US Pharm. 2021;47(3):3.
Stemming from a steep rise in opioid-overdose deaths in the United States, many states have implemented supply-controlling and harm-reduction policies to forestall that trend. A recent study by Indiana University researchers in JAMA Network Open reveals that the moves may have unintentionally caused those with opioid-use disorders to switch to alternative illicit substances, actually leading to more overdose mortality.
“Literature from public health to social sciences has presented mixed and contradictory findings on the impact of opioid policies on various opioid adverse outcomes,” said Byungkyu Lee, assistant professor of sociology at Indiana University and coauthor of the study. “Our findings suggest that the so-called opioid paradox—the rise of opioid-related deaths despite declines in opioid prescriptions—may arise from the success, not the failure, of state interventions to control opioid prescriptions.”
The researchers examined drug-overdose mortality data from 50 states and claims data from 23 million commercially insured patients in the U.S. between 2007 and 2018. Next, they looked at the prevalence of prescription-opioid abuse, opioid-use disorder, and overdose diagnosis, and the prescription of medications-assisted treatment and drug-overdose deaths before and after implementation of six state-level policies targeting the opioid epidemic.
The study found that the policies were linked to a lower proportion of patients who take opioids, have overlapping claims, receive higher opioid doses, and visit multiple providers and pharmacies. They also found that harm-reduction policies were associated with modest increases in the proportion of patients with overdose and opioid-use disorder. Additionally, the proportion of patients receiving medications-assisted treatment drugs increased following the implementation of supply-controlling policies.
Brea Perry, professor of sociology at Indiana University and coauthor of the study, said the results point to the power of big data to provide insights into the opioid epidemic and how to best reverse it. “Our work reveals the unintended and negative consequences of policies designed to reduce the supply of opioids in the population for overdose,” Dr. Perry said. “We believe that policy goals should be shifted from easy solutions such as dose reduction to more difficult fundamental ones, focusing on improving social conditions that create demand for opioids and other illicit drugs.”
All overdose deaths increased after implementation of naloxone access laws, the study found. Good Samaritan laws were also associated with increased overdose deaths. Furthermore, mandatory prescription drug–monitoring programs reduced overdose deaths from natural opioids and methadone, and the implementation of pain clinic laws was linked to increased overdose deaths from heroin and cocaine. On the other hand, a prescription limit law was associated with a decrease in overdose deaths from synthetic opioids.