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Another year of double-digit decline in prescription opioid use in 2020 is expected to reduce usage in the United States to levels not seen since the early 2000s, completing a 20-year cycle that peaked in 2011 and has declined steadily since
Decreases in prescription opioid use over the past nine years were driven by changes in clinical use, regulatory and reimbursement policies, and in progressively more restrictive legislation enacted since 2012
The impact of COVID-19 on use of prescription opioids has been modest, with use largely rebounding to baseline levels since June
Use of medication-assisted treatment was disrupted by the COVID-19 pandemic, and its use remains highly variable across individual states
Co-prescribing benzodiazepines and opioids — consistently identified as increasing the risk of abuse and/or death — has declined in recent years, but still occurs in more than 1 million patients over the age of 65
Total national prescription opioid use has declined by 60% from the peak volume in 2011 after another year of double-digit decline that is expected in 2020, according to the latest report from the IQVIA™ Institute for Human Data Science, Prescription Opioid Trends in the United States: Measuring and Understanding Progress in the Opioid Crisis.
Decreases in prescription opioid volume over the past nine years have been driven by changes in clinical use, regulatory and reimbursement policies, and in progressively more restrictive legislation enacted since 2012. The declines have been greatest in the highest doses of prescription opioids — over 90 morphine milligrams equivalents per day — which present the highest risk of opioid use disorder.
"These significant decreases are evidence of the positive impact of the collective efforts to reduce the use of prescription opioids by the medical community, public health authorities, and legislators at the state and federal levels," said Haiden Huskamp, Henry J. Kaiser Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School. "Reducing the overuse and misuse of prescription opioids continues to be an important public health priority both during the COVID-19 pandemic and beyond."
"We will continue to monitor the course of the opioid epidemic," said Murray Aitken, IQVIA senior vice president and executive director of the IQVIA Institute for Human Data Science. "The burden of the epidemic varies from state to state and is also very dependent on the different strategies and interventions taken by the individual states. As an example, the use of medication-assisted treatment, which was disrupted in 2020 due to COVID-19, remains highly variable across states. Continued research efforts are very important to learn from the impact of the different strategies states are undertaking to curb the opioid epidemic."
The report also draws attention to the risks of co-prescribing benzodiazepines and opioids in the elderly population. About 1.2 million Americans over the age of 65 are estimated to be receiving a combination regimen and therefore at an increased risk of abuse and/or death. This number has declined from about 1.7 million in 2016, a lower rate of decline than seen in under 65 year-olds. A total of about 18 million seniors are using prescription opioids, benzodiazepines, or a combination, representing about 30% of the 59.4 million total Americans receiving these medicines.
Additional key findings in the report include:
COVID-19 impact on use of prescription opioids was modest and has largely rebounded to baseline levels since June
New opioid prescribing levels fell sharply in March/April to about 50% of baseline, while continuing prescriptions fell by 6%, with all prescriptions returning to baseline levels in June
Opioid prescriptions written by surgery specialists – including oral, general, orthopedic and dental – declined the most at the peak of shutdown in late April
From early March to early June, healthcare providers wrote longer opioid prescriptions than typical to mitigate COVID-19 disruptions to patient care, offsetting much of the prescription volume decline and resulting in 1-2% lower morphine milligram equivalents being dispensed cumulatively than expected
Use of medication-assisted treatment was disrupted by COVID-19 in 2020 and remains highly variable in use across states
Use of MAT (including buprenorphine, naltrexone and others, but excluding methadone) was disrupted this year, with new prescription regimens falling as much as 22% in April/May, yet rebounded from June until September, then began to weaken since September, and are likely to result in an interruption to the increase in MAT use seen in recent years
Across states, the use of MAT varies widely, even between states with highest overdose death rates. Delaware and Maryland use about one-third the amount of MAT as West Virginia, yet are among states with the highest rates of opioid deaths
All of the New England states have lower-than-average prescription opioid use and higher MAT use than average, reflecting their efforts to enact controls on opioid prescribing while also supporting opioid dependency programs in recent years
Every state has reduced prescription opioid use on an MME per capita basis in 2019 compared to the prior year, and variation between states has declined since the peak year of use in 2011
In 2019, prescription opioid MME per capita declined between 10% and 29% in every state compared to 2018, with the national average declining by 15% to 366 MME per capita
Alaska and Washington, D.C. had the largest declines in 2019, of 29% and 28% respectively, and are now ranked 30th and lowest in their 2019 per capita level, while Maine and Kentucky had the smallest declines of 10% each and rank 29th and 4th, respectively.
Among the 10 states with the highest use of prescription opioids in 2011, Oregon (8th highest) and West Virginia (6th highest) have made the most relative progress, and now rank 25th and 24th, respectively, based on their 2019 use
The difference in per capita MME use between the five states with the highest and lowest levels has fallen from 870 MME in 2011 to 349 MME in 2019, as all states have reduced their levels of prescription opioid use, though there is still a more than three-fold difference between the highest- and lowest-use states
Opioid prescriptions paid for in cash — seen as an avenue for potential misuse — have fallen to less than 6% of total volume
Patients filling prescriptions with cash are not subject to the same payer review and scrutiny as those filling prescriptions through Medicare, Medicaid or commercial insurance
Since 2011, opioid prescriptions paid for in cash have declined the most among all pay types, falling from 9% to 6% in 2019 of a substantially smaller number of prescriptions (unadjusted for strength)
States with the highest share of cash-paid opioid prescriptions are Mississippi, then other Southern/Southeastern states and North Dakota
Research priorities for pain management have significantly moved away from opioids and abuse-deterrent formulations toward non-opioid analgesics and the pursuit of therapeutics for diseases accompanied by symptomatic pain
Unmet needs in pain management and addiction are being addressed with increased clinical research activity, including new mechanisms of action and digital therapeutics
The most significant shift in recent years has been toward non-opioid analgesics, which includes compounds used to treat pain disorders and symptomatic pain, but that do not modify the underlying disease, and the pipeline has increased threefold since 2017 to 115 products in both preclinical and clinical development
There has also been a doubling over the past five years in the pipeline of disease-modifying treatments for conditions with symptomatic pain, including sickle cell anemia, hemophilia and neuropathy, and where advances in these areas may prevent patients from initiating opioid treatment
The full version of the report, including a detailed description of the study methodology, is available at www.IQVIAInstitute.org. The study was produced independently as a public service, without industry or government funding.
About the IQVIA Institute for Human Data Science
The IQVIA Institute for Human Data Science contributes to the advancement of human health globally through timely research, insightful analysis, and scientific expertise applied to granular non-identified patient-level data.
Fulfilling an essential need within healthcare, the Institute delivers objective, relevant insights and research that accelerate understanding and innovation critical to sound decision-making and improved human outcomes. With access to IQVIA’s institutional knowledge, advanced analytics, technology, and unparalleled data, the Institute works in tandem with a broad set of healthcare stakeholders to drive a research agenda focused on Human Data Science, including government agencies, academic institutions, the life sciences industry, and payers. More information about the IQVIA Institute can be found at www.IQVIAInstitute.org.
IQVIA (NYSE:IQV) is a leading global provider of advanced analytics, technology solutions and clinical research services to the life sciences industry. Formed through the merger of IMS Health and Quintiles, IQVIA applies human data science — leveraging the analytic rigor and clarity of data science to the ever-expanding scope of human science — to enable companies to reimagine and develop new approaches to clinical development and commercialization, speed innovation and accelerate improvements in healthcare outcomes. Powered by the IQVIA CORE™, IQVIA delivers unique and actionable insights at the intersection of large-scale analytics, transformative technology and extensive domain expertise, as well as execution capabilities. With approximately 68,000 employees, IQVIA conducts operations in more than 100 countries.
IQVIA is a global leader in protecting individual patient privacy. The company uses a wide variety of privacy-enhancing technologies and safeguards to protect individual privacy while generating and analyzing information on a scale that helps healthcare stakeholders identify disease patterns and correlate with the precise treatment path and therapy needed for better outcomes. IQVIA’s insights and execution capabilities help biotech, medical device and pharmaceutical companies, medical researchers, government agencies, payers and other healthcare stakeholders tap into a deeper understanding of diseases, human behaviors and scientific advances, in an effort to advance their path toward cures. To learn more, visit www.iqvia.com.
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