Rx Opioid Safe Prescriptions

General information December 19, 2016

While opioid use in San Mateo County is currently not as big a problem as that of many other communities, it’s important that everyone understand the risks and benefits related to prescription pain medications (opioids).

Research shows that when the prescribing of opioids declines, overdose rates decline.

It’s up to all of us to prevent prescription pain medication dependency and deaths.

What are opioids?

Opioid pain relievers are prescription pain medications that can be dangerous and addictive, even for people who have no history of substance use disorders. Commonly prescribed opioids include hydrocodone (Norco, Vicodin®), oxycodone (OxyContin®, Percocet®), fentanyl (Duragesic®, Fentora®), methadone, and codeine.

Opioids are frequently prescribed for management of short-term (acute) pain. They have also been prescribed to people who suffer from long-term (chronic pain). Unlike treatment for acute pain, research has shown opioids are not an optimal treatment for chronic pain. Long-term use of opioids increases the risk of dependence leading to potential substance misuse or substance use disorders.

Across the United States in the last two decades, opioid prescriptions, drug overdose deaths, and emergency department visits have risen dramatically, and place a strain on our families, hospitals, and the entire community.

Based on research by Anne Case and Angus Deaton, published in Proceedings of the National Academy of Science, for each drug overdose death, there are approximately 130 other people dependent on opioids.

Research has also shown prescription opioids can be a gateway to heroin use due to substance misuse and substance use disorders.

Why should I talk with my patient before prescribing an opioid?

In the past two decades across the US, the number of filled opioid prescriptions has been increasing as have overdose deaths. When someone takes increasingly higher doses of opioids over an extended period of time – the risk of dependence increases. Research shows that when prescription opioids are reduced without tapering or patient support, individuals with substance use disorders can turn to heroin, and injection drug use can lead to the spread of Hepatitis C and HIV.

Why are prescription pain medications a concern right now?

Between 1990 and 2010, prescription painkiller (opioid) sales quadrupled in the U.S, with emergency department visits for prescription drug overdoses doubling between 2004 and 2011.

In just one year, over 24 million opioid pills were prescribed and filled by San Mateo County residents. That’s 43 pills for every resident over 18. Nationally, drug overdoses now cause more deaths than traffic accidents.

What prescriptions should I be careful in prescribing?

There are many types of prescription medication you should be cautious about prescribing as they can lead to potential misuse:

Opioid painkillers: Derived from the opium poppy (or synthetic versions of it) and used for pain relief. Examples include hydrocodone (Norco,Vicodin®), oxycodone (OxyContin®, Percocet®), fentanyl (Duragesic®, Fentora®), methadone, and codeine.
Benzodiazepines: Central nervous system depressants used as sedatives, to prevent seizures, and relieve anxiety. Examples include alprazolam (Xanax®), diazepam (Valium®), and lorazepam (Ativan®).
Hypnotic: Sleeping tablets effective in initiating sleep, including zolpidem (Ambien, Sonata, Lunesta)
Stimulants: Central nervous system stimulants used to treat attention deficit hyperactivity disorder (ADHD). Examples include dextroamphetamine/amphetamine (Adderall®, Adderall XR®), and methylphenidate (Ritalin®, Concerta®).

How does San Mateo County opioid use compare to other communities?

In San Mateo County, we are seeing opioid use and prescriptions rising and we want to ensure everyone is aware of the benefits and the risks of taking these medications and avoid the suffering many communities are facing. While opioid use in San Mateo County is not currently as big of a problem as many other communities, it’s important to discuss the benefits and harms of all pain management alternatives.

What is San Mateo County Health doing to prevent opioid use?

County Health is performing county-wide drug surveillance for opioids, marijuana, and illicit drugs. This includes tracking and reporting:

Emergency Medical Services alert when a patient requires two or more doses of Naloxone
Poison control calls for opioids, marijuana, and illicit drugs
Alert from San Mateo County Coroner’s Office for cases of fentanyl and heroin
Review of emergency department drug overdose visits
Review of deaths related to opioids, marijuana, and illicit drugs
Collaboration with San Mateo County Narcotics taskforce

The Health System also issued a Health Alert to all physicians in San Mateo County on February 7, 2017, and launched a public awareness campaign shortly thereafter. Read the Health Alert here.

How you can help

Please follow the CDC guidelines here.

Consider alternative pain treatment before prescribing opioids or, for acute pain, prescribe fewer doses (1 to 3 days) and lowest possible dose.
Discuss known risks of taking opioids during patient counseling, as this could be the first time patients are learning about the risks involved.
Don’t prescribe opioids unless you and your patients have a plan to stop therapy. Dependency can start in as little as one week.
Always check CURES 2.0 before giving a prescription to a patient.
Ask your patient if they have any history with substance misuse or substance use disorder. Patients with mental health and substance use disorders tend to stay on opioids for long-terms and at higher doses. Research has shown that in San Mateo County, teens misusing opioids are using medicine prescribed to relatives.
Consider prescribing Naloxone for all patients using opioids for chronic pain to help prevent a deadly overdose.
Consider buprenorphine or methadone in combination with behavioral therapies for patients with opioid use disorder.
If you suspect a patient is opioid dependent and has multiple prescriptions contact the San Mateo County Health Behavioral Health and Recovery Services at 1-800-686-0101 and refer them for treatment or develop an agreement to taper opioid use.