A report released recently by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows one in every 20 Americans misused prescription painkillers last year. This discovery is particularly relevant because the drug war, combined with changes to U.S. health care law, may have helped exacerbate the so-called opioid epidemic.
In 2015, an estimated 119 million Americans older than 12 used prescription psychotherapeutic drugs — a term used in the SAMHSA report to refer to “pain relievers, tranquilizers, stimulants, and sedatives,” though pain relievers were the most commonly used.
Researchers used that estimate, along with the data gathered from 68,000 surveys to produce the report. According to the report, “[a]ll estimates (e.g., percentages and numbers) presented in the report are derived from NSDUH [National Survey on Drug Use and Health] survey data.”
SAMHSA found the use of prescription psychotherapeutic drugs “in the past year was fairly common in the United States,” with about 44.5 percent of the population claiming to use prescription psychotherapeutic drugs in 2015.
The report also found one in every “14 Americans older than 11 misused or abused the drugs” and that about 2.7 million people, or at least 1 percent of the adult U.S. population, “have a prescription drug use disorder.”
While the report seems to confirm the increase in opioid use among Americans in recent years, it also unveils another seldom discussed point.
According to SAMHSA, “[a]mong people aged 12 or older, an estimated 18.9 million misused prescription psychotherapeutic drugs in the past year, representing 7.1 percent of the population.”
SAMHSA classifies “misuse” as any “use of prescription drugs that were not prescribed for an individual or were taken only for the experience or feeling that the drugs caused.”
The vast majority of those who misused the drugs claimed to have obtained them from a friend or family member, as shown in the graph below.
But the second most common way pain relievers were reportedly obtained raises more questions than answers.
Among those who sought access to opioids without actually needing them, 36.4 percent reached out to a doctor or stole the prescription from a health care provider.
According to Time, changes to U.S. health care law may have helped give patients addicted to opioids an easy way to go back to the hospital for more.
“As part of an Obamacare initiative meant to reward quality care,” Time’s Sean Gregory writes, “the Centers for Medicare and Medicaid Services (CMS) is allocating some $1.5 billion in Medicare payments to hospitals based on criteria that include patient-satisfaction surveys.” Some of the questions found in these surveys include: “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?” and “How often was your pain well controlled?”
To physicians who handle Medicare and Medicaid patients and refuse to fill in prescriptions when they ask for a particular painkiller by name, a defiant stand may lead to less funding or a loss of earnings.
“The government is telling us we need to make sure a patient’s pain is under control,” Dr. Nick Sawyer, a health-policy fellow at the UC Davis Department of Emergency Medicine, told Gregory. “It’s hard to make them happy without a narcotic. This policy is leading to ongoing opioid abuse.”
What started as an effort to help officials better gauge the quality of health care services, Dr. Sawyer appears to contend, may have led to a greater problem among patients who have become addicted to painkillers.
Since 1999, Time reports, “fatal prescription-opioid overdoses in the U.S. have quadrupled.” In 2014, opioids were involved in 60 percent of 47,000 drug overdose deaths. And while official reports on deadly incidents involving opioids in 2015 are yet to be released, SAMHSA reports that 12.8 percent of people aged 12 or older who used pain relievers in the past year — about 12 million people— “misused” the drugs.
According to a 2012 study published in the Archives of Internal Medicine, patients who often agree they are “satisfied” with they care they receive from hospitals and physicians are the ones who are more likely to spend more on prescription drugs. They also have higher mortality rates than those who claim to be dissatisfied with medical service.
From the study:
“In addition, patients often request discretionary services that are of little or no medical benefit, and physicians frequently accede to these requests, which is associated with higher patient satisfaction. Physicians whose compensation is more strongly linked with patient satisfaction are more likely to deliver discretionary services.”
If this remains true in 2016, and patients continue to ask for prescription painkillers by name — which is the case detailed in the Time article, “How Obamacare Is Fueling America’s Opioid Epidemic” — it might not be a stretch to consider many who obtained prescriptions without the need for opioids may have simply asked a doctor for help. This is an estimation SAMHSA’s own report seems to back.
But until a detailed study is carried out on this subject, it’s hard to pinpoint one single factor that has helped boost opioid use and abuse in the United States.
What we know for a fact is that officials continue to wage a war on drugs.
According to a Drug Enforcement Administration (DEA) report released last year, most new heroin addicts have a history of prescription drug use, leading many to conclude that “[t]he turn to heroin is partially exacerbated by the government’s own attempts to curb the painkiller addiction it helped create.”
As lawmakers pass more legislation while also combating the opioid addiction crisis, those who are addicted to opioids and other drugs who do not have access to health care are forced to go to the streets for their fix. As the crisis becomes much more widespread and a greater number of former patients go after painkillers in the black market, dealers who are not concerned with product quality put the lives of these users in grave danger.
Are intricate, complex laws to blame for this vicious cycle? Or it all just a huge coincidence?