Illinois ranks among nation's lowest in opioid prescribing
Opioid prescribing in Illinois has decreased since 2012 to give the state the ninth-lowest rate in the nation.
Doctors across the state wrote 51.1 opioid prescriptions per 100 Illinois residents in 2017, the most recent year for which data from the Centers for Disease Control and Prevention is available.
The rate is down from a recent high of 66.1 prescriptions per 100 people in 2012. But even in that year, the state's prescribing rate ranked 10th-lowest in the nation.
Cook County had the lowest opioid prescribing rate in the region in 2017, at 37.2 prescriptions per 100 people, followed by Kane County at 37.5. DuPage, Lake and Will counties also fell below the state average, at 42.2, 47.5 and 50 prescriptions per 100 people, respectively. Prescribing rates were highest in McHenry County at 56.8 per 100 people, according to the CDC.
By contrast, doctors in the state with the highest prescribing rate in 2017 - Alabama - wrote 107.2 opioid prescriptions per 100 people, down from 134.6 in 2010. The state with the lowest - Hawaii - had a rate of 37 prescriptions written per 100 people.
"Our state was never a big abuser of the prescribing practices," DuPage County Coroner Richard Jorgensen said, "and we continue to diminish the amount."
Experts in substance use disorders say Illinois' decrease in prescribing is a result of changing mindsets about the risks and benefits of opioids. A gradual decrease in prescribing can be a good thing, experts say, but too quickly cutting off patients from pain medications can be just as risky as overprescribing because it can lead people to illicit drugs.
"Having a responsible approach to opioid prescribing is really key for all medical professionals," said Chelsea Laliberte Barnes, co-founder and executive director of the Arlington Heights-based nonprofit Live4Lali, which works to prevent substance use disorder. Doctors, she said, need to be "making sure people aren't in pain, but doing it appropriately."
County coalitions formed to fight overdose deaths have been educating doctors about the risks of overprescribing opioids for long-term pain control, as have organizations such as the Illinois Academy of Family Physicians.
Patients taking opioids can develop a tolerance, leading them to need higher doses to achieve pain control. The medications cause withdrawal symptoms that can feel like the flu, so decreasing doses must be done carefully over time.
Dr. William Campbell of Campbell Health Solutions in Tinley Park is a member of the Illinois Academy of Family Physicians and its representative on the Illinois Prescription Monitoring Program Advisory Committee. He said the organization's physician education emphasizes the importance of considering patient prescription history and risk factors for substance abuse.
While some doctors are reluctant to change former practices of writing opioid scripts freely, and others are "swearing off opioids" in fear of getting any more patients hooked, Campbell said the best approach splits the difference, prescribing opioids only in small doses and always with consistent follow-up care.
Doctors are advised to keep dosages below 50 morphine equivalents and to use strong caution if dosages rise above 90 morphine equivalents, Campbell said. The prescription monitoring program helps doctors keep track of what they are giving to patients and where else patients might be getting medications.
These new practices are a departure from previous norms, when pain was classified in the 1990s as the "fifth vital sign" after temperature, pulse, blood pressure and respiratory rate, and opioids were believed to be a low addiction risk when used to treat chronic pain.
"It's just the fact that we didn't know any better until recently," Campbell said. "Once we knew better, we implemented new guidelines to keep people safe."