How have prescription opioids increased?

Posted on by TheLastPsychiatrist . Bookmark the permalink.

“America uses 99% of the Vicodin in the world.”  Yes, but the question is how.

Vicodin= hydrocodone

From 2000 to 2010:

  • number of prescriptions increased from 88M to 139M: 60% increase
  • aggregate production by weight (kg) increased from 21k to 50k: 140% increase
  • survey of lifetime use: 6M users to 24M

So what is happening is that number of prescriptions being handed out has increased, but the number of tablets on each script has gone up WAY more (e.g. #60 tabs to #100 tabs)– and those extra tablets are being shared among people.


A case study of NYC is illustrative:

825k prescriptions for hydrocodone and 900k prescriptions for oxycodone (Percocet) were written in NYC in 2009.  But that’s not the full story, and anyone who has lived in NYC is going to look at this and say, “duh”:

NYC hydrocodone

Across the country a similar pattern:

Alaska, Indiana, Louisiana, Maine, Maryland, Missouri, Mississippi, Montana, North Carolina, and West Virginia, with rates of 87-200 defined daily doses per 1,000 Medicaid beneficiaries.

California, Minnesota, New Jersey, New Mexico, New York, Pennsylvania, Tennessee, and Vermont, with rates of 0 to 39 defined daily doses per 1,000 Medicaid beneficiaries.


What’s happening is what everyone already knows is happening: a small group of doctors, under the influence of the prevailing “market forces”/demand are giving out more prescriptions with MANY MANY more tablets on each prescription.

sources of narcotics

Those tablets are then shared with other people.  There’s a reservoir of pills out there.

In the U.S., the prevalence of non-medical opioid use was 5.6%.  2M people are diagnosed with opioid abuse/dependence.

That may seem like a lot, but if you consider that 24M have used opioids at any time for any reason, then the point is that it is incorrect to make the generalization that Americans are weak, or overmedicated.

A tiny segment of the population is responsible for all of that use/abuse; and a tiny number of doctors are handing out all the pills.

FYI: many of the overdoses of Vicodin, etc, are due to the Tylenol toxicity, not the opioid.


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5 Responses to How have prescription opioids increased?

  1. Guy Fox says:

    Then that pie chart is incorrect. The categories should be “Took from a friend or relative = 4%” and “Drug dealer = 96%”. (Tangential personal beef: pie charts are always terrible, and people who use them are prima facie suspect.)

    The FYI re: tylenol toxicity reminded me of an anecdote. My cousin had to go the the emergency room a few months ago with what sounds like terrible abdominal pain, crapping blood in various consistencies and shocking quantity. They kept him overnight, did a colonoscopy and took some biopsies. They couldn’t find any bad bacteria or viruses, so the initial diagnosis was that buddy was abusing non-prescription painkillers. Everybody who knows him knows that’s about as likely as Jesus doing miracles at your kid’s birthday party, so he got a second opinion. Turns out he’s allergic to milk, and he was just doing a number on his large intestine with too much pizza and grilled cheese, got an infection, and blech.
    That the doctors’ first thought was painkiller abuse indicates that they probably know what their colleagues (or they themselves) are up to. The alleged painkillers were supposed to be non-prescription, but they were thinking horses, not zebras, it’s just that painkiller abuse is horse to them. Those doctors also never followed up with him on it, which indicates that they’re not willing to do much when they suspect something.

  2. mb says:

    Vicodin would be considerably safer if acetaminophen / Tylenol was not combined with the hydrocodone. But legal hydrocodone is available only in combination with other ingredients.

    One of the stated purposes of adding acetaminophen is to limit the intake of hydrocodone by making it toxic at higher-than-prescribed doses. Thus, we are killing people in order to prevent some of them from becoming addicted to hydrocodone.

    • Or says:

      It’s hard to believe they mix in acetaminophen for that purpose. I thought they mixed in emetics to prevent overdoses more safely.

  3. CubaLibre says:

    “A tiny segment of the population is responsible for all of that use/abuse; and a tiny number of [dealers] are handing out all the [drugs].”

    A natural result of having segments of the population that are considered useless. Because we cannot simply kill or deport them, we have to keep them out of the hair of productive society. Therefore the disease > medication > addiction > crime > prison > disease cycle.

  4. Napsterbater says:

    Man, I followed House’s Vicodin addiction through eight seasons and never once did they mention that Vicodin was cut with Tylenol, nor did it ever make acetaminophen OD a plot point. I feel robbed.