Prescription for Abuse: The Progression of Prescribing Opiates in Washington State

JAN. 27, 2012
ByEthan Morris
KCTS 9 Executive Producer of Public Affairs

Ethan Morris

Insiders in the health and medical community refer to it as “The Change.”

In the mid-1990s, the State Medical Quality Assurance Board issued a new directive. Doctors, they said, were under-treating pain. They urged physicians to begin using opioids – semi-synthetic forms of opium such as hydrocodone (Vicodin) and oxycodone (OxyContin) – which, up until then, had only been used for the most severe types of pain associated with cancer and end-of-life. Now, doctors were encouraged to use them for chronic and acute pain too.

The medical community responded. “Dramatic, dramatic increases,” says Caleb Banta-Green, an epidemiologist with the University of Washington’s Alcohol and Drug Abuse Institute. “In Washington state, we’ve gone from about 10 million daily doses of hydrocodone – Vicodin – to about 45 million daily doses of that one medicine, just in Washington state, so there are enormous increases in the medication being prescribed and used.”

Those enormous increases have had an unintended result. More prescriptions has meant more people using. More people using has meant more people abusing. More people abusing has meant more overdoses. More overdoses and more deaths. In 2008, more than 500 people died of a prescription pain medication overdose – more than died in car accidents.

“Prescription opiates are quite widely available and accessible. One in five adults is prescribed an opiate every year in the United States. One in ten adolescents is prescribed an opiate every year in the United States. So there’s just a lot of these meds out there and in the community.”

A Clear Direction

To help health professionals, policy makers, and the public understand what is happening, Banta-Green and his collegues at ADAI created a series of maps based on data they have collected from across the state.

The first map gives a snapshot of prescription drug use in 2000. It’s based on amounts of prescription drugs confiscated by police and sent to the State Crime Lab for testing. “A conservative estimate of drug arrests,” Banta-Green says. The areas in green show where there was some drug activity. The darker the green, the more activity. In 2000, most counties had little to no prescription drug use.

But by 2009, the picture has changed dramatically. There’s evidence of heavier prescription drug use in nearly every county in the state. “The directionality’s pretty clear,” Caleb says. “For the prescription type opiates there was basically none in 2000 and in 2010 it’s everywhere.”

Heroin use follows the same trend. In 2000, heroin use is widespread, but the rates are relatively low, fewer than 25 people for every 100,000.

Eight years later, heroin is in all but four counties, with higher rates in rural counties such as Whatcom, Skagit and Grays Harbor. “If you look at 2000, we had heroin up and down I-5 and along I-90 and that was about it,” says Caleb. “In 2010, it’s really expanded. Not everywhere, but it’s expanded into some of the mid-sized cities, places like Port Angeles and Grey’s Harbor and Bellingham.”

Another way Banta-Green looked at the problem is through treatment rates. In 1999, almost no one was being treated for prescription drug addiction in Washington.

But by 2010, all of the counties in dark blue reported major increases in the number of people seeking treatment for opioid dependence.

Two People a Day

By far, the grimmest picture is the comparison of overdose deaths. This map shows the rate of overdose deaths from 2000 to 2002 from either prescription opioids or heroin.

By 2009, the overall number of opiate deaths has doubled.

Caleb Banta-Green: “So what we’re seeing in Washington state, if you look at all opiate drugs, heroin and prescription, we had about 344 [deaths] in 2000, and we had about 722 in 2009. So we’re more than doubling. That’s more than two people a day who are dying with some form of opiate in their system.”

A Lot of Vigilance

Caleb Banta-Green and others at ADAI hope the data they’ve compiled will help bring increased awareness to the prescription drug problem – not just on the part of doctors and regulators, but the public at large.

“You think about the vigilance, all of the tools, all of the devices we have for traffic safety. Everybody locks their kid up in a car seat, everybody puts their kid in a seatbelt, adults have to wear seatbelts, there’s all these requirements to prevent this type of injury. And there are all sorts of laws built around that. And it’s just part of our concept. It’s not something we really even question anymore. But we don’t have the same types of interventions in place for medications.”

Special thanks to Caleb Banta-Green, Meg Brunner, Nancy Sutherland, and everyone at ADAI.