Prescriptions for the powerful painkiller oxycodone have spiked by nearly 30 percent over the last three years in the Bay State as other opiates drop — a trend experts are calling a frightening red flag in the scramble to control an exploding drug abuse epidemic, a Herald analysis shows.
Those working with addicts and their families say oxycodone in 30-milligram tablets — dubbed “Roxy” or “Perc 30s” on the street — have overtaken OxyContin as an abuser’s pill of choice, another possible explanation for the drug’s jump.
“To hear that prescription painkillers, any prescription painkiller, is on the rise in this state is concerning. That’s going to lead to more overdoses across the state,” said Kristin Nolan, executive director of outpatient services for Spectrum Health Systems. “A lot of what we’re seeing in the media is heroin overdoses, but these painkillers, that’s where a lot of these people start out. They have surgery, they get a prescription painkiller and the next thing they know, they’re addicted.”
Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing and chief medical officer of Phoenix House, a non-profit network of addiction treatment centers, including in Massachusetts, called the increased use of oxycodone a “big problem.”
“Those are the drugs that patients are getting addicted to,” he said, “and those are the drugs where drug dealers are going to doctors saying they have pain, they get the prescriptions and they end up on the black market.”
A Herald analysis of statewide data from May 2011 through April 2014 provided by Symphony Health Solutions, which tracks and analyzes drug trends, showed a number of stunning developments:
• Prescriptions for oxycodone have increased by 27 percent, with OxyContin — the potent, controlled-release, name brand form of oxycodone — ticking up by 2 percent. It comes as overall prescriptions for powerful opiates have steadily slid from more than 3.9 million to 3.79 million, with several drugs, like Percocet and Fentanyl, following suit;
• Across more than 25 pediatric specialties, oxycodone prescriptions have jumped 34 percent to reach more than 15,600 by the end of the three-year span, even as the prescribing of opiates overall for kids has dipped;
• Prescriptions doled out for “pain medication” more than doubled, from 17,829 through the first 12 months to 46,525 by the end of the three-year time frame.
Kolodny said “pure” oxycodone is generally used to treat chronic pain.
“It’s very concerning because what’s fueling the epidemic is that very practice — opioid use for chronic pain,” he said. “Massachusetts has got to do better to get the right educational messages out to prescribers.”
Opiate addiction burst into the public consciousness this year, when state police estimated as many as 185 fatal overdoses occurred between November and February. The next month, Gov. Deval Patrick declared a public health emergency, and ordered a range of steps, including convening an Opioid Task Force, bringing together New England governors for a regional response and attempting — unsuccessfully — to ban the powerful painkiller Zohydro.
The increased awareness to stem the problem makes the trend even more worrisome, experts say.
Cheryl Bartlett, commissioner of the state’s Department of Public Health, said she’s heard “anecdotally” from addiction specialists about growing concerns around oxycodone. The state, she said, is planning to convene a committee to gauge what new policies could help stem “diversion” — industry lingo for theft and misuse — for a range of prescriptions, hopefully by year’s end.
The overall trend follows decades of spikes in drugs with a “high potential for abuse.” State data shows prescriptions steadily climbed since the early 1990s before doubling from roughly 2 million in 2001 to 4.4 million by 2012. Opioid-related deaths nearly doubled in the same time frame, hitting 642 in 2011.
Joanne Peterson, founder of Learn to Cope, which runs support groups for families of substance abusers, said the wild popularity of oxycodone in 30-milligram tablets also may explain the spike.
“The data makes complete sense to me,” she said. “It’s all Oxycodone-30.”
Dr. John Fallon, senior vice president of the state’s largest health insurer, Blue Cross Blue Shield, said a movement of prescribing less Tylenol-laced medications — because of concern that long-term use can damage a patient’s liver — could explain the push toward oxycodone as a substitute painkiller.
If so the data, he said, may represent more of “shifting in categories.” Fallon pointed to Blue Cross’ own efforts to control prescriptions by limiting how much a doctor can prescribe without the company’s approval, which helped spark a 50 percent decline in OxyContin in its network since July 2012. They track the drug pill by pill.
“I wish it was all going down,” he said. “But it’s a journey, and it’s a patchwork quilt of solutions.”
Nancy Coffey, the DEA’s diversion program manager for New England, said the key is better educating prescribers.
“Up until a couple of years ago pain management wasn’t even addressed in medical school,” she said. “It’s a relatively new field. Doctors were prescribing these powerful narcotics and people were unaware the addiction that was going to occur.”
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Prescription rate for oxycodone soars – Boston Herald