Blog | Tuesday, June 28, 2011

QD: News Every Day--Prescription opiates causing more treatment admissions


Prescription opiates rose to one-third of all treatment admissions in 2009, from 8% in 1999, reflecting the rising trends in prescription opiate abuse. There were nearly 2 million substance abuse treatment admissions in 2009 among people ages 12 and older were reported to the Treatment Episode Data Set, a reporting system involving treatment facilities from across the country.

Five substance groups accounted for 96% of admissions: alcohol (42%), opiates (21%), marijuana (18%), cocaine (9%), and methamphetamine/amphetamines (6%), reported the Substance Abuse and Mental Health Services Administration. The data came from 49 states and Puerto Rico. Georgia and the District of Columbia did not report admissions for 2009. One person can be reported as multiple admissions in a year.

Treatment admissions for alcohol decreased from 48% in 1999 to 39% in 2005, but then increased steadily to 42% in 2009. And, 44% of admissions for alcohol abuse involved other drugs. People often arrive in treatment programs with multiple problems, including dependency or addiction to multiple substances of abuse, the report noted, and treating this population requires an integrated system of care.

Alcohol was the leading drug of abuse for treatment admissions among all major ethnic and racial groups except persons of Puerto Rican origin, who cited opiate abuse as their leading problem.

Marijuana-related admissions rose from 13% in 1999 to 18% in 2009. Marijuana was either the primary or secondary reason for substance abuse treatment in 86% of all admissions involving those between the ages of 12 and 17.

Cocaine admissions fell from 14% to 9% from 199 to 2009. Methamphetamine/amphetamines admissions rose from 4% of all admissions in 1999 to 9% in 2005, but then decreased to 6% in 2009.

In April, the Obama Administration released Epidemic: Responding to America's Prescription Drug Abuse Crisis, a comprehensive action plan for reducing prescription drug diversion and abuse by supporting the expansion of state-based prescription drug monitoring programs, and recommending more convenient and environmentally responsible disposal methods to remove unused medications from the home.

Coincidentally to the report's release, the journal Pain Medicine published a special supplement on pain, in which the lead editorial outlined the issues involved for physicians. Among the main concerns:
--A significant proportion of people who die from opioid-related overdose had histories that included risky behaviors, psychiatric disorders, and/or substance use disorders. These behaviors can threaten effective opioid therapy, and while clinicians may recognize them, they often lack the language to describe them.
--When pain is the principal complaint at the time of the first opioid prescription, many patients who eventually enter detoxification treatment are recidivist, or had early first use of alcohol or illicit drugs.
--Physician error also causes harm, and methadone presents special challenges.

ACP Internist reported on prescription opiate abuse and outlined ways internists can intervene, as well as available resources to help them with this patient group.