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26 Apr 2016 Research

Study: What’s Causing the Opioid Epidemic?

Ruchi Dhami
Ruchi Dhami
Director of Market Research & Development

In 2013, the Mayo Clinic published a study that showed that nearly 70% of Americans currently take at least one prescription medication, and of these people, more than half take at least two. One-fifth of Americans will take five or more prescription medications today. For context, that’s about 63.8 million people. That’s almost the entire population of the UK, taking five or more prescription drugs every single day.

So that’s a lot of people, but what are they taking? Lots of things: antibiotics, antidepressants, blood pressure medication, opioid painkillers etc., but for the purpose of this post, we’ll be looking at opioid prescriptions in particular and the current epidemic. Here’s the thing: 13% of Americans have a prescription for opioids right now. Our own internal research shows that about 60% of Americans have filled a prescription for opioid painkillers at some point in their lives. Opioids are everywhere. But just how understanding are people of the risks associated with such drugs? After doctors scribble down OxyContin on a little blue script pad, do the people walking away with those prescriptions understand what they have in their hands, and what implications those drugs have on the public health of Americans?

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My team and I wanted to understand the general public’s perception of prescription medications. Do people know what drug safety looks like? Do they understand what misuse is? How are they interacting with prescriptions in their households, particularly with their children? Given that 4 in 5 (or 80%) new heroin users started out misusing prescription painkillers, we wanted to know if America’s potentially lax perceptions are contributing to opioid addictions.

The Study

To better understand what the average American adult knows about prescription drugs — their uses, their safety, how they can be distributed — we created a survey. The survey had 30 questions, and was broken into four core areas used to evaluate a person’s understanding of drug safety and risks. We sent the survey through a paid research audience that is representative of the American adult population. In the end, we had 463 people fill out the survey to completion and were included in our sample.

Understanding Prescription Directives

We first asked our respondents to evaluate three scenarios. In these vignettes, a character obtained and took a pharmaceutical drug under different circumstances. The first two vignettes followed Mary, who was given a prescription for Percocet. In the first scenario, Mary’s doctor instructs her to take 1 tablet every 12 hours, and in the second, she is instructed to take 1 tablet every 12 hours or as needed. In both scenarios, Mary takes two tablets at once. Respondents are asked to evaluate if Mary had misused her medication. When her instructions are to take her medication once every 12 hours, and instead she takes two, 86% of respondents felt that Mary had misused her medications. In contrast, when her instructions are to take her medications as needed and she proceeds to take two, only 55% of respondents felt that Mary had misused her prescription.

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Why the 30% drop? The instructions to take medications pro re nata (PRN, or more colloquially, “as needed”) is pretty vague, and without context, it can be interpreted thousands of ways. Is Mary’s doctor instructing her to take her Percocet whenever she feels pain? Or is the directive to only take her medication when the pain is severe? Most commonly, PRN means to take a medication whenever it’s needed, but up to some daily maximum. When a doctor gives clear cut instructions, such as “take 1 tablet every 12 hours,” it is understood by almost all of our respondents that any deviation from that directive is wrong. However, when a doctor allows for some “wiggle room” and leaves some of the decision making to the patient, it suddenly becomes unclear what to do.

Evaluating Criminal Severity

In the next scenario, we asked our respondents to evaluate an interaction between two co-workers, Jim and Bill. Jim accepts Vicodin tablets from Bill, who shares a similar shoulder pain to Jim and has a prescription from his doctor. Even though 82% of respondents believe that Bill illegally distributed a prescription drug, only 27% of all respondents think that Bill can and should be charged for the illegal distribution of prescription drugs. In contrast, 62% of respondents think that Bill can, but shouldn’t be charged with distribution.

To me, this is really interesting. There are a few reasons why respondents might have felt that, when it comes to the conviction of such distribution, legal action should not be taken.. For starters, Bill gave Jim 10 Vicodin tablets, which isn’t really that much in the grand context of cartels or drug ring operations. True, it’s not a huge quantity, but it’s enough to cause some serious damage. For example, Bill doesn’t know if Jim is taking other medications that could have serious or potentially fatal reactions with Vicodin. This also shows that people aren’t taking the distribution of prescription painkillers as seriously as the distribution of other controlled substances. Imagine if we swapped out Vicodin for heroin. Would the responses change? Steve Pasierb, the President and CEO of The Partnership at Drugfree.org, articulates this relationship quite well in a statement about parents: “Parents fear drugs like cocaine and heroin and want to protect their kids. But the truth is that when misused and abused, medicines — especially stimulants and opioids — can be every bit as dangerous and harmful as illicit street drugs. Medicine abuse is one of the most significant and preventable adolescent health problems facing our families today.” While it is true that illicit street drugs can have devastating consequences, it is important for everyone to understand that prescription medications can have equally severe repercussions.

Reporting on Personal Behaviors

This was an important section and consideration for our research, since it demanded objective answers. It’s much easier to say something like, “I workout 3 times a week,” with accuracy rather than saying, “I am moderately fit” with accuracy. Many people might be inclined to think they are more fit than the general population, but when looking at specific, objective behaviors, it may reveal otherwise. The same concept holds true in this case. So, what did we discover about individuals’ prescription drug behaviors?

Nearly one third of our respondents reported having taken a pharmaceutical drug without a medical prescription. On the other hand,  87% of our respondents reported having received, filled, and brought home a prescription medication at some point in their lives. Of these respondents, the most common prescriptions brought home were antibiotics (85%), prescription opioid pain medication (60%), blood pressure medication (35%), and antidepressants (31%). A majority (59%) of our respondents reported having had three or more prescriptions, and 23% reported having five or more prescriptions. These data are consistent with nationally reported statistics on prescription medications.

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Here’s where things get interesting. While a majority of individuals are aware of where their prescription medications are stored (94%) and what prescriptions others in their household are taking (87%), the majority of respondents (52%) are not aware exactly how doses of their prescriptions are left at any given time. This is troubling, as we know that 54% of those who illegally obtain prescription medications are receiving or stealing these drugs for free from someone in their household or a close loved one. What’s more concerning is that over a third of parents (38%) have not explained prescription medication safety and risks to their kids. The consequences of this lack of communication between parents and children can be serious. For teens who misuse or abuse prescription medications, 62% claim that they use these drugs because they are easy to get from their parents’ medicine cabinets, and 51% believe that they aren’t illegal drugs.

Rating Personal Drug Safety Knowledge

For this portion of the survey, we asked our respondents to assess their personal understanding of prescription drug safety and risks. A majority of respondents (56%) believe that they have a firm or expert understanding of these medications. However, when compared to their responses for their own behavior and the above scenarios, 52% were not able to correctly identify misuse in the scenarios, and 53% did not report complete personal prescription medication safety habits.

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We wanted to understand why there’s this disconnect between what people think they know and what they actually know. In looking a bit further, we found that education and age both play a noticeable role in an individual’s ability to identify prescription misuse. There’s a slight difference between those with college degrees or higher, and those without college degrees. — 49% of individuals with a four year college degree or higher were able to correctly identify misuse versus 38% of individuals without a four year college degree. , There’s even a more significant difference when it comes to age — 52% respondents over 40 years old were able to correctly identify misuse versus 32% of respondents 39 years old and under..This makes logical sense — people with access to medications, and presumably more life experience, are going to be able to evaluate situations with a more informed lens. However, what is  concerning in our data is that 30% of our respondents reported that a physician, pharmacist, or prescribing medical provider did not explain the risks and safety precautions of their most recent prescription medication.

So, Who’s To Blame?

There’s a prescription opioid epidemic right now that is only growing. Doctors are prescribing more, and patients are understanding less, all resulting in the massive issue of prescription abuse. So, what’s causing the epidemic?

A few issues are at play here. For starters, to say that prescription medications are readily available is an understatement. If I wanted to, I could go to my doctor and get a prescription within 10 minutes. If I wanted it off the books, I could probably get a few Valium from any one of my friends before the sun set. Whose fault is this? Maybe doctors, maybe pharmaceutical companies. However, there’s also a case that patients are to blame too. As we move from a paternalistic (doctors make our medical decisions for us) medical interaction to a more autonomous (individuals make their own decisions) medical landscape, individual patients unequipped with the knowledge of drug safety have the ability to request (or maybe even demand) certain medications.

My biggest hang up on our data is that 30% of our respondents didn’t get all of the relevant information about their medications from their prescriber or pharmacist. This is an issue that can’t be blamed on “Big Pharma.” By law, pharmaceutical manufacturers have to include an information insert into every single prescription package that explains uses, risks, side effects, potential interactions, and recommended dosages. After that, the pharmaceutical company has done its part, and the burden of information is on the prescriber or pharmacist. If we do the math here, and say that, of the 87% of the US adult population who have filled a prescription at one point in their lives, 30% didn’t receive information about drug safety risks from a medical professional, that works out to be about 26% of the US adult population without this information. That’s 82.9 MILLION American adults who haven’t been properly educated on the prescriptions they are taking. If we assume that 13% of those people have prescriptions to opioids, we’re talking about almost 11 million people. This is no small issue. This is affecting millions of people every single day, and a lack of education is a completely preventable cause.

Finally, we need to talk about kids. On a macro level, yes, there is a public health issue with over-prescribing, and under-educating. On a micro level, there’s an issue in homes and in schools where children and teens are accessing, selling, stealing, and trading prescription medications. As I mentioned earlier, our data showed nearly 40% of parents have not had a conversation with their children about prescription drugs. Adolescents might not know the risks of prescription drugs, but their parents, guardians, and educators should. This information should be shared with adolescents regularly and seriously.

When looking at all of the variables here, I don’t think we can say any one group or person can be blamed for why there’s an opioid epidemic, or more largely, a prescription epidemic in the U.S. right now. It’s a multifold problem. There’s a lack of diligence in the way that information is being shared between drug manufacturers, prescribers and patients. The problem is that when you are under-educated on any specific issue, you don’t perceive as high of a risk and thus, you act differently. This is what we are finding in relation to prescription painkillers — people think they understand drug safety and risks, but their behaviors and judgments show otherwise. The truth of the matter is that we are still experiencing an opioid addiction epidemic in the United States and if everyone knew as much as they think they did, we might be seeing a lot more progress. Increasing education is key to mitigating risk on all fronts. Doctors must make prescription painkiller education a top priority, adults must seek education and information from medical professionals if its not being made readily available, and finally, we all must ensure that this information is passed down to adolescents who are at high risk for dipping into the medicine cabinet.

For more information on the opioid addiction epidemic, please visit drugabuse.com/library/prescription-opioid-addiction.

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