Opioids are a class of pain-relieving drugs that both reduce the number of pain signals sent by the nervous system and the brain’s reaction to pain signals. Opioids can be effective to relieve moderate to severe pain, but they are also highly addictive. Colorado in particular has a severe problem with prescription pain pill abuse, but it’s hoped that the new opioid classification will curb this issue somewhat.

Colorado has the second highest rate of pain pill abuse in the country.

The high rate of opioid abuse in Colorado is largely because of the over-prescription of opioids. According to a 2012 Denver Post article:

“Nonmedical use of painkillers in Colorado is 19 percent higher than the national average, according to the Centers for Disease Control and Prevention. To illustrate the “epidemic” nature of opioid abuse, the CDC said enough of the painkillers were sold in 2010 to medicate every American adult with a typical 5-milligram dose of hydrocodone every four hours for a month.”

The National Survey on Drug Use and Health found that 6% of Coloradans used prescription pain medications for non-medical purposes in 2010 and 2011. Among Coloradans from age 18 to 25, the rate of prescription pain medication abuse was 14%.

This rampant abuse of pain pills is resulting in hundreds of opioid-related deaths. 182 people died of opioid-related causes in 2000, but by 2009 this number had risen to 421. Additionally, opioid abuse can lead to heroin abuse. The two drugs can produce similar effects, but heroin is significantly cheaper than opioid pills on the street.

Hydrocodone-based drugs have been reclassified, which will result in stricter regulations.

Hydrocodone is an opioid-derived pain medication. It’s combined with several other medications, but the most common combination is hydrocodone and acetaminophen, commonly called Vicodin. Hydrocodone-based medications are the most commonly prescribed in the nation. Last year, almost 128 million prescriptions were written for hydrocodone-based medications. The recent reclassification of hydrocodone-based medications aims to reduce opioid abuse by reducing the number of prescription pills available.

Prescription drugs are classified into five schedules, ranging from I to V. Schedule V is the least harmful class of drugs with the least restrictive control. Schedule I is the most dangerous class. Schedule I drugs are not approved for any medical use and are considered extremely addictive.

Opioids like codeine and oxycodone are considered Schedule II medications. Until now, hydrocodone-based medications were classified as Schedule III, but they’ve now been moved to Schedule II. This means that individuals being prescribed hydrocodone-based medications will experience some key changes in how their prescriptions are handled, specifically:

  • Physicians can only prescribe hydrocodone-based medications for intervals of 30 days or less
  • Only three months of hydrocodone-based medications can be prescribed at a time (in 30 day intervals)
  • Rather than having their physicians call or fax in a new prescription after 90 days, patients must physically visit their doctors for a new prescription
  • Criminal penalties for conviction of abusing hydrocodone-based medications have increased

Most people who abuse pain medications obtain the pills from friends or family members. Another popular way to get pills is by “doctor shopping,” or visiting multiple doctors, feigning a need for pain medication to get multiple prescriptions, and building up a cache of pills. This means that the majority of prescription opioid abusers get their drugs from legal sources in one way or another. It’s for this reason that officials hope the stricter rules around hydrocodone-based medications will help curb the issues of opioid abuse and addiction.

While this sounds good in theory, concerns are already rising.

First and foremost, the new regulations mean that even people who legitimately need opioid pain pills must go through the effort of visiting their physicians every three months. For individuals living with a pain condition, this can be a serious burden.

Additionally, it’s possible that physicians may be overly cautious when prescribing pain medications and individuals who would benefit from hydrocodone-based medications might be denied it. Some prescription drug insurance plans also give larger breaks for long prescriptions, so the requisite 30-day-or-less interval might result in higher copays.

While the new restrictions on hydrocodone-based pain medications might aid in reducing the number of addicts and abusers, it’s only one part of the solution.

Simply making it more difficult to legally obtain opioids will not make the problems of abuse, addiction, and opioid-related deaths go away. There are several additional ways to address these issues, including:

  • Better patient education
  • Better disposal methods for leftover pills
  • Abuse-resistant medications

Better patient education should be a big part of opioid abuse prevention. PainDoctor.com, for example, follows a 12-step compliance checklist for opioid therapy. This checklist includes explanation of risks to the patient, as well as patient referral to other specialists, like psychiatrists, for any other issues, to lessen the risk of opioid abuse or addiction. Groups like Physicians for Responsible Opioid Prescribing (PROP) are working to promote programs just like this checklist that increase doctor-patient communication and improve patient education about opioids.

Additionally, an article in the Denver Post concerning Colorado’s high opioid-abuse rate pointed out the importance of better pill disposal methods. Currently, pharmacies aren’t allowed to take back leftover medication, so if an individual uses opioids for short-term pain relief, he or she may be left with several pills and no way to safely dispose of them. If the rules were changed to allow pharmacies to take back and destroy unused, leftover medications, it would help ensure those leftover pills don’t end up in the hands of opioid-abusers.

The pharmaceutical industry has also been attempting to curb opioid abuse by devising abuse-resistant medications. These pills may contain other substances that make them impractical, impossible, or unpleasant to use in any form other than a swallowed pill. For example, some might contain an irritant that’s harmless when swallowed, but if the pill is crushed and snorted, it would make the experience highly unpleasant. Other pills might be gel-filled capsules that make inhaling or injecting the opioid impossible.

Do you think the new restrictions on opioids will be more beneficial or harmful?

Image by kev-shine via Flickr


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