Fewer opioid painkillers are being prescribed to patients in half of U.S. counties, including most in Maryland, in recent years, but the amount remains three times what it was in 1999, according to new figures released Thursday by the U.S. Centers for Disease Control and Prevention.
The CDC and other public health officials have sought to curb prescriptions of these potent, but addictive painkillers because they are seen as a key contributor to the nationwide overdose epidemic. Users become hooked on them and later turn to cheaper and more deadly street drugs such as heroin.
"Despite the overall declines, the bottom line remains that we still have too many people getting too many opioids prescriptions for too many days at too high a dose," said Dr. Anne Schuchat, acting director of the CDC, during a press conference about the report, which showed prescriptions mostly declining from 2010 to 2015.
The report suggests the nation's health care providers already were making headway against the over-prescribing of opioids before the CDC issued new guidelines last year on opioids prescriptions. Public health officials expect the amount given to patients likely has continued to decline.
States such as Maryland have been working with doctors to first offer alternative drugs and methods of pain control. When they do prescribe opioids, the CDC wants doctors to consider the risks of addiction, lower doses and shorter durations.
In Maryland, the CDC reported that all but three counties saw declines in the amount of opioids prescribed with Allegany, Garrett and Talbot counties seeing increases. However, in 17 of the state's 23 counties, plus Baltimore City, opioid prescriptions were above the national average.
State health department officials were unavailable to comment, a spokesman said.
Nationally, the CDC said great variation remains among counties, with the highest-prescribing ones doling out six times more opioids per resident in 2015 than the lowest-prescribing ones.
The reasons weren't entirely clear, but many of the counties on the high end had a greater percentage of white residents, higher prevalence of chronic conditions such as diabetes and arthritis, higher unemployment and fewer big cities.
Mike Massuli, deputy director for addiction services in Cecil County in the northeastern corner of the state, said the higher amount prescribed in less populated areas may be because patients have a harder time accessing medical care so doctors could be sending them home with larger quantities.
Cecil was among the counties in Maryland with the highest amount of opioids prescribed per person in the state. Others were also largely rural and included Kent, Wicomico and Calvert. All, however, saw significant reductions in prescribing levels from 2010 to 2015.
Massuli and Ken Collins, Cecil's director for addiction services, said they have engaged everyone from doctors and patients to recovering addicts and law enforcement to stem opioid addiction. The county has even taken to collecting unused prescriptions in drop off boxes to clear medicine cabinets.
So has Wicomico County, which like Cecil has cut the amount prescribed by more than half between 2010 and 2015.
"The professional community is coming together to address the problem," said Cara Rozaieski, a spokeswoman for the Wicomico County Health Department. "It's the only way were going to get there."
Larger jurisdictions, including Baltimore City and counties such as Howard, Montgomery and Prince George's, with far lower amounts prescribed per person, also saw drops in opioid prescribing but by more modest levels.
Officials note that the majority of overdose deaths in Maryland have been linked to illicit drugs in recent years, though many people likely started their addictions with prescriptions.
The state Department of Health reported in June there were more than 2,000 overdose deaths last year, which was a 66 percent increase from 2015, a record jump. Most of those involved illegal heroin and fentanyl, an even more powerful opioid sometimes added to heroin. Prescription opiods accounted for some as did alcohol and other illegal drugs.
Dr. Leana Wen, Baltimore City's health commissioner, said one report showed up to 80 percent of people who use the opioid heroin began by using a painkiller they were prescribed or took from family or friends. That's why, she said, it remains important to continuing reducing the prescriptions, though changing patient demand and doctor behavior will take time.
"Hard for all us to recognize, we are a source of the problem," said Wen, an emergency doctor. "We have had a pill for every pain culture."
The state has taken several steps to reduce the addiction and overdose problem, though so far they have been largely unsuccessful.
This month, Maryland health officials began requiring doctors and other prescribers in the state's Medicaid health insurance program for low-income people to get prior authorization for prescribing some high-dose and long-acting opioids or any prescription that falls outside of the CDC guidelines.
Also by July 1, all doctors and prescribers were required to sign up for the state prescription drug monitoring program aimed at stemming "doctor shopping" in which patients visit multiple doctors seeking prescriptions.
Gene M. Ransom III, CEO of MedChi, the state medical society, said most doctors had signed up, as well as many other medical professionals who can write prescriptions, but they need to get used to using the system.
The state integrated the monitoring program into an electronic medical record system that allows medical offices statewide to share patient information such as emergency visits and X-rays when they use different facilities.
MedChi's own data shows that in the four years ending in 2016, opioid prescriptions dropped more than 13 percent in Maryland to fewer than 3.7 million and doctors in the state write fewer prescriptions than the national average.
"Everyone is talking about it and thinking about it when making decisions," Ransom said about the risks of prescribing opioids. "In the past, physicians didn't want patients calling back because they were in pain, or they were going into a weekend, so they didn't want them waiting for more pills.
"But they are now writing fewer scripts and doctors are reacting to the crisis..." he said. "The issue now is that we need more access to treatment."