NY doctors prescribe very few opioids. Not everyone believes it’s a good thing.

New Yorkers are far less likely to leave their doctor’s office with prescriptions for drugs like Vicodin or Percocet today than they were a decade ago, according to a new report from the state’s health department. government.

Nationwide, there was a 42% decrease in the number of opioid prescriptions filled between 2013 and 2022, according to the report. And patients now rarely get a seven-day supply of opioids from their first prescription, it finds.

While government health officials are celebrating the decline in opioid prescriptions, some drug policy researchers and doctors are worried about unintended consequences – including pushing patients to street drugs. The total number of opioid deaths in New York and nationwide has increased significantly in recent years, although preliminary data from the US Centers for Disease Control and Prevention showed a slight decrease by 2023.

Doctors began reducing opioid prescriptions after lawmakers in New York and other US states scrambled to pass laws in the 2010s to deal with rising rates of opioid addiction and overdose. In 2013, New York enacted a law requiring doctors to monitor patients’ opioid use through electronic records, and in 2016 a law went into effect banning prescription opioids from doctors. can be done on the first prescription.

By 2022, only about 15% of new prescriptions for opioids were for a seven-day supply, compared to 34% before the law was enacted, according to the department’s report of health.

“It is encouraging to see this positive trend in decreasing prescriptions for prescription opioids,” said Health Commissioner Dr. James McDonald in a statement.

But some patients who need opioids to manage chronic pain now face barriers to getting them, according to the New York State Medical Association.

The study also found that suddenly cutting off the supply of prescription opioids for patients who were dependent on them could lead to some turning to heroin, which led to another wave of deaths. and overdose, said Magdalena Cerdá, director of the Center for Opioid Epidemiology and Policy at NYU’s. Grossman School of Medicine.

“If treatment had been more accessible, that would have prevented some of these unintended consequences,” Cerdá added. He noted that there was little access at the time to the opioid replacement medication buprenorphine, which reverses the effects of opioid withdrawal.

The CDC refers to the increase in opioid prescriptions in the 1990s as the first wave of the opioid epidemic, and says that a second wave characterized by the rise of heroin overdose followed in the 2010s. That has given way to a third wave, driven by legally produced synthetic opioids such as fentanyl, according to the CDC.

Overdose deaths in New York and the state declined slightly in the years following the 2017 public health emergency declaration, but began to rise in 2020 and peaked in 2021 and 2022.

Cadence Acquaviva, a spokeswoman for the state health department, did not directly respond to concerns that restrictions on opioid dispensing have contributed to the increase in street drug use, but she acknowledged that “there are other ways to use opioids.”

Cerdá says the lesson learned from prescription opioid regulations is that policies that seek to reduce the use of dangerous drugs by cutting off supply must be accompanied by efforts to address the ongoing demand for those products – including the stress that causes people to abuse drugs in the first place. space.

Sheila Vakharia, deputy director of research and education engagement at the Drug Policy Alliance, which advocates for drug reform, agreed with Cerdá’s analysis.

He added that policies that restrict prescribing and promote physician care have also “created suspicion and mistrust by providers to patients who may be asking for these medications or who actually have a legitimate pain need.” to be treated.”

Dr. Jerome Cohen, president of the New York State Medical Association, said his organization has worked with the state health department to educate doctors about best practices when it comes to prescribing opioids, and he has no problem with others. limitations of instructions.

But he added that the backlash against opioids has led many insurance companies to require doctors to get prior authorization to prescribe pain relievers, even when renewing a prescription. in some cases.

“Right now there’s an unmet need,” he said. “Some patients who need opioid prescriptions aren’t getting them.”

Dr. Douglas Allen runs a pain management practice in Manhattan that uses a variety of pain management techniques in addition to opioids. He said he thinks state laws restricting opioid prescriptions have helped track down the “bad apples” who were overprescribing. But he noted that patients sometimes balked when he suggested they might benefit from opioids.

“It just takes education to explain how these specific medications are going to be appropriate for their situation,” he said.

Allen says he’s always trying to assess whether patients are using opioids long-term to manage their pain or to avoid withdrawal symptoms.

“If the patient is taking medication to not stop smoking, then there are better options like buprenorphine,” Allen said.

A state health department report on opioid prescribing found that it is still prevalent in areas outside of New York City. It’s still unclear why, but that gives the government clues as to “how it can target education and services” in the future, Acquaviva said.