Even though prescriptions for painkillers have been declining recently in the United States, doctors still issued enough opioid prescriptions in 2015 for 24-hour medication for every American for three straight weeks. That rate is quadruple the amounts prescribed by doctors in Europe.
Prescriptions per capita peaked in 2010 and have been declining since, but they are still triple the amounts prescribed in 1999. Half of the country’s counties experienced a decline from 2010 to 2015, but there are broad deviations. Those counties with the highest number of prescriptions had six times more opioid use per person compared to those counties with the lowest number of prescriptions.
Nationally, opioid addiction rates are highest in rural and mostly white areas. However, the prescription rates in the densely populated counties around Philadelphia are above-average. The region of south Jersey close to Philadelphia had even higher rates of opioid consumption.
Doctors and policymakers face conflicting challenges in solving the opioid epidemic. While the number of prescriptions per person and the rate of new users have declined, the average time duration of each script has increased by 33 percent, from 13.3 to 17.7 days. Even with a lower dosage, longer use of opiods significantly increases the risk of overdose and death.
The CDC has conducted research that shows counties with the highest addiction rates have the following characteristics:
- More white residents
- Higher number of dentists and general practice doctors
- Larger number of residents without a job or insurance
- More residents with disabilities, arthritis and diabetes
However, analyses by county reveals how little is known about where opioids orginate or why they are prescribed. In the counties around Philadelphia, for example, every county exceeded the national average of scripts per capita with the exception of Chester. In spite of having the highest death rate from drugs in the state, Philadelphia was only slightly above the state average and lower than the adjacent suburbs for opioid use per person.
The expansion of Medicaid through the Affordable Care Act(ACA) is credited with increasing the availability of treatment for opioid addiction. The ACA also has provisions that require private insurers to provide coverage for mental health and substance abuse. The Wolf administration is in favor of Medicaid expansion because the law has already given treatment for drug addiction to more than 170,000 Pennsylvanians.
The present Republican plan to reform health care would reverse previous Medicaid expansion and reduce other programs which provide treatment for drug addiction.