Ohio Reports Record Lows on Prescription Opioid Use Part 3

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By R Carter.

In Part 2 I looked at how the use of Suboxone has increased over a nine year period on a county by county level in Ohio. Part 3 looks at Ohio’s $1 billion annual efforts using the OARRS system.

Ohio State officials take great pride in their efforts to thwart opioid addiction, drug overdose deaths and their efforts are both noticable and commendable. So let’s review a score card and check that progress starting with an executive summary released by the State Board of Pharmacy on their PDMP system known as OARRS.

Fig 1 – 2018 Executive Summary

With a 41% decrease in the number of solid dose opioids dispensed and a 34% decrease in benzodiazepines Ohio’s efforts at cutting off the supply of drugs used to treat medical conditions is remarkable.

But what effect are these efforts having? Do they translate into fewer opioid deaths from prescribed medications? The short answer is yes as seen in Figure 2. Note the data for years 2018 and 2019 are incomplete as efforts to fully investigate unintentional overdose deaths takes time.

Fig. 2 – Ohio 2018 Number of Prescription Opiate Related Drug Overdose Deaths by Year

Note to reader, Figure 2 while labeled prescription opiate deaths, does not reflect prescription opioids only. It reflects those deaths where toxicology reports indicated a prescription opioid. There are likely other drugs which contributed to a death as more than 70% of prescription opioid related deaths involve other drugs, up to as many as six. We assume this graphic does not correlate with Ohio PDMP data. 

So from a high of 724 in 2011 to a low of 523 in 2017 this represents a 28% decrease in overdose deaths tied to the use of prescription opioids with roughly 70% of those related to other street drugs.

Now let’s compare that to illegal drugs.

Fig. 3 – Ohio 2018 Fentanyl and Related Drugs Overdose Deaths

 As of 2017, the most current and complete data, 3,431 deaths have occured from illegal fentanyl. Essentially no impact on this figure from reducing medical access to opioids.

This next graphic looks at the relationship between fentanyl and all other opioid related deaths.

Fig. 4 – Ohio 2018 Fentanyl and Related Opioid Overdose Deaths

Again the data for 2018 – 2019 is incomplete, but as of 2017, opioid related deaths from fentanyl remain the greatest threat to Ohioans with 72% of deaths tied to this substance. As investigators complete their work for 2018 and 2019 Ohio will likely set new records in fentanyl related deaths.

The last opioid related category is heroin and as in the previous graphs, multiple drugs are the normal in more than 70% of overdose deaths, these are those where heroin was identified on toxicology.

Fig. 5 – Ohio 2018 Percentage of Heroin Related Drug Overdose Deaths by Year

Because street drugs are almost always cut with fentanyl, even when the primary cause of death is something like cocaine, a positive results for any class of opioid qualifies it for inclusion in that category of a report.

Out of 4,163 opioid related deaths in 2017, 523 included a prescription medication or 12.6% and still we don’t know how many of these are caused by prescription opioids alone. While it’s almost certain Ohio’s Department of Health has these numbers, to date they do not publish them.

The OAARS system has been costing Ohio taxpayers on average $1 billion annually to operate. In 2018 they tracked 468 million solid doses of prescribed opioids at a cost to taxpayers of $1.5 billion. That works out to be roughly 216,666 individuals with monthly scripts. Less when you include acute pain treated with a 7 day supply following a diagnostic or surgical procedure. But using the 2018 numbers as a future forecaster, that comes out to nearly $7,000 per patient per year, for a reduction in prescribed opioids on average of 5.6% per year and that’s assuming there is no bottom except zero opioids for anyone. Yet the overdose death rate from illegal opioids continues to climb with new records expected in 2018-2019.

While Ohio’s Executive report draws attention to Ohio’s efforts in curbing opioid related deaths related to the medical use of opioids, it does not count the cost in quality of life for those Ohioans who have been forced tapered or terminated from pain medications. The Federal estimate in 2000 for the cost of untreated pain was over $100 billion annually, both in lost wages and productivity. Surly by now that estimate is far greater as Government continues to punish employable Americans for a problem which is clearly rooted in a criminal element.

At the current annual cost of $7,000 per patient, a reduction of 5.6% in prescription opioid deaths seem small in the face of growing illegal opioid deaths. Naturally this begs the question of whether the State would do a better job of reducing overdose deaths with $1 billion annually, directed towards law enforcement.

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