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Opioid Use Overtakes Tobacco

More adults in the U.S. use prescription painkillers than use tobacco, the latest milestone that highlights an opioid abuse epidemic sweeping the nation and particularly Tennessee, where there are more opioid prescriptions than people living in the state.

A survey released in September by the federal Substance Abuse and Mental Health Services Administration found that 37.8 percent of U.S. adults used prescription painkillers, compared with 31.1 percent who used tobacco products last year.

"You'd like to think that is good news and reflects a reduction of tobacco use, but unfortunately that's not the case," said Danny Winder, director of the Vanderbilt Center for Addiction Research and professor of molecular physiology and biophysics.

"It reflects the growing realization that addiction is a major public health problem," he said. "It's a particularly pernicious problem because of its prevalence. ... Anytime you have a substance that is legally available and has addictive properties, that's setting up the problem."

Tennessee has seen a surge in opioid use in recent years. The state ranks second in the nation for the number of per capita opioid prescriptions, with an average of 1.18 prescriptions per man, woman and child of medications such as hydrocodone, oxycodone, morphine and codeine. Only Alabama has more prescriptions per person. In 2014, the latest year in which data is available, at least 1,263 Tennesseans died from opioid overdoses — more than those who died in car accidents or from firearms.

The federal survey found women were more likely to use opioids than men. While nearly a third of all college graduates used opioids, its use was higher among those without a college degree and those who never earned a high school diploma. More than 40 percent of those unemployed across the country used opioids last year.

The surge in opioid use over tobacco use comes as no surprise to those on the front lines of treating addiction.

"We require tobacco companies to put warning labels on tobacco products; you don’t really see that in opioid products," said Dr. Richard Soper, chief at the Center for Behavioral Wellness, who is critical of the federal government for not taking stronger action. "As long as the FDA is continuing to approve opioids, there still will be access to it. There will still be doctors writing prescriptions."

Lawmakers, health care professionals, addiction specialists, hospital and insurance executives and others in Tennessee have taken steps to try to address the problem in recent years.

In 2013, a new law required Tennessee doctors prescribing painkillers such as hydrocodone, oxycodone and other controlled substances to check their patients' prescription history in an online database before signing the prescription slip.

Federal officials also have gotten involved, with regulations unveiled in July raising a limit on the number of patients doctors can treat with pain medicine addiction. Previously physicians could offer a narcotic used to treat opioid addiction to no more than 100 patients. Under the new regulations, they will be able to offer that medication to as many as 275 patients. Nationwide, the federal government is investing $94 million with the aim of getting 124,000 new patients into treatment and recovery, including $800,000 that went to three clinics in Tennessee in March.

State regulations now require physicians to dispense 30-day supplies requiring authorization before refilling.

And BlueCross BlueShield of Tennessee, the state's largest insurer, started a multipronged program to address opioid prescribing. This year the insurer reduced the number of pills that were allowed per prescription each month and began requiring doctors to get prior authorization from the insurance company before authorizing long-acting opiates such as OxyContin. The latter requirement is in part to get doctors and patients talking about opiate use, said Dr. Jeff Campbell, a corporate pharmacy director. The insurer will take more steps to tighten prescribing next year, he said.

Thus far, the insurer has seen a 10 percent to 15 percent reduction in utilization of such prescriptions, Campbell said.

The steepest challenge to addressing abuse, however, may lie in finding help for people battling opioid addictions who want it.

Only about half of an estimated 2.2 million people across the country with a prescription painkiller addiction have access to treatment, according to U.S. Surgeon General Dr. Vivek Murthy.

"This is just another sign that a lot more needs to be done," said Dr. David Edwards, a pain medication specialist and assistant professor of anesthesiology at Vanderbilt University Medical Center. "It’s not like tobacco where over the past decade every tobacco company was being sued and all the money and education had gone into play. We’re just starting with opioids. All the money is coming in and education has started, but I don’t think they have reached the majority of the public. I don’t see any slowing down yet. I think that will happen in the next five years, but I don’t see it happening anytime soon."

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