The U.S. "epidemic" of prescription-painkiller abuse may be starting to reverse course, a new study suggests.
Heroin abuse on the rise
Experts said the findings, published in the New England Journal of Medicine, are welcome news. The decline suggests that recent laws and prescribing guidelines aimed at preventing painkiller abuse are working to some degree.
But researchers also found a disturbing trend: Heroin abuse and overdoses are on the rise, and that may be one reason prescription-drug abuse is down.
"Some people are switching from painkillers to heroin," said Dr. Adam Bisaga, an addiction psychiatrist at the New York State Psychiatric Institute in New York City.
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While the dip in painkiller abuse is good news, more "global efforts" – including better access to addiction treatment – are needed, said Bisaga, who was not involved in the study.
"You can't get rid of addiction just by decreasing the supply of painkillers," he said.
Prescription narcotic painkillers include drugs such as OxyContin, Percocet and Vicodin. In the 1990s, U.S. doctors started prescribing the medications much more often, because of concerns that patients with severe pain were not being adequately helped.
U.S. sales of narcotic painkillers rose 300 percent between 1999 and 2008, according to the U.S. Centres for Disease Control and Prevention.
The increase had good intentions behind it, noted Dr. Richard Dart, the lead researcher on the new study. Unfortunately, he said, it was accompanied by a sharp rise in painkiller abuse and "diversion" – meaning the drugs increasingly got into the hands of people with no legitimate medical need.
What's more, deaths from prescription-drug overdoses (mostly painkillers) tripled. In 2010, the CDC says, more than 12 million Americans abused a prescription narcotic, and more than 16,000 died of an overdose – in what the agency termed an epidemic.
Declining prescription painkiller abuse
But based on the new findings, the tide may be turning, said Dart, who directs the Rocky Mountain Poison and Drug Centre in Denver.
His team found that after rising for years, Americans' abuse and diversion of prescription narcotics declined from 2011 through 2013. Overdose deaths, meanwhile, started to dip in 2009.
The findings are based on data from five monitoring programmes – four of which showed the same pattern of declining prescription painkiller abuse, Dart said.
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One, for instance, followed patients newly entering treatment for drug abuse. It found that the number who said they'd abused a narcotic painkiller in the past month fell from 3.8 per 100,000 in 2011 to 2.8 per 100,000 in 2013.
"The big 'but' is heroin abuse and overdose, which is increasing," Dart said.
Nationally, the rate of heroin-related deaths rose from around 0.014 per 100,000 in 2010, to more than 0.03 per 100,000 in 2013, the study noted.
"It's a good news/bad news story," said Dart, who agreed that some of the decline in painkiller abuse is due to some users switching to heroin.
Drug cartels expanding
A recent study highlighted the changing demographics of the U.S. heroin user. Today, it's often a middle-class suburbanite who started off on painkillers.
"You see drug cartels expanding into smaller towns. Heroin is reaching rural areas where it was never seen before," Bisaga said. "And that is going to be around for a long time."
Still, the switch to heroin is not the only reason for the decline in painkiller abuse, Dart said. He pointed to the flood of federal, state and local legislation passed in the last decade to combat prescription-drug abuse.
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Almost every state has prescription drug monitoring programmes, which electronically track prescriptions for controlled substances. They can help catch "doctor shoppers" – people who go from doctor to doctor, trying to get a new narcotic prescription.
Medical groups have also come out with new guidelines on painkiller prescribing, aiming to limit inappropriate use.
"I can't tell you which of these efforts is working," Dart said, "or if they're all working."
But both he and Bisaga said it's not enough to keep prescription painkillers out of the wrong hands.
"You have to reduce the demand, too," Dart said. That, he added, requires education on the addictive potential of painkillers and wider access to addiction treatment.
Medications for narcotic addiction are available, but not enough people get them, Bisaga noted.
"We still have 3 million people addicted to these drugs," he said, referring to painkillers and heroin. "We need to build a cadre of professionals who can treat them."
Dart said the public has a role in limiting painkiller abuse, too – by not automatically asking for Vicodin after a tooth extraction, for example.
"A segment of the population is susceptible to developing an addiction," Dart noted. "And it can happen to the fine, upstanding citizen, too."
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