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8 Billion Pills ... and Counting

Dr. Robert Valuck of the University of Colorado Skaggs School of Pharmacy is a leading figure in the opioid reform movement; a senior advisor to state legislatures and governors; and a partner to the Region VIII Opioid Misuse Consultation Team.
Dr. Robert Valuck of the University of Colorado Skaggs School of Pharmacy is a leading figure in the opioid reform movement; a senior advisor to state legislatures and governors; and a partner to HRSA's Region VIII Opioid Misuse Consultation Team.

In the midst of what has been called the most severe public health crisis since the onset of the HIV/AIDS epidemic, some eight billion new doses of opioid painkillers were legally prescribed last year, according to a leading expert.

Dr. Robert Valuck told listeners in a January webcast that seven out of 10 opioid misusers initially get them from someone in their immediate social circle – and that continued overprescribing by doctors and dentists is feeding a virtual stockpile of unused meds in American homes.

Most illicit use, he added, "is leftover opioids that are sitting around in medicine cabinets. People either get them, buy them, steal them or get handed them by a family member."

The President of the Colorado Consortium for Prescription Drug Abuse Prevention spoke in a webcast hosted by the HRSA-funded Community Health Association of Mountain/Plains States (CHAMPS).

While the estimated quantity of pills in public circulation is down – from 14 billion tablets in 2013 – there has been a four-fold increase in the sale of prescription opioids since 2001. And drug takeback programs and secure pill drops to get unused meds out of public hands have proven costly and even hazardous for many local pharmacies.

The takeback programs are considered an essential element of opioid control efforts. Colorado now funds more than 160 sites statewide -- including Walgreen's and CVS outlets, Kaiser-Permanente clinics and sheriff's offices.

The human, social and financial toll that has ensued from well-meaning clinicians' efforts to relieve their patients' pain, Valuck said, dwarfs what federal and state governments are spending to blunt the crisis. Over the next four years, he said, another half-trillion dollars in losses is projected.

Chart: Societal benefit of eliminating the opioid crisis. Total of $95.3 billion, broken down as: $43.2 billion in Productivity (fatal); $12.4 billion in Productivity (non-fatal); $12.2 billion in Health Care (overdoses); $9.2 billion in Health Care (indirect); $7.8 billion in Criminal Justice; $6.1 billion in Child and Family Assistance; and $4.4 billion in Education.An analysis by the University of Colorado Skaggs School estimates the costs of the Opioid Crisis -- including health care expenses, criminal justice, education and clinician training, and child support for orphaned and neglected children -- now approaches $100 billion per year in the U.S.

Some 190 million opioid prescriptions annually -- averaging 41 pills apiece -- "are going out at retail," Valuck noted. That equates to a combined 8 billion pills dispensed annually, "way too much," often in contravention of strict CDC guidelines for prescribing the drugs to anyone but cancer patients or those who are dying.

An estimated 11 percent of adults experience daily pain, the guidelines note, but more than 11.5 million Americans, aged 12 or older, reported misusing prescription opioids in 2016. These two facts are related.

Valuck observed that state, county and zip code-level studies have consistently found that as the number of legal prescriptions dispensed in an area rises, "it leads to more overdose deaths and more treatment admissions," as the drugs "leak" into a community.

In 2017, over 72,000 people died from drug overdoses in the United States – one every 10 minutes -- nearly two-thirds of which involved legally prescribed meds. Opioids accounted for 75 percent of those fatalities.

Of the estimated 21.6 million people who need substance abuse treatment, Valuck added, nearly 90 percent fail to receive it.

Three decades into the crisis, Valuck said, the full blown epidemic of opioid dependency also increasingly involves the use of fentanyl, heroin and illicit drugs like them. Nearly nine in 10 users of illegal narcotics now report starting out on opioid pain meds.

View the webcast HRSA Exit Disclaimer.

Date Last Reviewed:  February 2019