Many Americans suffer from chronic pain and deserve safe and effective pain management. Prescription opioids can help manage some types of pain in the short term. However, there is limited information about the benefits of opioids long term, and there are serious risks of opioid use disorder and overdose.
Prescription opioids provide a point of initiation of future opioid abuse or dependence. Pooling data from 2002 to 2012, the incidence of heroin initiation was 19 times higher among those who reported prior nonmedical pain reliever use than among those who did not (0.39 vs. 0.02 percent) (Muhuri et al., 2013). A study of young, urban injection drug users interviewed in 2008 and 2009 found that 86 percent had used opioid pain relievers nonmedically prior to using heroin, and their initiation into nonmedical use was characterized by three main sources of opioids: family, friends, or personal prescriptions (Lankenau et al., 2012). This rate represents a shift from historical trends. Of people entering treatment for heroin addiction who began abusing opioids in the 1960s, more than 80 percent started with heroin. Of those who began abusing opioids in the 2000s, 75 percent reported that their first opioid was a prescription drug (Cicero et al., 2014). Examining national-level general population heroin data (including those in and not in treatment), nearly 80 percent of heroin users reported using prescription opioids prior to heroin (Jones, 2013; Muhuri et al., 2013).
Vermont encourages prescribers to only prescribe opioids when essential, and instead use other means for controlling pain.
A single opioid prescription can be prescribed with a different number of doses, in differing strengths, or in different formulations. This can make comparisons across prescriptions challenging. Morphine milligram equivalents (MMEs) are a way to standardize and compare prescriptions across these variations. Many research experts, federal agencies (e.g., CDC, BJA, SAMHSA) and VPMS use MMEs in order to better understand the abuse and overdose potential of opioid analgesics.
Total MME is a good indication of the total amount of opioids dispensed in the state. Reducing the amount of opioids dispensed is an important part of the statewide strategy to reduce opioid overdose and dependence. Total MME is reported as a rate per 100 people in Vermont to allow comparisons between counties of different sizes.
Note: The 2014-2015 increase in MME is attributable in part to the August 14, 2014 rescheduling of tramadol from a Schedule V to a Schedule IV drug. VPMS only collects data on Schedule II-IV controlled substances; therefore prior to rescheduling, tramadol was not reported to VPMS and is not included in the calculations. The total MME of dispensed opioids has consistently decreased after 2015.
The 2020 decrease is partially due to the use of the 2020 VT census data which showed a reported a higher estimate than the Vermont population estimates that were previously used. Also, the COVID-19 pandemic, starting in March 2020, has disrupted the provision of healthcare in Vermont which can impact this number.