Louisiana is one of eight states that has more opioid prescriptions than it has residents. The state has the sixth highest prescription-per-capita rate at 1.03 pain-killer prescriptions written per Louisiana resident in 2015.
The over-prescription "crisis" is leading to addiction, more drug-related deaths and even higher insurance costs for the state, officials said.
The trend is found in neighboring Southern states, too. Alabama has the highest rate at 1.2 prescriptions per resident.
It is followed by Tennessee, West Virginia, Arkansas, Mississippi, Louisiana, Oklahoma and Kentucky to round out the top eight, which are states with a rate higher than 1, according to figures from IMS Health, an information technology company.
The Associated Press and the Center for Public Integrity recently investigated this data.
— is at the root of this rapid rise in abuse in Louisiana and across the country. Studies show these kinds of pills are most often stolen from the homes of family members and friends.
The number of overdoses had quadrupled nationwide since 2000, according to the U.S. Centers for Disease Control. According to the Trust for America's Health, the number of deaths caused by painkiller overdose has tripled in Louisiana since 1999. Louisiana recorded nearly 780 overdose deaths in 2014, the USA Today Network reported in February.
Dr. David Holcombe, regional administrator and medical director of the Office of Public Health Region VI in Central Louisiana, said over-prescribing is an “epidemic” that has been growing for decades.
“We have been building to this,” Holcombe said. “… It didn't happen by accident.”
How we got here
It’s the result of a number of factors, beginning with aggressive advocacy from the pharmaceutical industry for these prescriptions as well as misinformation that opioids were not as addictive as other drugs.
That misinformation even led to a company being fined for false advertisement, he said. So prescriptions written for moderate pain “just exploded.”
The National Institute on Drug Abuse defines opioids as medications that relieve pain. Falling in this class are hydrocodone (like Vicodin), oxycodone (OxyContin, Percocet), morphine, codeine and other related drugs.
“This has been a disaster almost created and then perpetrated,” he said. “It's driven by pharmaceutical greed, physicians prescribing and patient demand.”
“One other thing that's driving this is at some point medical providers were more or less bombarded with information that pain became the fifth vital sign,” Holcombe continued. “So total pain relief became the goal and achieving that goal was easier with significant pain medication.”
What once was reserved to treat more extreme pain and terminal illnesses became the most common prescription for moderate pain relief, which Holcombe called an “inappropriate use of opioids.”
Hydrocodone products are the most commonly prescribed for a variety of painful conditions, including dental and injury-related pain. Morphine is often used before and after surgical procedures to alleviate severe pain. Codeine, on the other hand, is often prescribed for mild pain, according to the NIDA.
What can be done?
There already are some efforts to fight over-prescription and its effects, namely drug abuse, like the Drug Enforcement Agency's National Prescription Drug Take-Back Day. The annual event offers convenient way of disposing of unneeded or expired prescription drugs.
More than 6.2 million pounds of medication have been collected through this, making it harder for them to be abused. The next event is Oct. 22. Visit the DEA's website on the event to search for a collection site near you.
The number of prescriptions in Louisiana has dropped from previous years. In 2013, there were 5,497,900 opioid prescriptions written. Two years later that number was down to 4,818,944, a decrease of nearly 679,000 prescriptions.
But Holcombe argues more can be done, like making better use of the Prescription Monitoring Program operated by the Louisiana Board of Pharmacy.
The database includes anyone in Louisiana that has been prescribed a controlled substance. The problem, Holcombe points out, is that it is not mandatory for every prescriber to check first.
“It has been hugely important, but curiously, it is required that pharmacists check it before administering the prescription but not physicians before prescribing,” he explained.
Changing that would be “a very, very simple thing that could be done to squelch the over-prescribing taking place,” Holcombe said.
“My opinion is making that mandatory for physicians to check would be hugely important,” he said.
While efforts like Drug Take-Back Day and the monitoring program help, there remains work to be done to keep people from dying over this problem.
In addition to the 780 Louisiana drug-overdose deaths reported in 2014, the CDC reported a 300 percent increase in opioid prescription sales nationally since 1999.
There also has been a rise in deaths for the first time in 10 years for certain demographic groups — primarily middle-aged white and lower-income Americans — attributed in part to opioids, suicide and chronic liver disease, Louisiana Department of Insurance reported citing a study by the Brookings Institution's Hamilton Project.
A lesser-known consequence of opioid over-prescription the department noted is the effect on insurance costs in Louisiana.
"In addition to the costs to individuals and families that these drug abuses and opioid dependencies cause, there is also a cost to the insurance system as a whole," Louisiana Insurance Commissioner Jim Donelon said in a Sept. 29 release. "Louisiana workers have a higher frequency of opioid use when injured than most other states. This is a dangerous trend that has reached crisis proportions."
It’s not just opioids
The conversation of over-prescription doesn’t stop with opioids. The problem is much bigger than that.
“In the South and in Louisiana we are higher for opioid prescriptions, but also for antibiotics and prescriptions in general per capita,” Holcombe said. “So it's actually a regional problem.”
Not only is it a widespread problem, but it also creates other dangerous issues. Overuse of antibiotics is leading to development of resistant organs and people addicted to opioids are moving to harder drugs.
“What we're seeing is people who are already addicted (to opioids) have moved over to heroin,” Holcombe said. “We're seeing a huge spike in (heroin use). … The vast majority of heroin users didn't start with heroin. They started on legal opioid prescriptions.”
Holcombe called this all “a huge package deal.”
“And it's all related to opioid use and is driven by physician prescriptions,” he said.
And legal prescriptions are the only ones being counted in the IMS Health data. These figures don't include people getting drugs illegally and those abusing them.
"You can count those in overdoses," Holcombe said.
While efforts to reduce the number of prescriptions written in the first place are important, so are resources on the back end. Improving access to rehabilitation programs will play a vital role in preventing overdoses and helping addicts change their lives.
“From a societal point of view, we must make access to rehabilitation programs available,” Holcombe said. “… That's a problem for a lot of states. Demand is so huge and resources are so limited.”