March 14, 2019
Pharmacy researchers at the University of New England, Husson University and Geisinger Commonwealth School of Medicine report a national decline in fentanyl prescribing and single out Maine as the state with the highest decline.
The study, “Trends in the Medical Supply of Fentanyl and Fentanyl Analogues: United States, 2006 to 2017,” is published in the journal Preventive Medicine.
National per capita prescribing of fentanyl dropped (-17.9 percent) from 2016 to 2017, exceeding reductions in the prescribing of morphine (-13.3 percent), hydrocodone (-12.3 percent), oxycodone (-10.1 percent), and codeine (-8.8 percent).
The study found Maine had the greatest percentage of decrease in Fentanyl use (-30.6) while Mississippi had the lowest (-10.3).
“Maine has the most comprehensive opioid-prescribing legislation of any state and showed a decline that was more than twice as great as states that had not implemented an opioid-prescribing law,” said co-author Brian Piper, assistant professor of neuroscience at the Geisinger Commonwealth School of Medicine.
According to co-author Kenneth McCall, professor and residency director at the University of New England’s College of Pharmacy, “Recent legislation in Maine includes mandatory use of the prescription drug monitoring program by prescribers and pharmacists, a limit on the supply of acute opioids, an opioid dose prescribing cap and penalties for non-adherence to these regulations.”
“Reducing opioid overdose rates requires a multifactorial approach.” said co-author Stephanie Nichols, Pharm.D., BCPS, BCPP, associate professor of pharmacy practice at the Husson University School of Pharmacy. “Throughout opioid prescribing, and especially during opioid dose reduction, it is critical that providers screen patients for opioid use disorder and provide evidence-based treatments to those diagnosed.”
Further study is necessary to identify which aspects of these laws are most impactful on changing opioid use patterns.
The authors concluded that “the substantial fentanyl reductions identified here may provide an early indication of further strategies which could aid in a return to more cautious and restrained prescription opioid use.” They go on to note “at this point, the data does suggest that Maine’s laws could serve as a model for other states or for national legislation.”
Prescription drug data was obtained from the US Drug Enforcement Administration (DEA) Automated Reports of Consolidated Orders System (ARCOS). The DEA ARCOS database reports quantities of prescription-controlled substances including fentanyl base, alfentanil, remifentanil and sufentanil for each state by distributor: pharmacies, hospitals, practitioners, and teaching institutions.