- The Washington Times - Monday, May 7, 2018

States that have made it more difficult for opioids to be overprescribed have seen an increase in overdose deaths as drug users turn to cheaper heroin and synthetic fentanyl, according to a review of drug studies.

Between 2015 and 2016, more than half of U.S. states reported at least a 40 percent increase in drug overdose deaths, and of those, more than 19,000 deaths were related to illicit and synthetic opioids.

In Maryland, one of the top five states with the highest rates of drug overdose deaths, the number of prescriptions for opioids decreased but overdose deaths related to fentanyl rose sharply, from fewer than 400 in 2015 to more than 1,000 deaths a year later. More than 200 deaths were related to prescription opioids during the same period.

In Florida, 1,566 people died from overdoses related to synthetic opioids in 2016, compared to 200 in 2013.

“It’s hard to see somebody passed out in a car that’s crashed into a wall with a needle sticking out of their arm,” an undercover narcotics officer says in a public service announcement issued by the sheriff’s office in Orange County, Florida.

Florida saw some success in curbing overdose deaths from prescription opioids in part thanks to its Prescription Drug Monitoring Program in 2011. After that, oxycodone-related overdose deaths declined by 25 percent.

The increased use of prescription drug monitoring programs is a key feature of the federal plan to combat the opioid epidemic. All 50 states and the District of Columbia have either a working PDMP or plans to start one.

Yet each system varies widely in form and function, making it difficult for researches to identify best practices and efficient methods to implement nationwide.

“Programs operate under different regulatory agencies, collect different types of data, require data to be updated at different intervals, and allow access to different groups of people,” researchers from Columbia University’s Mailman School of Public Health wrote in a study published in the journal Annals of Internal Medicine.

Examining 2,661 records of programs across the country, researchers were able to identify only 17 studies that looked at how policies regulating such programs affected death rates in the states.

Overall, the researchers found little evidence to support that programs increased or decreased fatal and non-fatal overdoses.

But an unintended consequence popped up in at least three studies: Heroin-related overdoses in states increased when prescription pills became harder to come by.

“Of the 6 studies examining the relationship between PDMP enactment and heroin-related overdoses, 3 found a statistically significant post implementation increase in these events,” the authors wrote.

The Columbia researchers cited work by Chris Delcher at the University of Florida, who found that the 25 percent decrease in oxycodone deaths was offset with a “statistically significant increase” in drug deaths related to heroin — from just over 50 in 2011 to upwards of 200 in 2014.

In another study, Brown University researcher Angelica Meinhofer found that between 2010 and 2012, one year before and after the implementation of the PDMP, street prices for oxycodone in Florida increased by 238 percent. There were 139 new heroin related deaths, she wrote.

The Columbia researchers recommend that any use of a prescription monitoring program should be coupled with increased efforts to identify people with opioid dependency and intervene to provide medication-assisted treatment or other evidence based treatment methods.

The research did highlight some key features with positive outcomes on reducing opioid abuse within the monitoring systems, which all related to near daily or weekly use of the system.

Last year, the Centers for Disease Control and Prevention made more than $28 million available for grants to states to help fight the opioid overdose epidemic. For 39 states and the District, funds are in part meant to increase the use of PDMPs and “improve clinical feedback from the system,” according to the agency’s website.

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