While Ohio’s opioid prescription rates fall, their use rises in hospitals

Connor Gillmor
May 7, 2018 · 5 min read
With the continued rise of opioid use in hospital settings, patients are still becoming addicted even with new preventative measures in place. (photo/arstechnica)

National prescription opioid painkiller deaths have been on a significant rise since 2013 while Ohio’s death rates have fallen in this category. Even when removing fentanyl from the equation, the death rate has steadily risen. The deaths from 2014 to 2015 rose by about four percent or about 600 deaths. This data does exclude fentanyl from Ohio’s numbers as well.

“Fentanyl is a powerful synthetic opioid… that is similar to morphine but is 50 to 100 times more potent,” according to the National Institute on Drug Abuse or NIH.

The drug has caused a massive spike in deaths by overdose since 2013. In Ohio alone, deaths went from just under 100 to over 1,100 from 2013 to 2015.

All other forms of unintentional drug overdoses have risen in recent years in Ohio, except for prescription opioids, excluding fentanyl. (Graphic/Ohio Department of Health)

This decrease in Ohio’s general prescription opioid death could be a result of a recent crackdown on prescription policies. Guidelines for the new procedures dictate that doctors can’t prescribe more than seven days of opioids to adults and no more than five days to minors. While there are exceptions to the rule, these new more strict rules have sent a message to doctors and pharmaceutical companies alike.

The Center for Disease Control published data shows that even with the increasing number of deaths from non-prescription opioids rising, the prescription numbers are continuing to fall with the falling prescription opioid overdose rate. (graphic/Connor Gillmor)

The number of prescriptions in Ohio peaked at over 102 prescriptions per 100 people in 2010, and that has declined steadily every year since. Other reasons for the drop can be attributed to Attorney General Mike DeWine suing pharmaceutical companies to recoup some of Ohio’s costs of fighting against the Opioid Crisis. These costs are totaling as high as $8 billion per year.

DeWine blames the companies for their roles in the current nationwide epidemic.

“In 2014 alone, pharmaceutical companies spent $168 million through sales reps peddling prescription opioids to win over doctors with smooth pitches and glossy brochures that downplayed the risks of the medicines,” he said in a press conference in May of last year.

But is enough being done to lower the prescription of opioids in Ohio?

Even with the efforts of DeWine and the new prescribing standards, Ohio still has a higher prescription rate than the national average of 70.8 per 100 people as compared to Ohio’s 75.3 per 100. The national average of hospital-related opioid use is also substantially lower than Ohio’s.

Ohio’s hospital-related opioid use per 100,000 people in inpatient care is significantly higher than the national average according to the Healthcare Cost and Utilization Project. (graphic/Connor Gillmor)

Even though the prescription rates have fallen, doctors are still using opioids in hospital settings at a much higher rate than ever before. The total number has increased by nearly 160 percent since 2013 and is more than 130 percent higher than the national average.

The jump could be a result of opioids being highly monitored and dosages regulated in a hospital setting, but even when accounting for Ohio’s higher rate of inpatient care that reasoning begins to shows cracks.

Ohio’s rate of inpatient care as of 2016 was 13 percent of the state’s population or 1.5 million people versus the national average of 11 percent of the population or over 33 million people.

In DeWine’s “Ohio Opioid Distributor Complaint” as of Feb. 26, 2018, it states,

“despite Defendants’ duties regarding opioid diversion, which presents a known or foreseeable danger of serious injury, Defendants intentionally, unlawlessly, recklessly, and/or negligently failed to prevent opioid diversion.”

Doctors are also partly to blame for the situation that Ohio and the rest of the country are in. In an NPR report titled “Hospitals Brace Patients For Pain To Reduce Risk Of Opioid Addiction,” they tell the story of Michelle Leavy who after having a cesarean section, was prescribed opioid painkillers and became addicted.

“Before I went to work I took them, and to get the kids after school I had to take them. Then I was taking them just to go to bed. I didn’t really realize I had a problem until the problem was something more than I could have taken care of myself,” Leavy says in the article.

She is a mother of three and was a paramedic that had seen people suffer from addiction. She knew how it happened in others and was still unable to prevent the onset of her addiction through the painkillers. It highlights how dangerous opioids can be to even trained professionals and how underestimated their danger is in hospital settings.

Leavy was not the only person who has been found to have issues with addiction post-surgery. In a study about prolonged opioid use after low-risk surgery, around 28,000 patients were prescribed opioids within seven days post-surgery, and another 30,000 were prescribed them one year after surgery.

The study found that the patients who were prescribed opioids within seven days of surgery were 44 percent more likely to be long-term users of the drugs a year after the surgery.

That is not to say that doctors are trying to get their patients addicted to opioids. Doctors want to help their patients by making the pain as minimal as possible and lead them down an easy recovery path.

“If I could awaken them without any pain whatsoever, I was the slickest guy on the block and it was a matter of enormous pride,” said Anesthesiologist David Alfery in the NPR article.

While prevention of pain is a noble priority to have for your patients, it is a factor in the addiction that continues to occur in the United States medical system.

Michelle Leavy lost her job and fiancé because of her addiction, but managed to conquer it through rehab. Since she has begun to recover, she managed to avoid opioids even after emergency gallbladder surgery.

“I mean it hurt, but I lived.”