The number of prescription opioid pills distributed in Penobscot County dropped more than 21 percent between a 2011 peak and 2014, according to recently released data from a U.S. Drug Enforcement Administration database.
But the decline didn’t change the county’s distinction as the New England county with the most prescription opioid pills prescribed per person over a nine-year period as the nation’s opioid addiction crisis intensified.
The drop in opioid prescriptions between 2011 and 2014 became evident in newly released Drug Enforcement Administration analyzed by the Washington Post. The first batch of those data, which showed numbers of pills distributed across the country between 2006 and 2012, came out in July of last year. The Post added two more years of data, from 2013 and 2014, in an analysis it published earlier this week.
A number of other Maine counties also saw the number of opioid pills prescribed per person drop in 2013 and 2014, according to the newly released data. However, Maine remained an opioid prescription hotspot.
Maine counties made up nine of the 10 New England counties with the highest number of pills prescribed per person between 2006 and 2014. Rhode Island’s Kent County was in the top 10, ranking fourth. Penobscot, Somerset and Kennebec counties in Maine had the highest rates of pills prescribed per person over that nine-year period, averaging 54.6, 50.6 and 50.3 pills per person each year respectively.
The drop in opioid pills prescribed after 2011 corresponds with a heightened focus in Penobscot County on scrutinizing and limiting opioid prescriptions.
In early 2013, Penobscot Community Health Center started a controlled substance stewardship effort, in which the federally qualified health center started scrutinizing internal prescription data and giving feedback to its health care providers about their opioid prescribing and alternatives to addressing a person’s chronic pain.
“As you do that work, it catches people’s attention and you start to gain a benefit of people just being aware that that is being undertaken,” said Dr. Noah Nesin, Penobscot Community Health Center’s vice president of medical affairs. “That prescribing is being scrutinized, and the organization is actively moving toward a different way of treating chronic pain, and that accelerates the process.”
The effort that began in early 2013 has since resulted in a 77 percent reduction in the number of patients on opioids at PCHC, Nesin said.
The National Institute on Drug Abuse reports that three quarters of people who started abusing opioids such as heroin in the 2000s started with prescription opioids.
Another factor that might have led to the drop in Penobscot County was the formation of the Community Health Leadership Board, a group of health care providers in the Bangor area who started working together to address the opioid epidemic in 2014, including by developing prescribing protocols designed to ensure patients met similar requirements to get an opioid prescription regardless of their health care provider.
In Bangor, the number of hydrocodone and oxycodone pills distributed peaked at 4.6 million in 2011, and has gone down ever since. It reached 3.3 million in 2014, a drop of almost 28 percent.
According to Nesin, that number is expected to have dropped further since 2014.
Between 2016 and 2017, prescription opioid sales dropped more in Maine than in any other state. That drop followed the adoption of a law that sharply limited opioid prescriptions statewide, limiting prescriptions to 30-day pill supplies for chronic pain and seven-day supplies for acute pain. It also limited patients to a dose equivalent to 100 milligrams of morphine per day.
“I think we’re all hoping that we’ve reduced our numbers,” said Bangor Public Health Director Patti Hamilton. “I think if you talk to any providers, there’s a renewed awareness.”
The number of people who died from drug overdoses has also started to decline, with 354 people dying from overdoses in 2018, down from 417 the year before.
In Penobscot County, prescription opioids have been readily available in service centers including Bangor and Newport since the 1990s, when doctors first started prescribing opioids for chronic pain, said Nesin.
In the 1990s and early 2000s, the marketing of prescription opioids targeted rural states with a workforce prone to injuries and chronic pain and targeted prescribers who were isolated and did not rely on peers or other resources for information, Nesin said.
“When those resources are pharmaceutical companies themselves it created a distortion in prescribing that took hold and grew,” he said. “Places like these have really been disproportionately impacted.”
Maine has a lawsuit pending against Purdue Pharma, the manufacturer of OxyContin, and a number of Maine counties and cities are participating in a different, nationwide lawsuit against a range of opioid manufacturers, distributors and pharmacies.