Case Example: Opioid Abuse and Misuse in Utah1

In 2005, Utah had the largest incidence of reported nonmedical use of pain relievers, along with an increase in prescription opioid-related deaths. Between 1999 and 2007, deaths in Utah attributed to poisoning by prescription pain medications increased nearly 600%, from 39 to 261. In 2008, the Utah Department of Health added 12 questions to the state’s Behavioral Risk Factor Surveillance System (BRFSS) survey to better understand how state residents obtain and use prescription pain medication.

A problem with prescriptions

The survey revealed causes and suggested possible approaches to reducing opioid-related problems. Some of the findings included1:

20.8% of responding Utah adults aged ≥18 years had been prescribed an opioid pain medication during the preceding 12 months
Providers commonly prescribed more doses than were used by patients
Of patients prescribed an opioid pain medication:
- 3.2% reported using their medication more frequently or in higher doses than had been directed by their doctor
- 72% reported having leftover medication
- 71% of those with leftover medication reported that they had kept the medication
1.8% of all adults reported using prescription opioids that had not been prescribed to them
- Pain relief was the most common reason reported for using prescription opioids not prescribed to the individual

Select Results From Utah Behavioral Risk Factor Surveillance System (BRFSS) Survey1

TABLE. Percentage of respondents aged ≥18 years who reported using a prescription opioid medication in the preceding 12 months, by reported medication-related behaviors — Behavioral Risk Factor Surveillance System, Utah, 2008
Behavior	No.*	%†	(95% CI§)
Used opioid pain medication prescribed to respondent by a doctor	5,330	20.8	(19.2–22.3)
For last prescription fill, used opioid medication more frequently or in higher doses than prescribed	1,058	3.2	(1.6–4.7)
For last opioid prescription fill, had leftover medication	1,058	72.0	(68.3–75.7)
What did respondent do with leftover medication?	751
Disposed of it		25.2	(21.0–29.5)
Gave it to someone else		2.3	(0.1–4.5)
Kept it		71.0	(66.4–75.6)
Other		1.5	(0.8–2.2)
For last opioid prescription fill, what type of pain was the indicated treatment?	1,058
Short-term pain		71.0	(67.3–74.6)
Long-term pain		14.7	(12.2–17.2)
Both		14.4	(11.4–17.3)
Used opioid pain medications not prescribed to respondent	5,330	1.8	(1.4–2.3)
Reasons for using opioid pain medication not prescribed to respondent (multiple responses permitted)	93
To relieve pain		72.4	(57.9–81.7)
For fun		15.3	(0.8–20.5)
To relieve anxiety		3.7	(0.6–5.5)
To relieve other physical symptom		2.2	(0–5.4)
Other		10.5	(9.5–29.2)
From whom did respondent obtain the opioid pain medication?	93
Friend or relative		97.0	(94.3–99.8)
Acquaintance		1.8	(0–4.3)
Other		1.2	(0–2.6)
How was the opioid pain medication obtained?	93
Given without charge		85.2	(73.3–97.2)
Took without knowledge or permission of owner		9.8	(0–20.7)
Purchased		4.1	(0–10.0)
Other		0.9	(0.4–1.4)
* Weighted by age, race, and sex to mirror the Utah adult population aged ≥18 years. † Subgroup percentages might not add to 100.0% because of rounding. § Confidence interval.

Utah recommends…1

In 2009, the Utah Department of Health published guidelines to reduce the morbidity, mortality, and disability associated with misuse or abuse of prescription drugs, especially narcotics. The recommendations include:

Use opioid medications for acute or chronic pain only after determining that alternative therapies do not deliver adequate pain relief
Use the lowest effective dose
Prescribe no more than the number of doses needed, based on the usual duration of pain severe enough to require opioids for that condition
Reserve long-acting or sustained-release opioids for long-term pain
Counsel patients to dispose of unused medication properly once the pain has resolved
Seek specialty consultation if patients continue to experience severe pain without functional improvement despite treatment with opioids
Periodically request a report on the prescribing of opioids to their patients by other providers (such reports generally are available from the state prescription drug monitoring program)

Continue the discussion Response to an epidemic How SPRIX® (ketorolac tromethamine) Nasal Spray may help

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EFFICACY AFTER MAJOR SURGERY Patients underwent hip/knee replacement and total hysterectomy.

REFERENCE:

Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. Adult Use of Prescription Opioid Pain Medications—Utah, 2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5906a1.htm. Accessed August 16, 2011.