Opioids

Years of high levels of prescribing pharmaceutical opioids, combined with heroin and fentanyl use, has created a public health crisis.

Widespread use of prescription and illicit opioids has in turn exacerbated existing social and public health problems, including homelessness, family disintegration, child maltreatment and increased the potential transmission of hepatitis C and HIV through needle sharing.

Rates of neonatal abstinence syndrome (NAS), when a baby withdraws from drugs they were exposed to in the womb, have risen substantially in recent years due to opioid abuse. In 2017, the rate of NAS was 13.7 per 1,000 live births, nearly 4 times the rate a decade ago.

Overdose Deaths

Nearly 90 percent of drug overdose deaths in Philadelphia involve opioids. Poisonings, which include unintentional drug overdoses, are now the leading cause of death for individuals ages 25 to 44. For the first time in years, rates of premature mortality (measured as years of potential life lost before age 75) have increased due to the number of fatal drug overdoses among younger adults.

In 2017, Pennsylvania had the third highest drug overdose rate in the nation at 44.3 per 100,000 people while the national average was 22 deaths per 100,000 people.

However, these are underestimates of the total non-fatal drug overdoses that occur, as many individuals never go to the ER when overdoses are reversed in community settings.

Overprescribing of Opioids

Pennsylvania’s health care and pharmaceutical systems bear significant responsibility for the over-prescribing of pharmaceutical opioids to the state’s population. Nationally, 80 percent of new heroin and fentanyl users began their opioid use with painkillers such as, Oxycontin, Vicodin, and Percocet that were prescribed by their doctor.

According to an analysis conducted by the Philadelphia Department of Public Health, the prescribing of opioids by health care providers is skewed.

Just 1 percent of prescribers write nearly 25 percent of opioid prescriptions. The next 10 percent of prescribers write nearly 50 percent of prescriptions. And more than half of prescribers write virtually no opioid prescriptions at all.

In order to reduce the over-use of opioids, it is critical to reduce prescribing by licensed physicians, nurse-practitioners, and physicians’ assistants. Local health departments are well positioned to employ state data to serve public health and public safety objectives.

Prescription Drug Monitoring Program

To help prevent prescription drug abuse and protect the health and safety of our community, Pennsylvania's Prescription Drug Monitoring Program (PDMP) collects information on all filled prescriptions for controlled substances. This information helps health care providers safely prescribe controlled substances and helps patients get the treatment they need.

The PDMP is a statewide program that collects information about controlled substance prescription drugs that are dispensed to patients within the state.

The purpose of the PDMP established by Act 191 of 2014 is two fold:

1. To be used as a tool to increase the quality of patient care by giving prescribers and dispensers access to a patient's controlled substance prescription medication history, which will alert medical professionals to potential dangers for purposes of making treatment determinations; and

2. To aid regulatory and law enforcement agencies in the detection and prevention of fraud, drug abuse and the criminal diversion of controlled substances.

Beyond the established benefits to the individual patient and prescriber, the PDMP can serve as a key resource to groups outside of the individual patient/provider relationship.

Since Pennsylvania’s PDMP collects comprehensive dispensing data, it is the ideal tool to help identify prescribers at risk of over-prescribing or prescribing inappropriately.

The PDMP can assist local health departments monitor prescribing practices and identify unusual prescribing patterns, identify “pill mills,” and can inform community-based prevention strategies.

In 2020, PHPC helped enact legislation giving Pennsylvania’s local health departments access to data in Pennsylvania’s PDMP.

Local health departments can use aggregate data on opioid prescribing patterns to:

• Target our education to high-volume prescribers to persuade them to write fewer prescriptions

• Shape those educational messages according to the medical specialties and prescribing practices of these high-volume prescribers

• Evaluate the effect of these steps by measuring changes in providers’ prescribing patterns

Policy Priorities

• Pennsylvania and the federal government should use PDMP data to monitor and regulate over-prescribing of opiates by prescribers and by “pill mills,” in order to reduce the state’s opioid emidemic.

• Pennsylvania should pursue policies that reduce the barriers to entry for opioid use disorder treatment, and should make naloxone widely accessible to prevent death.