
Source: Centers for Disease Control and Prevention
Dr. Thomas Frieden, director of the C.D.C., said the pattern provided a hopeful example of the effect that policy could have on one of this country’s most entrenched public health problems, one that takes the lives of more than 20,000 Americans a year.
“This tells us that policies and enforcement work,” Dr. Frieden said. “This is an epidemic that was caused largely by inappropriate prescribing, and it can be fixed to a significant extent by improving prescribing.”
With the decline, the rate of prescription drug deaths in Florida fell to 2007 levels, a significant achievement. Pain clinics had proliferated in Florida, and by 2010 the state was home to 98 of the 100 doctors nationally who dispensed the highest quantities of oxycodone directly from their offices, according to the report. In the six years before Florida changed its laws, deaths from drug overdoses surged by more than 60 percent.
Florida has reported that about 250 pain clinics had been closed by 2013, the C.D.C. said, and the 98 doctors who had prescribed high volumes of oxycodone dwindled to 13 in 2012. By 2013, there were none. The decline documented by the federal agency does not include a continued fall in deaths in the first half of 2013, the most recent reporting period for the state.
The national rate of prescription drug deaths has remained persistently high through 2011, the most recent year for which there is national data.
Dr. Nathaniel Katz, an adjunct assistant professor of anesthesia at Tufts University School of Medicine in Boston, whose company, Analgesic Solutions, develops treatments for pain, said Florida’s prescription drug monitoring program had made it much more difficult for patients to shop for doctors, a practice that raises the risk of overdose.
“Florida has finally shut down criminal prescribing, after years of flooding the market by unbridled prescribing,” he said.
Overdose deaths from illicit drugs like heroin and cocaine increased slightly in the period covered by the report, possibly a sign of people switching away from prescription drugs. Still, the increase did not offset the decline in Florida’s prescription drug deaths. For example, there were 668 fewer overdose deaths from opioid painkillers in 2012 than in 2010, compared with 60 more heroin deaths. In all, 108 people in Florida died of heroin overdoses in 2012, compared with 2,116 who died from prescription drug overdoses.
A few states have reported declines in overall drug deaths, but none as deep and sustained as Florida’s. In Washington State, a substantial decline in prescription opioid drug deaths was offset by a rise in fatal overdoses of illicit drugs. In Utah, a reduction in prescription opioid drug deaths was not sustained, and North Carolina’s decline, like Washington’s, was wiped out by a subsequent increase in fatalities from illegal drugs, said Dr. Leonard Paulozzi, one of the authors of the report.
In Florida, deaths declined for those drugs for which prescribing also dropped. Oxycodone prescribing fell by about a quarter, the report found, while morphine prescribing increased, as did deaths from it.
The sheer number of prescriptions has helped drive abuse in the United States. In 2012, more than 259 million prescriptions for pain pills were dispensed, federal researchers said, enough for every American adult to get a bottle of them. In a separate analysis on Tuesday, federal researchers found that most of the highest prescribing states were in the South. Doctors in Alabama, the highest prescribing state, wrote almost three times as many prescriptions per person as doctors in Hawaii, the lowest prescribing state.
The C.D.C. report noted that a 2010 formulation of oxycodone that made abusing it harder may have also contributed to the decline. But most of the decline in both prescribing and deaths happened after 2011, leading federal researchers to put less emphasis on that as a reason.
Source: Forensic Magazine