April 19, 2018
A new report published by the IQVIA Institute for Human Data Science (“Medicine Use and Spending in the U.S.,” April 2018) shows that Tennesseans filled 6,709,154 opioid prescriptions at retail pharmacies in 2017, a nearly 9 percent decrease from the previous year and a 21.3 percent drop from 2013. Tennessee outperformed most of its contiguous states and is on par with the national average for year-over-year improvements and five-year trends.
The Tennessee Medical Association, the state’s largest professional organization for doctors, points to the data as validation of the medical community’s ongoing efforts to self-regulate prescribing and reduce initial opioid dosage and supply.
“This report shows that Tennessee’s medical community is driving real change in the initial supply of opioids in our state, despite the fact that clear data to help us identify who is writing excessive amounts for patients is available only to government regulators,” said Nita W. Shumaker, MD, TMA President. “Physicians for decades were told these medications were completely safe and faced potential litigation if we did not treat pain aggressively. As a result, patients developed unrealistic expectations about pain management. Once we recognized the addictive dangers of these medications we worked hard to change the culture and improve supervision. The report confirms that we are making progress.”
National trends show 22.2% fewer opioid prescriptions were filled in 2017 than had been filled in 2013, with every state in the nation showing some reduction in the past year. In 2017, a total of 196 million opioid prescriptions were filled in the U.S., representing an 8.9% decrease from the prior year – the sharpest single-year decrease reported by IQVIA.
Prescription opioid volumes in the U.S. peaked in 2011 at 240 billion milligrams of morphine milligram equivalents and have declined by 29% to 171 billion MMEs.
TMA for years has led statewide efforts to educate physicians, physician assistants and nurses on safe and proper prescribing. Since 2012, the association has trained more than 5,000 healthcare providers through its live and online courses.
TMA was also a catalyst to changing the prescribing educational requirements for Tennessee physicians and has led the way on important public policies and other initiatives, including the Controlled Substance Monitoring Database (CSMD), which has reduced doctor shopping by 50 percent.
“The government and general public expects us to police ourselves, and many are not aware of the comprehensive efforts from within the industry, beginning as soon as we recognized the issues with misuse and abuse. This report underscores the progress we have made in controlling the supply. Of course, we still have a long way to go. We need access to data from the CSMD to compare ourselves to each other for quality assurance; this is already effective in many other areas of medicine. We need to change our approach to ‘pain management’ and continue educating on diagnosis-based screening and treatment protocols. We will continue educating patients about the dangers of opioids including proper storage and disposal. And we will continue to advocate for funding for comprehensive treatment options for addicted patients.”
Leading Tennessee physicians representing TMA have been actively involved in the state legislature this year as lawmakers considered Governor Haslam’s TN Together initiative to address the opioid abuse epidemic. TMA successfully advocated for important modifications to make sure the new law does not unreasonably obstruct patients in legitimate pain from getting the care they need. New restrictions on prescribing and dispensing will no doubt achieve the governor’s stated goal of reducing overall initial supply, but TMA remains concerned about unintended consequences. Patients may have more difficulty accessing effective pain management under one of the most comprehensive and restrictive opioid laws of any state, especially considering the lack of access to and insurance reimbursement for alternative, non-opioid therapies. Further, as access to addictive prescription drugs decreases, the use of deadly illicit drugs and accidental overdose deaths continues to climb.