Opioid prescriptions in Berkshires drop nearly 25% in a year


PITTSFIELD >> With opioid and heroin addiction receiving increased attention nationwide, the number of people receiving opioid prescriptions in Berkshire County has dropped nearly 25 percent in less than a year.

The potential negative effects of opioid medications have been of increasing concern to doctors, legislators, and advocacy groups as opioid addiction continues to grip the region. The decline in prescriptions illustrated in Department of Public Health data doesn't come as a surprise to local medical professionals.

"There's an increasing awareness, particularly in the primary care community," said Dr. Daniel Doyle, Berkshire Medical Center's chief of staff. "The practitioners are exercising a lot more restraint."

In less than a year, the number of people receiving opioid prescriptions in the Berkshires has declined 24.6 percent, according to the data collected by the Department of Public Health, which notes a disclaimer in its report that "it is important to emphasize that increases or decreases in a single measure may not indicate an increase or decrease in prescription misuse or abuse." The number of actual doses prescribed dropped 24.9 percent during that same span.

In Berkshire County, 6,936 people received a schedule II opioid prescription between April and July of 2016, according to data released in August by the Department of Public Health. That's a decline from the 7,470 people receiving opioid prescriptions in the three months prior, and from the 9,201 people who received opioid prescriptions from July to September of 2015.

Unintentional deaths attributed to opioids in Massachusetts rose from 786 in 2010 to 1,289 in 2014, although fewer than half were believed to be due to painkillers, according to state estimates. The most recent estimates released by the Department of Public Health put the number of opioid-related overdose deaths in Massachusetts at 1,659 in 2015 — a record high of 24.6 deaths per 100,000 residents and a 23 percent increase since 2014.

A law passed unanimously by the state Legislature earlier this year was enacted in an effort to stem the number of opioid prescriptions, which have been reexamined in the wake of rising overdose numbers. Massachusetts is one of only four states to pass such a law.

The new law mandated a limit of 7 days for any first-time opioid prescriptions and forced practitioners to review it every time they prescribe a schedule II or schedule III drug.

Although Massachusetts has had a prescription monitoring program for years, revamped and increased access to patient information has led to a decrease in prescriptions, particularly in the emergency department, Doyle said.

The new system, named the Massachusetts Prescription Awareness Tool and launched in August, also includes patient records from Rhode Island, Vermont and Connecticut, with plans to include more states in the future.

On the individual level, the system allows a prescriber to review a patient's prescription history, both in Massachusetts and bordering states, so that he or she can "balance the potential needs for pain management with the potential for misuse," said Monica Bharel, the commissioner of the Department of Public Health.

"At the macro level, it is a very powerful analytics tool that allows us to look at prescription trends," Bharel said.

Prior to the state Legislature's action, opioid prescriptions were actually already on the decline in Massachusetts, mirroring a national trend. Massachusetts doctors wrote up 4.84 million such prescriptions in 2013, but that number declined to 4.07 million, a drop of nearly 16 percent.

"In general, we're just starting in this process and I'm pleased to see that drop, but it's going to take a little bit more time to actually see what the trend will be," Bharel said, noting the continuing climb in deaths linked to opioids.

According to the most recent report, 5.4 percent of residents in Berkshire County receive a Schedule II opioid prescription, compared to the state average of 4.9 percent.

But reining in opioid prescriptions won't be an all-encompassing solution to the ongoing heroin epidemic, Doyle noted.

"Our controlling opiate prescriptions is an important part of it, but it's not the only driver," Doyle said.

Weighing the benefits and dangers of powerful prescription medication is not a new topic of conversation in the Berkshires' healthcare community.

Ann McDonald, a registered nurse. noted the 10 years of work by the Berkshire Health Systems Community Pain Management Project she helps manage. The program is a coalition of local healthcare personnel, substance abuse specialists, and law enforcement agencies that aim to treat pain while avoiding drug misuse and addiction.

Measures taken to combat misuse can include electronic prescriptions, better urine testing to ensure the patient is taking the proper amount of medication, and improved patient education, according to McDonald.

The group is looking for ways to treat pain without opioids — for example, an alternative treatment like yoga can help with a patient's mobility — but reimbursement can be an issue, McDonald said.

"Our community and certainly BHS organizationally is committed to evaluating nonmedicinal [treatment] for acute and chronic pain," McDonald said.

Relative to many other states, Massachusetts residents receive fewer prescriptions for painkillers. The commonwealth had 0.6 opioid prescriptions per capita in 2015, compared to the national average of 0.71. Alabama, which leads the country in prescriptions per capita, had twice as many in 2015.

The consequences for doctors accused of mishandling opioid prescriptions can be severe, and those who do can lose their license to practice or have it suspended.

In January, North Adams primary care Dr. Shaohua Tang had his license suspended by the Massachusetts Board of Registration in Medicine after allegedly reducing the bill of a patient in exchange for computer repair services.

Despite knowledge that the patient had been diagnosed with polysubstance abuse disorder, Tang allegedly continued to prescribe a powerful prescription — fentanyl — to the man. A day after his final prescription, the man died of an overdose, according to state documents.

Contact Adam Shanks at 413-496-6376


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