Spring 2018

13 nmdental.org Opioid Prescribing and Drug Overdose Death in New Mexico By Jim Davis, MA, Michael Landen, MD, MPH Epidemiology and Response Division, New Mexico Department of Health Introduction The opioid epidemic in the United States continues to grow, with over 64,000 overdose deaths in 2016. The prescribing of opioids for pain accelerated in the late 1990’s due to an increased emphasis on pain treatment and strong marketing by the pharmaceutical industry. In combination with social factors, this led to a large increase in opioid use and opioid use disorder. By 2010, the United States, with 4.6% of the global population had been consuming 80% of the global prescription opioid supply (Manchikanti et al, “Therapeutic use, Abuse, and Nonmedical Use of Opioids: A Ten-Year Perspective”, Pain Physician 2010; 13:410-435 ). Opioid overdose deaths began rising in New Mexico in the early 1990’s as heroin use became established in parts of the state. The prescribing of opioids for pain accelerated in the late 1990’s along with the rest of the country. In the early 2000’s, as in much of the rest of the US, overdose deaths involving prescription opioids began to increase. By the mid-2000’s, overdose deaths involving prescription opioids exceeded those involving heroin in New Mexico. The overall drug overdose death rate in New Mexico has been high but relatively stable since 2008, while rates in other parts of the country have risen sharply in the last few years. In much of the US, prescription opioids were the entry point to heroin use in the 2000’s [ref]. Although there were other paths to heroin in NM, a point-in-time survey of clients of the DOH Syringe Services Program in 2017 showed that half of heroin users had used prescription opioids prior to using heroin. In other parts of the US, particularly the Northeast, a third phase of the opioid epidemic has evolved with the increasing availability of illicitly manufactured fentanyl and fentanyl analogues. Fortunately, NewMexico has not had anywhere near as many fentanyl overdose deaths as seen in Eastern states. Some risk factors for prescription opioid overdose include chronic use (90 days or more), high doses (90 MME/day or more), concurrent prescription of opioids and benzodiazepines, overlapping prescriptions frommultiple prescribers, and the use of multiple prescribers and pharmacies. Most dental prescribing of controlled substances is for low doses and short durations. continues on next page 