The nation's opioid crisis, which claimed more than 350,000 lives between 1999 and 2016, isn't solely linked to illicit drugs like heroin and fentanyl.
"In too many cases, addiction still starts with a prescriber's pen," FDA Commissioner Dr. Scott Gottlieb said of the opioid epidemic in a speech this month. "The number of prescriptions being written is still too high."
Those numbers, though, have been declining since 2011, and new data released Thursday from the Iqvia Institute for Human Data Science, an industry researcher, show the decline accelerated last year, helped by changes in regulation of opioid prescribing and in reimbursement policies from insurers.
"Some of the programs, perhaps many of the programs that have been put into place in the past year or two seem to be having an impact," said Murray Aitken, executive director of the Iqvia Institute, in an interview. The data show, he said, "a significant drop."
Here's a look at the opioid trends, in four charts:
The number of opioid pills prescribed peaked in 2011 and has since declined by 29 percent.
In 1992, prescription opioid usage was about 22 pills per adult American, according to the Iqvia Institute. At the peak in 2011, usage was 72 pills per adult in this country; that's now declined to 52.
The number of prescriptions accelerated its decline in 2017, with an even faster drop for high doses.
The number of opioid prescriptions in the U.S. declined by more than 10 percent per month between January and December 2017, the report showed. High-dose prescription opioids, which carry a higher risk of dependence and overdose, saw an even faster decline, of more than 16 percent last year.
Fewer people are starting on opioid prescriptions, and more people are starting medically assisted treatment for opioid addiction.
The number of patients getting new prescriptions for opioids — defined as those who haven't been prescribed one in the previous year — declined by 7.8 percent in 2017. New prescription starts, particularly for chronic pain, can be a key indicator of future opioid use, Iqvia said.
The decline can be attributed to a few reasons, according to Aitken: increased use of nonopioid pain treatments, like ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs), as well as public awareness about overuse and misuse of opioids.
At the same time, more patients appear to be starting on so-called medication-assisted therapies to treat opioid addiction, such as buprenorphine, the data show.
"What we're reporting is almost a doubling in the number of new patient starts using one of these medication-assisted therapies," Aitken said, "going from about 42,000 patients a month at the beginning of 2015, up to 80,000 a month at the end of 2017. So quite a rapid increase in the use of those medication-assisted therapies."
Still, though fewer opioids are being made available by prescription, data from the Centers for Disease Control and Prevention show prescription pain drugs are no longer the biggest cause of drug-overdose deaths; they were overtaken by heroin around 2015, and by synthetic opioids, like fentanyl, in 2016.
Prescription opioids, though, are still a major part of the problem; the number of deaths caused by all three categories continued to increase through 2016, according to the CDC.
"A crisis that began with the lawful prescribing of prescription medicines has evolved into a disaster involving illicit drugs, and increasingly, super-potent forms of illicit fentanyl," FDA's Gottlieb said in his speech, delivered at the National Rx Drug Abuse and Heroin Summit in Atlanta. "So even as medical prescriptions are falling, overdose deaths are rising."