Long-term painkiller use on the rise, with more patients taking dangerous combos

Amid growing controversy over prescription painkillers, a new study shows that patients who are prescribed opioids continue to use them over a long period of time, indicating potential abuse. The report could add fuel to the fire as lawmakers and industry groups continue to battle companies producing the drugs.

Pharmacy benefits manager Express Scripts ($ESRX) looked at pharmacy claims from 6.8 million Americans who filled at least one prescription for an opioid between 2009 and 2013. Nearly half the patients who took opiate painkillers for more than 30 days during the first year of the study continued to use them for three years or longer. Almost half of chronic opioid users took only short-acting meds instead of longer-acting drugs, increasing their risk for addiction, according to the Express Scripts report.

The study also uncovered some lax--and potentially dangerous--prescribing habits. About 60% of patients taking opiates were also prescribed drugs that don't mix with the powerful painkillers. Nearly 27% of people used multiple opiate painkillers at the same time. And about one in three took an antianxiety med along with an opioid--a common cause of overdose deaths, the report points out.

Dr. Glen Stettin

"Not only are more people using these medications chronically, they are using them at higher doses than we would necessarily expect," Dr. Glen Stettin, a senior vice president at Express Scripts, told The New York Times. "And they are using them in combinations for which there isn't a lot of clinical justification."

Still, the report was not all doom and gloom: The study found that the number of Americans using prescription painkillers declined 9.2% in the past 5 years, a potentially good sign for drugmakers and regulators looking to ward off criticism. But the number of opioid prescriptions filled and the number of days the meds were prescribed jumped by more than 8% between 2009 and 2013.

"It suggests that we still have a lot more work to do in better informing the medical community that opioids may not be safe or effective for long-term chronic pain," Dr. Andrew Kolodny, chief medical official of drug treatment organization Phoenix House, told the NYT.

The study casts another dark cloud over the industry, as companies continue to face pushback for opioid painkillers. Purdue Pharma is fighting the state of Kentucky in court over claims involving Medicaid fraud and false advertising for its opioid medication OxyContin. The litigation follows similar suits, with companies like Actavis ($ACT), Endo ($ENDP) and Teva ($TEVA) facing claims in Illinois and California for allegedly overstating the benefits of opioid painkillers while deceiving the public about the risks.

Last month, the FDA approved Purdue Pharma's Hysingla, a tamper-resistant, all-hydrocodone painkiller intended to poach Zogenix's ($ZGNX) market share for its controversial pill Zohydro, which isn't tamper-resistant. Meanwhile, Zogenix is plugging for FDA approval of a new, abuse-deterring formulation of Zohydro. The company expects the FDA to decide on the updated version of the drug in the first quarter of 2015.

- here's the Express Scripts report
- read the NYT story (sub. req.)

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