(CN) – Prescription opioid use declined for the first time in a decade in the first quarter of 2018, but consumption remains higher than levels found in other counties, according to new research.
The study in the medical journal BMJ also found the use of opioids in the United States vastly exceeds that of other countries, with individuals in the U.S consuming 88 percent more prescription opioids per capita than second-ranked Germany.
Opioid use and average daily dose have not “substantially declined” from their peaks in 2012 and 2013, the study found, despite a brief period of leveling off period after those years.
People used higher daily doses of prescription opioids in 2017 than in 2007, though the study did not speculate on the reason for the increase.
A national survey found that 65 million opioid prescriptions were written between January 1 and April 30, 2018, down from 73 million in the same period in 2017, according to Justice Department spokesman Mark Pettit.
Researchers used data from a national database of medical and pharmacy claims to examine trends in prescription opioid use by 48 million Americans.
Study participants were covered either by private insurance, Medicare or Medicare Advantage, which is offered by private insurers on behalf of Medicare, between January 2007 and December 2016.
Individuals receiving Medicare benefits and those with disabilities had the highest rates of opioid use, the highest rate of long-term use and the largest average daily doses, which the study said might reflect “the high burden of illness” in that population.
Some 52 percent of disabled Medicare beneficiaries used opioids annually, compared with 14 percent of people with private insurance and 26 percent of older Medicare Advantage recipients.
In the third quarter of 2012, 45 percent of disabled Medicare recipients aged 45 to 54 used opioids, the highest rate among all groups.
“The U.S. has the highest rate of opioid use in the world, consuming seven times more prescription opioids per person than the [United Kingdom],” the study said. “An average of 40 people die in the U.S. every day from prescription opioid overdose, and opioid use has been declared a public health emergency.”
Opioids work on the nervous system in the body or specific receptors in the brain to reduce the intensity of pain. Brand names include OxyContin, Opana, Subsys, Fentora and Duragesic, as well as generics like oxycodone, methadone and fentanyl.
A representative for Purdue Pharma, the manufacturer of OxyContin, did not respond to a request for comment. But in a statement on its website, Purdue Pharma says it is “acutely aware of the public health risks” of opioids and have decided that its sales representatives will no longer promote opioids to prescribers.
The company said it supports limiting opioid use by a patient to no more than seven days.
Opioids should only be used when “alternative treatment options are inadequate,” the company said.
The study found that among privately insured individuals, the most commonly used drug was hydrocodone. But in terms of volume, oxycodone and hydrocodone had similar usage.
A National Center for Health Statistics report said 68,400 people died of drug overdoses across the U.S between October 2016 and October 2017, a 12 percent increase from the 61,000 overdose deaths reported the year before. Opioids were involved in over 46,000 of the overdose deaths.
Forty percent of those 46,000 deaths were from prescription opioids, equivalent to about 89 deaths per day, according to a U.S. Centers for Disease Control and Prevention report.
Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014, but there has not been an overall change in the amount of pain Americans report, according to the CDC.
Cities and states have taken prescription opioid manufacturers to court in an effort to hold them to account.
Los Angeles Mayor Eric Garcetti called opioid a “killer on our streets.” And on May 3, the city sued nine pharmaceutical companies in federal court, claiming the fraudulent and negligent business practices of Big Pharma led to the city’s opioid crisis.
Companies intentionally mislead doctors and patients about the appropriate uses, risks, and safety of opioid drugs and downplayed the high risk of addiction, the complaint said.
Several other cities and states have filed similar lawsuits.
In July, the U.S Department of Justice said it will “encourage vigilance on the part of opioid manufacturers” by adopting a rule to limit production of opioids if it sees a particular brand being abused on a large scale by the public.
Relatively little is known about opioid use among people outside of the government-provided Medicare program, the researchers said, since recent studies have focused on the sale and supply of opioids.
The study did not examine opioid use by uninsured people.
Researchers suggested doctors and patients consider whether long-term opioid use improves the patient’s ability to function and, if not, move to other treatments.
“Evidence based approaches are needed to improve both the safety of opioid use and patient outcomes including pain management and ability to function,” the researchers said.