It has been six months since her son, Brandon Greene, died from a suspected overdose. His mother cries frequently. And inconsolably.
She thinks that if fewer painkillers are prescribed, countless Americans would be spared the horrors and heartache of opioid addiction that she and her family have endured.
Greene, 28, of Covington, Ky., had been addicted to heroin, a fact Vance didn’t know until she was called to a hospital June 15 because her son wasn’t breathing. What she did know was that her son had acquired an opioid addiction after being prescribed painkillers for chronic back and leg pain that started about six years before he died.
Like about 75% of the people who use heroin, Greene first was addicted to prescription painkillers. He was part of a nationwide crisis of opioid addiction and overdose death that was spurred by the over-prescription and misuse of painkillers.
Greene’s pain, said his mother, came from injuries he got while caring for — and, often, carrying — his paraplegic father, John Greene, since Brandon was 18.
Greene’s path to death is a common one, and Vance wants it cut off.
“You can’t keep prescribing pain medication,” she said, “if you’re not taking care of the problem.”
Nationwide move to limit prescriptions
State laws, public health guidelines and American Medical Association standards are forging the path to cut back the prescribing of pain pills in the United States. The hope is that fewer people will become addicted to opioids, the way Greene’s son did, and fewer will die from an overdose, as he did.
Painkiller prescribing is dropping, according to medical societies, states keeping track and the Centers for Disease Control and Prevention.
But the shift isn’t uniform. Five states had prescription rates that were higher in 2016 — by as much as Iowa’s 12.1% — than they were back in 2007, a USA TODAY NETWORK analysis of the CDC’s data shows.
Prescription rates also vary, sometimes widely, inside the states. The CDC data notes “in about a quarter of U.S. counties, enough opioid prescriptions were dispensed for every person to have one.”
Despite the overall drop, more than 650,000 prescriptions for painkillers are dispensed on an average day across the nation, says the federal Department of Health and Human Services. “Leftovers” are out there as a temptation: They can be diverted to non-patients, scooped up by bored teenagers searching medicine cabinets, misused by patients already addicted.
National health and addiction experts say it’s imperative to keep an eye on prescriptions going out to the public, and parents of addicted children have demanded a governmental response. The combination has more states enacting laws to try to curb over-prescription.
People who have experienced heroin addiction talk about what it feels like the first time they used and what it feels like when the drug wears off.
Not all doctors are happy to see a governmental hand in their work, but many are accepting the laws and rules as a consequence of the nationwide overuse of opioids.
After all, from 1999 to 2014, sales of prescription painkillers in the United States nearly quadrupled. And overdose deaths from opioids, including heroin, quadrupled since 1999, with prescription opioids “a driving factor in the 15-year increase in opioid overdose deaths,” the CDC says.
It made sense that lawmakers stepped in, said Andrew Kolodny, founder of Physicians for Responsible Opioid Prescribing and co-director of opioid policy research at the Heller School at Brandeis University.
Monitoring makes a difference
To flag doctor-shoppers — people who are going from one doctor to another to get more prescriptions — while tracking doctors’ prescribing decisions, all but one state has set up prescription monitoring databases. (The holdout is Missouri.) The systems track a range of prescriptions, including opioids.
Kentucky was the first state to make its prescription monitoring database, the Kentucky All Schedule Prescription Electronic Reporting system, mandatory for prescribers. The Kentucky Office of Drug Control Policy reports that its system is doing some good.
Precisely how much is an open question.
Drug overdoses are now the number one killer of American under age 50. Nearly 736,000 people have died from drug overdose in the U.S. since 1999. Mike Nyerges
In 2016, the state tallied 301.7 million pain pills prescribed. “That’s a 70 million pill reduction in five years in the commonwealth,” said Van Ingram, executive director of the office.
Yet, “even at that number, that’s enough opioids to give every man, woman and child their own pill bottle with 70 pills,” Ingram said.
In addition, Kentucky residents continue to get opioid prescriptions more frequently than people in other states. In 2016, the state’s opioid prescription rate of 103 scripts per 100 residents was 46% higher than the national rate.
Ingram doesn’t know what an ideal number of prescriptions is, but he’s sure the answer is fewer.
The American Medical Association Task Force to Reduce Opioid Abuse encourages all physicians who are considering whether to prescribe opioids to check their state prescription monitoring program first.
Sixteen states make practitioners check their state’s database before they write a prescription, according to a May 2016 Pew Charitable Trusts report.