“The purpose of quotas are to provide for the adequate and uninterrupted supply for legitimate medical need of the type of Schedule I and II controlled substances that have the potential for abuse, while limiting the amount available to prevent diversion.”

~Drug Enforcement Agency Public Affairs

On October 4, 2016, the United States Drug Enforcement Agency announced they will be capping the amount of opioids that drug manufacturers are allowed to make in 2017. This will result in dramatic reductions, by an average of 25%. The production of certain opioid drugs will be curtailed even further:

• Oxymorphone – -45%
• Hydromorphone – -38%
• Hydrocodone – -34%

This is the largest reduction in opioid production in 20 years.

Why a Reduction in Opioid Production – Why Now?

The DEA says that the reason for the ordered reduction is a decreased demand, thanks to opioid awareness and anti-abuse campaigns. There is also already currently a surplus supply of opioid medications, thanks to a “buffer” of overproduction.

The goal of the reduction is to control the supply of dangerous opioid drugs, while at the same time keeping these drugs out of the hands of people who may potentially misuse them.

How Bad the Problem Prescription Opioids in Colorado and the Rest of the United States?

“Fourteen billion opioid pills are now dispensed annually in the United States – enough for every adult American to have a bottle of pills.”

~US Senators Joe Manchin, Dick Durbin, Edward Markey, Sherrod Brown, Angus King, and Amy Klobuchar, in a letter to the DEA that requested the opioid reduction

The Centers for Disease Control and Prevention have referred to an “opioid epidemic” in America, and the statistics suggest that the colorful phrasing is more than just mere hyperbole:

• Drug overdoses are the #1 cause of accidental death in this country – 47,055 overdoses in 2014.
• The largest percentage of overdose deaths are opioid-related:
  • 18,893 were caused by addiction opioids and opiates.
  • 1999-2008, painkiller sales numbers, prescription painkiller treatment admissions, and overdose death rates in America all rose comparatively.

The problem of prescription drug abuse in Colorado is quite significant:

• Every year, almost a quarter of a million Coloradans misuse prescription medications.
• 35 Colorado residents die every month from prescription overdoses.
• Annually, 7600 people in Colorado go to the emergency room because of drug overdose.
• More than 8 out of 10 – 86% – are there because of prescription pain pills.

Are There Any Downsides to Limiting Opioid Production?

“It could backfire on us dramatically, if all of a sudden, this guys that’s got ongoing chronic pain can’t get at it. What’s your alternative?”

~Tom Truszinski

Physicians worry that some patients may not get the pain coverage that they need. Already, the US Surgeon General, Dr. Vivek Murthy, has called for changes in the way opioids are prescribed.

But addiction experts are more worried that when opioid painkillers become even more difficult to obtain, people who are physically dependent or addicted may switch to heroin. That has already occurred to a significant degree – when legislation changed and databases were created that made prescription abuse harder, deaths due to opioid painkillers have plateaued or gone down.

But there’s been a trade-off – heroin abuse and overdose deaths have skyrocketed:

• Nationally, 10,574 deaths in 2014 were heroin-related.
• 80% of new heroin users begin by misusing prescription pain pills.
• 94% did so because opioids were “far more expensive and harder to obtain”.
• In Colorado, heroin deaths and treatment admissions have tripled in recent years.
• In Denver, heroin killed more people than any other drug in 2014.
• In Northeast Colorado, heroin deaths have increased by a factor of 16.

At the end of the day, anything being done to address opioid deaths in Colorado and in the rest of the United States is a good idea, but that good idea and those good intentions have to be tempered with reality:

• Treatment services for opioid addiction need to be expanded.
• In anticipation of increased heroin use, anti-overdose drugs need to be made more readily available, especially to first responders.
• Both physicians and the public need to be educated about alternatives to opioids for effective pain management.

West Virginia Senator Joe Manchin said, “I applaud their commitment to reversing this trend. There are simply too many opioid pills on the market, and the DEA is an important partner in addressing that problem.”

SOURCES:

https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-23988.pdf

https://www.dea.gov/divisions/hq/2016/hq100416.shtml

http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf