North Dakota sees steep drop in opioid painkiller prescriptions
FARGO — The prescription of narcotic opioids in North Dakota has fallen sharply over the past several years in what a physician's advocate described as a "cultural change" in response to rising concerns over the opioid epidemic.
The number of opioids dispensed in North Dakota dropped from 180,410 in early 2015 to 139,836 this fall, or 22.5 percent, according to figures from the North Dakota Board of Pharmacy's prescription drug monitoring program.
Because of heightened awareness, clinics, hospitals and health systems have adopted more restrictive protocols for prescribing opioids, including recommendations from the Centers for Disease Control and Prevention.
"We want to make sure we prescribe responsibly," managing patients' pain but not unnecessarily prescribing opioid painkillers, said Courtney Koebele, executive director of the North Dakota Medical Association, which represents physicians.
Doctors are following evidence-based protocols and closely monitoring patients who are on opioid painkillers, she said. The more conservative prescribing pattern reflects a "cultural change" in the health care industry, she added.
The reduction in opioid prescriptions appears to have accelerated in recent quarters, with one of the sharpest drops this year, from the second quarter to the third quarter, when dispensing fell by 5.6 percent, according to the North Dakota Board of Pharmacy's database.
Another barometer, North Dakota Medicaid claims payments, also shows a significant and continued decrease in opioid prescriptions.
An analysis of claims shows opioid prescriptions per Medicaid recipient decreased 72 percent from 2012 to 2017, measured as morphine equivalent doses. The unit of measure is used to enable comparisons, since 10 milligrams of morphine is not equivalent to 10 milligrams of oxycodone, for instance.
"I'm very encouraged by the results," said Brendan Joyce, a pharmacist and administrator of pharmacy services with the North Dakota Department of Human Services, which administers the Medicaid program.
"We know there are fewer narcotic prescriptions than there were in 2012," he said. "We also know that the doses are lower than they were in 2012."
Joyce said he ran the claims analysis because he was curious to see the prevalence of opioid prescribing. The Medicaid pharmacy program has put in place a series of protocols to try to prevent misuse and reduce the risk of addiction, he said.
"Given the opioid news lately, we wanted to see where we were sitting," he said. "We've done quite a few things over these past few years."
But as doctors and other practitioners are becoming more restrictive in prescribing opioid painkillers, and narcotic prescriptions and other controlled drugs are carefully tracked by pharmacists and others, some addicts are turning to street sources, said Michael Schwab, executive vice president of the North Dakota Pharmacists Association.
"As we're starting to deploy these tools, we've started to see the rise of heroin, fentanyl and carfentanil," he said, referring to potent opioids that have become common street drugs, increasing the risk of overdose.
A unit of carfentanil, a synthetic opioid, is 100 times as potent as the same amount of fentanyl and 5,000 times as potent as a unit of heroin — and 10,000 times as potent as a unit of morphine.
In North Dakota, deaths from opioid use increased each year from 2013, when 20 overdose deaths were recorded, rising to 43 deaths in 2014 and 61 deaths in 2015, according to the most recent figures available from the Centers for Disease Control and Prevention.
In Cass County, opioid overdoses resulted in 23 overdose deaths last year, compared to eight deaths so far this year, according to figures compiled by public health officials. The drop in deaths is attributed to a variety of factors, including widespread distribution of overdose antidote kits, but health officials warn that a lethal batch of street narcotics could cause a cluster of deaths.