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Decrease in opioid dispensing may be linked to increase in heroin overdoses

Rates of opioid dispensing and prescription opioid overdoses dropped significantly after the introduction of abuse-deterrent OxyContin and withdrawal of propoxyphene, however, rates of heroin overdose have continued to rise, according to recently published data.

“The introduction of abuse-deterrent OxyContin and withdrawal of propoxyphene at the end of 2010 were associated with sudden, substantial and sustained decreases in prescription opioid dispensing. During the same time frame, we identified a trend toward acceleration of the previously increasing rate of heroin overdose,” Mark R. LaRochelle, MD, MPH, of the department of population medicine, Harvard Medical School, and colleagues wrote.

Researchers evaluated claims from a U.S. health insurer, covering 31.3 million people, to assess the correlation of abuse-deterrent OxyContin (oxycodone hydrochloride, Purdue Pharma LLC) and market withdrawal of propoxyphene with opioid dispensing and overdose rates.

Results demonstrated that overall opioid dispending rates decreased by 19%, 2 years after opioid market change occurred (absolute change = – 32.2 mg morphine-equivalent dose per member per quarter; 95% CI, – 38.1 to – 26.3).

At 2 years after market change, an absolute change of –11.3 mg (95% CI, –12.4 to –10.1) was seen in dispensing of extended-release opioids, 3.26 mg (95% CI, 1.4-5.12) absolute change in long-acting opioids, – 8.19 mg (95% CI, – 9.3 to – 7.08) absolute change in propoxyphene and – 16.2 mg (95% CI, –18.8 to –13.5) absolute change for other immediate-release opioids.

Rates in overdoses attributed to prescription opioids decreased by 20% (absolute change = 1.1 per 100,000 members per quarter; 95% CI, – 1.47 to – 0.74) 2 years after market changes, but a 23% increase in heroin overdoses (absolute change = 0.26; 95% CI, – 0.01 to 0.53) was seen.

The researchers noted that the challenge is finding a balance between stopping opioid abuse and still finding a way for those who benefit from opioid therapy to access it. Additionally, LaRochelle and colleagues stated that there is extensive documentation of opioid users transitioning into heroin abusers, and efforts are needed to combat this issue.  

“Given the decreased supply of prescription opioids, those seeking out an opioid could be turning to heroin, which may partially explain the tremendous increase in heroin overdose deaths over the past few years both locally and nationally. Our results indicate the potential of pharmaceutical changes in helping combat the opioid epidemic, but we stress the need for complementary interventions targeting the identification and treatment of addiction to curb opioid abuse,” LaRochelle said in the release. – by Casey Hower

Disclosure: The researchers report no relevant financial disclosures.