Reduce Access to Prescription Drugs

Return to Opioid Top-Level Strategy Map

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One of the reasons people begIn misusing opioid pain medication is the drug can be easy to access for appropriate, prescribed medical use. There are a multitude of reasons for the legitimate use of opioids under the close care of medical professionals. We must prioritize dual efforts, making sure we reduce access to those prescription opioids for those who might misuse while making sure patients who need opioids are able to access them.  

Background

Understanding more about how people access opioids, especially prescription opioids, can help us understand how we can reduce access.  

Access to Opioids for Non-Medical Use (Misuse)

The vast majority of misused prescription opioids come from friends and family of the person misusing through both intentional and unintentional diversion. The annual National Survey on Drug Use and Health (NSDUH) indicated that more than half of people misusing opioids received their prescription opioids through these methods. Only 6.5% sourced their prescription opioids from a drug dealer.   

Source of Graphic: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2018.

According to the survey (which always is influenced by the sample surveyed and their honesty in answering the survey) indicates that of people who misused pain relievers, the majority (53.1%) responded that they received them from a friend or relative.  

• 38.5% received them from a friend or relative for free.
• 10.6% purchased them from a friend or relative
• 4.0% took them from a friend or strange

The survey also examined why people were misusing prescription pain medication.

Source of Graphic:  LegitScript

It would be helpful to have (or find) better research on this, but given that this poll showed that 62.6% of the people who misused prescription pain relievers claimed to have done so for pain, it would seem plausible that the person giving them their own prescription pain relievers were trying to help them deal with the pain, not trying to help them get high or feed an addiction to aviod withdrawal symptoms. 

This data would suggest to important strategy issues:

1. It is not enough to lock up pain medications to avoid diversion.  If people are givng them to friends or relatives or if they are selling them, that person would not be stopped by a typical locked box.  They already know how to open that. 
2. A strategy to reduce prescription drug misuse should include a strong emphasis on educating people to not give or sell their medications to anyone else.  This might include educating people on how they can best respond when a friend or relative approaches them to get prescription pain medication to help them address their pain problem. 
3. A strategy should emphasize prompt disposal of pain medications after their prescribed use is no longer needed. If people quickly dispose of their presecription pain medications when they are not necessary, they would be less likely in a situation where a friend or relative who was struggling with pain (or perhaps pretending to struggle with pain or who was struggling with paid related to withdrawal) would be able to pursuade the person to give them or sell them the drugs. 
4. People who might be approached by friends and relatives who are seeking access to pain medications (the #1 source based on the NSDUH) should become important actors in a strategy that emphasizes helping people before their brains have been changed due to ongoing use or misuse of opioids.   A good strategy would equip these people with ways to help their friends and relatives with both physical pain and with ways to get help for other factors that may be driving misuse of opioids. 

Opioid Access and Misuse Among Teens is Decreasing

The 2017 Monitoring the Future survey of 8th, 10th and 12th graders shows encouraging news -- it's getting harder for teens to access prescription opioids.  Only 35.8 percent of 12th graders said they were easily available in the 2017 survey, compared to more than 54 percent in 2010   Overall, 43,703 students from 360 public and private schools participated in this year's MTF survey. 

Opioid misuse is also decreasing. For example, among high school seniors, past-year misuse of pain medication, excluding heroin, decreased from a peak of 9.5 in 2004 to 3.4 percent in 2018. The past-year misuse of Vicodin decreased from a peak of 10.5 percent in 2003 to 1.7 percent in 2018, and Oxycontin misuse has decreased from the peak rate of 5.5 percent in 2005 to 2.3 percent in 2018. Furthermore, students in the 12th grade believe that opioids are harder to obtain than in the past. In 2010, 54 percent of students in 12th grade believed that these drugs were easily accessible, as compared to 32.5 percent in 2018. 

Death from overdose is the most serious consequence of prescription drug misuse. And while the number of deaths from drug overdose remains quite low overall, the rate of overdose deaths among adolescents is increasing. In 2015, 4,235 youth ages 15-24 died from a drug-related overdose; over half of these were attributable to opioids. 

The health consequences of opioid misuse affect a much larger number of people. For example, the Centers for Disease Control and Prevention (CDC) estimates that for every young adult overdose death, there are 119 emergency room visits and 22 treatment admissions.

Tools and Resources

Solutions and Tools focused on this objective.

Promising Practices and Case Studies

Examples from communities that have implemented tools focused on this objective

 

Scorecard Building

Potential Objective Details [Under construction]
Potential Measures and Data Sources [Under construction]

 

Resources to Investigate

More RTI on Reducing Access to Opioids