The decrease in use of the popular opioid comes in the wake of concerted efforts at the state level by the attorney general’s office and at the city level starting with the Bloomberg administration to discourage doctors from over-prescribing the drug.
In 2013, New York City residents filled 1.27 million prescriptions for oxycodone, a Schedule II narcotic pain reliever, according to data from the state health department’s Bureau of Narcotic Enforcement.
That was about 10,000 fewer prescriptions than were filled in 2012, or a 1 percent decline, and follows a five-year period where the number of oxycodone prescriptions across New York City increased roughly 125 percent, or an average of 25 percent each year.
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The news comes a week after the city’s health department released a report showing overdose deaths had once again increased, but by a smaller percentage than in years past, and provides city and state officials with some hope the decline in prescriptions will foreshadow a decline in overdose deaths.
“The big thing is we’re no longer creating new addicts,” said Terrence O’Leary, the state director of the Bureau of Narcotic Enforcement. “People much smarter than me point to this as an iatrogenic epidemic, that it was the change in prescribing that led to this. So what we need to do is correct the prescribing behavior.”
The trend in oxycodone follows a similar trend in hydrocodone (such as Vicodin) where prescriptions have been declining for four years. But 2013 was by far the biggest drop, with city rates falling 22 percent, a decrease that was roughly equal throughout all five boroughs.
According to the state health department, the largest decline came in March 2013, the first full-month after Attorney General Eric Schneiderman reclassified hydrocodone as a Schedule II narcotic. New York was the first state to do so and the federal government made the move last month.
Hydrocodone prescriptions dropped 20 percent in the first full quarter after the rule change as compared to same quarter in the year prior. During that period, there was also a 14.6 percent increase in buprenorphine prescriptions, which is used to treat opioid addictions.
Within the city, the largest decrease in oxycodone prescriptions last year was on Staten Island, where the opioid problem has been particularly acute.
Assistant city health commissioner Dr. Hillary Kunins told Capital last week that health department employees went door-to-door in the borough last summer trying to persuade physicians to think twice before writing another opioid prescription.
The latest data from the Office of the Special Narcotics Prosecutor, shown in a chart provided to Capital by the office, appear to validate that approach, though the increases had been slowing since 2011, leading some to suggest Staten Island had reached a saturation point.
Oxycodone prescriptions on Staten Island increased about 40 percent between 2008 and 2012, but decreased 5 percent in 2013. Brooklyn and Queens each saw a 2 percent drop. Manhattan fell about two-tenths of 1 percent and the Bronx increased 3 percent.
State officials said the average daily supply remained flat, meaning the reduction in prescriptions is a reliable indicator the number of pills has decreased.
O’Leary, of the Bureau of Narcotic Enforcement, said the decrease is not limited to New York City and reflects a change in physician attitude throughout the state that has been a long-time in the making.
Public health officials had to undo 20 years’ worth of physicians’ belief that pain is what a patient says it is, and that doctors should not second guess their patients, O’Leary said.
Bridget Brennan, the city’s special narcotics prosecutor, said last week that pharmaceutical companies had been pushing these drugs on doctors for years, and downplaying their potential for addiction. What was needed, she said, was a countervailing push to re-sensitize physicians to the dangers of opioids.
“Frankly, the medical community has taken notice,” she said.
Much of that has been attributed to prescribing habits, particularly in southern states which have the highest rates of prescriptions.
The C.D.C. recently reported that in 2012, doctors wrote 259 million prescriptions for opioid painkillers, enough for every adult in the nation. Alabama and Tennessee led the country with 143 painkiller prescriptions for every 100 people.
States across the country took steps to limit prescriptions. Florida, for example, stopped health care providers from dispensing prescription painkillers from their offices and saw a 50 percent decline in oxycodone-related deaths. Kentucky began requiring doctors to check patients’ histories before writing new prescriptions, which ultimately led to sharp declines in prescriptions.
Some addiction experts worried that reducing the number of pills through a program such as I-Stop would lead to an even greater increase in heroin because addicts needed to find a new way to satisfy their habit.
Whether that actually happens and to what degree is hard to tell. Heroin surged even before prescription opioids declined but cutting the supply of one drug certainly increases the risk that addicts shift to another drug.
That doesn’t mean getting pills off the street wasn’t the right move, O’Leary said.
“I don’t think it was unforeseen, I think it was unfortunate,” he said.
Brennan, the special narcotics prosecutor, said no one government action is responsible for the drop in prescriptions. Rather, she said, it is a confluence of events that include increased media attention, tougher penalties for doctors who negligently prescribe, Schneiderman’s moves, an effective awareness and education campaign as well as other measures.
But one year’s decline, Brennan said, does not mean the problem is solved.
“This is not something that is going to be fixed with a snap of a finger,” she said.
In response to news of the decline, Schneiderman said in an email, “A sharp drop in the number of hydrocodone prescriptions is an important step forward in our ongoing fight against opioid addiction in New York—and is a key goal of I-STOP, our legislation that mandated the reclassification of this highly addictive and widely abused drug. With that, we lower the chance that our kids might find unused pills in a parent’s medicine cabinet and the chance that patients themselves become addicted to a prescription drug.”
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City reports trend-busting drop in oxycodone prescriptions – Capital New York