West Virginia just had its biggest annual drop ever in the number of prescription painkillers and other powerful drugs dispensed — but the number of fatal drug overdoses in the state continued to rise.
That's because an increase in the use of illegal opioids — including heroin, fentanyl and carfentanil — has more than made up for the decrease in prescription opioid-based painkiller use in West Viriginia.
And the state remains the leader in overdose deaths per capita in the United States, which is dealing with an epidemic of abuse of prescription painkillers and illegal opioids.
"The 884 drug overdose deaths reported in 2016 was a record high for the state, but 2017 numbers are on pace to surpass that total," said the West Virginia Board of Pharmacy's annual report.
In 2017, the total number of doses of prescribed controlled substances — which includes opioid-based painkillers such as oxycodone — dispensed in West Virginia fell by a whopping 31.3 million compared with 2016.
But even after that 12 percent decrease in doses, there were still almost 236 million doses of controlled substances dispensed in West Virginia, according to the pharmacy board's report.
The drop first was reported by the Charleston Gazette-Mail newspaper.
Half of the controlled substance doses detailed in the report — more than 118 million — are opioids. The other substances included anti-anxiety medications and amphetamine products.
West Virginia has just 1.8 million people. The means the doses of legal opioids dispensed in the state last year were equivalent to 65 doses for every man, woman and child.
Still, the state has made big strides in decreasing the number of prescription opioid-based painkillers dispensed. Last year, there were 18 million combined fewer dispensed doses of oxycodone and hydrocodone, which were the biggest factors in the overall decrease seen in the dispensing of controlled substances.
And since 2011, there have been 61 million fewer combined doses of those two types of painkillers dispensed in the state.
But in a sign of how prevalent painkiller abuse remains in the state, there was an increase of about 1 million doses of buprenorphine, a medication used to treat opioid dependency.
Michael Goff, acting executive director of the pharmacy board, attributed the big decreases in opioids dispensed to the fact that "the word's out" about the drugs.
"There's a lot of articles dealing with, doctors and pharmacies are concerned, there's lawsuits everywhere," Goff said.
West Virginia's struggles with the opioid epidemic have received considerable attention from the media. And the state's high rate of prescriptions for the drugs have been cited in lawsuits against makers of opioids and distributors.
The state pharmacy board, for its part, sends out letters to pharmacies and health providers when a person who was prescribed or dispensed drugs by those entities fatally overdoses.
"We've sent out hundreds" of letters, Goff noted.
The board also is notified when an individual sees eight or more doctors and visits five different pharmacies within a six-month period, and sends out a letter to providers in such cases, he said.
While such actions and an overall increase in awareness of the problems with prescription medication may have driven down the dispensing rate, and fatal ODs from those drugs, the death rate from illegal opioids has spiked considerably.
In 2016, there were about 250 fatal ODs linked to heroin in West Virginia — almost five times the number seen in 2012. The increase in fatal ODs from fentanyl, a synthetic opioid often illegally sold, was even more dramatic.
Fentanyl-linked deaths reached about 350 in 2016, or about seven times the number seen just two years before that. Fentanyl is now responsible for more OD deaths in West Virginia than any other controlled substance.
The Gazette-Mail noted that West Virginia lawmakers are now considering legislation that would seek to reduce the number of painkillers that doctors can prescribe.
That proposed law would restrict the first prescription a person received for short-term pain to just a seven-day supply.
Last week, a study published in Becker's Hospital Review found that refilling prescriptions for opioids — as opposed to the amount of opioids taken after first being prescribed — significantly boosted the risk of abuse.
The risk "increased 20 percent with each additional week of opioid use and 44 percent with each additional prescription refill," the study found.
"Additionally, researchers found dosage — the amount of opioids taken over a 24-hour period — had minimal correlation to the risk of misuse when compared to prescription length," the study said.
"For patients taking opioids for two weeks or less, the risk of misuse was not influenced by dosage levels, even when the dose was twice as high. However, high opioid dosage did display a significant correlation to misuse in patients taking opioids for nine weeks or more."