Americans filling far fewer opioid prescriptions

The number of prescriptions for opioid painkillers filled in the U.S. fell dramatically last year, showing their biggest drop in 25 years and continuing a decline amid increasing legal restrictions and public awareness of the dangers of addiction, new data show.

Health data firm IQVIA's Institute for Human Data Science released a report Thursday showing an 8.9 percent average drop nationwide in the number of prescriptions for opioids filled by retail and mail-order pharmacies. All 50 states and the District of Columbia had declines of more than 5 percent. Declines topped 10 percent in 18 states, including all of New England and other states hit hard by the opioid overdose epidemic, such as West Virginia and Pennsylvania.

FILE - This Aug. 15, 2017, file photo shows an arrangement of pills of the opioid oxycodone-acetaminophen, also known as Percocet, in New York. Health data firm IQVIA's Institute for Human Data Science released a report Thursday, April 19, 2018, showing an 8.9 percent average drop nationwide in the number of prescriptions for opioids filled in 2017 by retail and mail-order pharmacies, which fill the bulk of prescriptions. (AP Photo/Patrick Sison, File)

"We're at a really critical moment in the country when everybody's paying attention to this issue," said Michael Kleinrock, the institute's research director. "People really don't want them if they can avoid them."

There was an even greater drop in total dosage of opioid prescriptions filled in 2017, down 12 percent from 2016. Reasons for that include more prescriptions being for a shorter duration, a 7.8 percent decline in new patients starting on opioid prescriptions and far fewer high-dose prescriptions.

Opioid doses are measured in "morphine milligram equivalents." (A standard Vicodin pill has the equivalent of 5 milligrams of morphine.) Prescriptions for dosages of 90 morphine milligram equivalents per day or more, which carry the highest addiction risk, declined by 16 percent last year, according to the report.

The U.S. is estimated to consume roughly 30 percent of all opioids used worldwide.

Opioid prescriptions and daily doses rose steadily starting in the 1990s, fueled by factors including marketing of new opioid pills such as Oxycontin. Use peaked in 2011 at levels far above those in other wealthy countries where national health systems control narcotics more aggressively.

The U.S. decline began after overdoses and deaths from prescription opioids and illicit narcotics soared, and multiple groups pushed back.

The federal government and about half the states have enacted restrictions, such as limiting the dose or duration of opioids that can be prescribed. Insurers and drug stores began imposing similar limits on opioid use for acute pain, as opposed to cancer and chronic pain patients. The Drug Enforcement Administration increased prosecution of heavy prescribers. And numerous medical groups have issued guidelines urging prescribers to offer other pain-management options when possible and to limit doses and duration of opioid prescriptions.

Despite those measures, deaths from drug overdoses have continued to increase in the U.S. and emergency rooms saw a big jump in overdoses from opioids last year, according to government data.

Doctors have been heeding the messages from medical groups, and some worry they'll be arrested or lose their license if they provide too many opioids, said Bob Twillman, executive director of the Academy of Integrative Pain Management, which represents doctors and others who treat pain patients and gets some funding from opioid makers.

"We get a lot of phone calls from patients whose primary care doctors have said they won't prescribe opioids at all," and want referrals to other doctors, Twillman said.

The opioid data are part of IQVIA's annual report on U.S. drug-spending trends. It noted that last year the total spent on prescription drugs, after multiple discounts and rebates drugmakers give to middlemen, was $324 billion, up 0.6 percent. The report forecasts that after such discounts, drug spending will rise by 2 percent to 5 percent annually for the next five years.

WASHINGTON (AP) — The maker of a drug for Lou Gehrig’s disease that recently failed in a large study said Thursday it will pull the medicine from the market, acknowledging it didn't help patients with the deadly neurological condition.

Amylyx Pharmaceuticals announced it will voluntarily halt sales and marketing of the drug in the U.S. and Canada, where new patients will no longer be able to get a prescription.

“While this is a difficult moment for the ALS community, we reached this path forward in partnership with the stakeholders who will be impacted and in line with our steadfast commitment to people living with ALS," company co-founders said in a statement. Patients already taking the therapy who wish to continue will be able to enroll in a program to receive it for free.

The Food and Drug Administration approved the much-debated drug, Relyvrio, in September 2022, following a years-long advocacy campaign by patients with amyotrophic lateral sclerosis, or ALS.

The drug's failure is a bitter disappointment for patients and advocates, who have pressed the FDA and other federal agencies to fund and approve more experimental therapies for the fatal muscle-wasting disease.

Relyvrio's withdrawal leaves just three ALS medicines available to U.S. patients, only one of which has been shown to extend survival by several months.

Cambridge, Massachusetts-based Amylyx also said Thursday it will lay off 70% of its more than 350 employees as part of a major restructuring effort. Company executives said they plan to continue studying Relyvrio and another experimental drug for several rare diseases, including Wolfram syndrome, which causes childhood diabetes and blindness.

Company shares climbed more than 7.5% in trading Thursday morning.

Amylyx said last month it was considering pulling its drug after a clinical trial in 600 patients failed to show any improvements in survival or other health measures, such as muscle strength or walking ability.

The company's voluntary action resolves what could have been a major dilemma for the FDA. The agency's regulators would not have had a clear path to quickly force the drug from the market if the company had refused to remove it. That's because the FDA granted the drug full approval, despite the preliminary nature of the company's data on effectiveness.

The 2022 approval was mainly based on results from one small, mid-stage study that was criticized by some of the agency’s own internal scientists. Normally the agency requires two large, late-stage studies that show a clear benefit before granting approval. But at the time FDA officials explained that “regulatory flexibility” was appropriate when reviewing Relyvrio, “given the serious and life-threatening nature of ALS and the substantial unmet need.”

The medication is part of a string of drugs for deadly, degenerative diseases that have won FDA approval in recent years despite questionable evidence they work.

ALS gradually destroys the nerve cells and connections needed to walk, talk, speak and breathe. Most patients die within three to five years of a diagnosis.

Relyvrio is a powder that combines two older drugs: a prescription medication for liver disorders and a dietary supplement associated with traditional Chinese medicine.

Amylyx faced criticism for pricing the drug at $158,000 for a year’s supply. Sales were disappointing, with some patients discontinuing the medicine after only a few months.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

FILE - This image provided by Amylyx Pharmaceuticals shows the drug Relyvrio. The maker of a drug for Lou Gehrig’s disease that recently failed in a large study said Thursday, April 4, 2024 it will pull the medicine from the U.S. market, acknowledging it didn't help patients with the deadly neurological condition. (Amylyx Pharmaceuticals via AP)