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Feature Opioid Prescription

Containing the opioid overdose epidemic

BMJ 2012; 345 doi: (Published 14 December 2012) Cite this as: BMJ 2012;345:e8340
  1. Michael McCarthy, editor
  1., Seattle, Washington, USA
  1. mxmc{at}

Michael McCarthy looks at moves in Washington State to stem the rise in prescription opioid misuse

In the late 1990s, Washington State began to relax its rules regulating the prescription of opioids. Shortly thereafter, overdose deaths began to climb.

“We saw the deaths increase within a year,” says Gary Franklin, medical director for the Washington Department of Labor and Industries, which administers compensation for job related injuries and illnesses for more than 3.2 million workers in the state.

“These were productive people who were working the day they came into the system with a back sprain or whatever, and three years later they were dead from an accidental overdose of opioids,” Franklin says. “I had never seen anything so sad.”

The deaths triggered an investigation which found that as opioid regulations had been relaxed in the state there followed a modest increase in overall opioid prescriptions, but a marked shift towards prescriptions for more potent, long acting opioids, such as transdermal fentanyl, oral methadone, and oral oxycodone, the proportion for these formulations rising from 19.3% in 1996 to 37.2% in 2002.1

During the same time period, the average daily morphine equivalent doses (MED) for long acting opioids had risen 50% to 132 mg/day. “Doses,” says Franklin, “were going through the roof.”

US rates of sale of prescription painkillers, deaths, and admissions for substance misuse (1999-2010)2

The investigation also identified 32 deaths that were “definitely or probably” related to unintentional overdoses among patients covered by Franklin’s agency and 12 more that were possibly related. Most deaths were in men; the average age was 40 years.

Only two of …

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