The number of opioid prescriptions filled in Michigan declined again last year as the state continues its efforts to reduce the use of opioids.

Between 2017 and 2018, opioid prescriptions dropped 15%, according to a report released Tuesday by the Michigan Department of Licensing and Regulatory Affairs. Between 2015 and 2017, the number of prescriptions dropped 10.7%

It’s unclear if opioid-related deaths declined in 2018; the state has yet to release those figures. But previous declines in prescriptions have not led to a decline in the number of opioid deaths.

Prescription medication is not the cause of most opioid-related deaths. In Michigan and across the nation, synethetic opioids, mainly fentanyl, is responsible for more opioid-related deaths than anything else.

“Reducing prescribing alone will not decrease the overdose deaths we’re experiencing today,” said Dr. Chad Brummett, an associate professor of anesthesiology at the University of Michigan and pain specialist. “However we have to recognize that at its origin and at its core, the opioid epidemic is a prescribing epidemic … created by physicians and prescribers, most of whom had good intent with their prescribing. In order to insure that we’re not continuing to fuel the fire, we need to reduce presdribing to appropriate levels. … However this will not by itself decrease the fentanyl and heroin deaths today.”

For that, he said, there needs to be increased access to Narcan (naloxone), the opioid overdose-reversing agent, and to treatment. 

Last years’s decline in opioid prescriptions coincided with a 134% increase in the registration of prescribers, pharmacists and delegates such as nurses with the Michigan Automated Prescription System. MAPS tracks controlled substance prescriptions, including opioid prescriptions.

Since June 1, 2018, prescribers have been required by law to register with MAPS and to review MAPS reports before issuing more than a 3-day opioid prescription.

In 2017, opioid-related overdose deaths in Michigan reached a record high, according to the Michigan Department of Health and Human Services. Based on preliminary data, 1,941 of that year’s 2,729 overdose deaths were opioid-related. While that figure represented a 9% increase in opioid-related deaths over 2016, it also represented a slowing of the year-over-year increase in opioid-related deaths, perhaps the result of greater familiarity of Narcan.

At the beginning of the crisis, opioid medication was the cause of most overdose deaths.

When those pills became too difficult to find — nationally, opioid prescriptions peaked in 2012 and has decreased every year since — addicts turned to heroin, which is less expensive.

The number of heroin-realted deaths skyrocketed. Now the heroin supply is tainted with the synthetic opioid fentanyl. Synethetic opioids — namely fentanyl and its analogs — are now responsible for the majority of opioid deaths.

Fentanyl is 50 times stronger than heroin and up to 100 times more potent than morphine, according to the U.S. Centers for Disease Control and Prevention.

The percentage of opioid users seeking who started with heroin jumped from 8.7% in 2005 to 33.3% in 2015, according to a report published in 2017 the journal “Addictive Behaviors.”

The use of commonly prescribed opioids, oxycodone and hydrocodone, dropped from 42.4% and 42.3% of opioid initiators, respectively, to 24.1% and 27.8% in 2015, such that 

The study, done on opioid users seeking treatment, pointed out that as the most commonly prescribed opioids have become less available, more people have turned to heroin as a starter opioid.

Contact Georgea Kovanis: gkovanis@freepress.com or 313-222-6842.

Read or Share this story: https://www.freep.com/story/news/health/2019/06/19/michigan-opioid-prescriptions-fall/1488003001/