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Popular opioid painkiller falls from top ranks of prescribed drugs in Erie County

The tide appears to be turning against prescribing opioid drugs.

Hydrocodone-acetaminophen – a powerful, narcotic painkiller combined with Tylenol – was the most prescribed medication in Erie County for nearly a decade, according to Medicaid data. Local doctors routinely prescribed the drug at a rate of 70,000 to 80,000 prescriptions a year.

Last year marked a watershed moment, with hydrocodone-acetaminophen dropping to third place in the prescription rankings. And so far this year, the drug's ranking has dropped even further – to fifth place.

"The trend is telling me we are fighting the battle against opioid abuse, and we are clearly having success, but I wouldn't declare victory yet," said Erie County Medicaid Inspector General Michael R. Szukala.

With more than 250,000 residents throughout Erie County receiving Medicaid benefits, the Medicaid prescribing data is considered fairly reflective of larger drug prescribing trends countywide. More than 3 million Medicaid prescriptions were written in Erie County last year, and 1.3 million so far this year.

County Executive Mark Poloncarz called the latest data in the county's annual Medicaid analysis report "promising," a sign that local and state efforts to fight opioid abuse are taking effect. So far this year, the county's Department of Health has 256 confirmed or suspected opioid-related deaths.

The combination drug hydrocodone-acetaminophen had been listed as the most-prescribed drug for Medicaid recipients from 2008 to 2015, the earliest year for which the county has electronically tracked the information.

The common, anti-inflammatory painkiller ibuprofen has claimed the top spot both this year and last. Available over the counter, ibuprofen in higher doses requires a prescription.

Atorvastatin calcium, an anti-cholesterol medication sold under the brand name Lipitor, is now the second-most prescribed Medicaid drug, followed by omeprazole, an acid reflux and ulcer medication sold under the brand name Prilosec. Lisinopril, used to treat blood pressure, ranks fourth.

The reduction in hydrocodone-acetaminophen prescriptions may be the result of multiple efforts to curb opioid abuse. Last June, Gov. Andrew Cuomo signed legislation that initially limits physicians from prescribing more than a seven-day supply of opioid drugs. The legislation also mandates physician training on addiction and pain management.

In addition to greater physician awareness and training promoted locally and nationally, the state has continued programs like I-STOP, a prescription-monitoring program enacted in 2013 to halt doctor shopping for opioid prescriptions.

Hydrocodone no longer the most-prescribed drug to Medicaid patients

As doctors search for less addictive alternatives to addressing severe, chronic pain, it appears more physicians are turning to gabapentin, sold under the brand Neurontin. This drug used to treat epileptic seizures and pain related to nerve damage. In 2014, gabapentin ranked 12th among prescribed Medicaid drugs. But this year, it has moved up to ninth place.

While considered much safer and non-addictive than potent opioid drugs like hydrocodone, it can also be prone to misuse and abuse. Nationally, more health care professionals and pharmacists have begun expressing concern about increased gabapentin prescriptions.

"I fear gabapentin is the next battle on the horizon," Szukala said.

The local Medicaid report is coveted by insurance and hospital representatives, Poloncarz said.

"We're one of the few counties that do this type of report," he said.

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