How did we get here?
Several factors have contributed to the rise in the use of opioids over the past 20 years. In the 1990s, in response to reports of under treatment of chronic pain, health organizations began to advocate for more aggressive pain control. Long acting opioids were developed and approved by the Food & Drug Administration (FDA) for patients with persistent pain that requires stable around the clock dosing.
The unintended consequences of opioid misuse, abuse and related overdose rose dramatically in the early 2000s which spurred states to implement drug monitoring programs. Multiple organizations published guidelines for appropriate utilization. The FDA required that some opioids be removed from the market, reclassified or reformulated to be more difficult to manipulate and abuse.
Although prescriptions written for opioid medications have decreased since reaching their peak in 2010-12, they remain three times as high in 2015 as in 1999, and death rates from opioid-involved overdose have continued to increase driven by illicit fentanyl and heroin.
Data from the Centers for Disease Control (CDC) show prescribing of opioids has increased in three ways since the 1990s:
- Opioid use for chronic non-cancer pain increased the number of opioid prescriptions written
- The use of opioids to treat chronic pain conditions increased the average length of time for which opioids were prescribed
- Average doses of opioids prescribed are higher for patients who are prescribed long-term opioids so the average doses per patient have also increased 6