The United States is in the midst of an epidemic of prescription opioid overdoses. The amount of opioids prescribed and sold in the US quadrupled since 1999, but the overall amount of pain reported by Americans hasn’t changed. This epidemic is devastating American lives, families, and communities.
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.
Most individuals who become dependent on opioids begin through the use of prescription opioids. 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 is encouraging patients and prescribers to use opioids only when essential due to these risks, and instead use other means for controlling pain.
Morphine milligram equivalents (MMEs) are the amount of morphine an opioid dose is equal to when prescribed. Many research experts, federal agencies (e.g., CDC, BJA, SAMHSA) and the VPMS use MMEs prescribed to standardize the dose across different formulations of drugs in order to better understand the abuse and overdose potential of opioid analgesics. The total MME is a good indication of total amount of opioids dispensed in the state and reducing the amount of opioids dispensed and used is an important part of the statewide strategy to reduce opioid overdose and dependence.