There is an ongoing opioid epidemic in the USA. This map from the CDC shows US prescribing rates. That map is from the collated prescriptions per 100 people. The CDC shows that the rates of prescriptions are starting to slow down, but, for every 100 people there are 59 prescriptions for opioids, as of 2017. That’s insane. The distribution of these prescriptions skew heavily toward a handful of states: Arkansas, Mississippi, Alabama, Tennessee, Louisiana, Oklahoma, West Virginia, and Kentucky. These states have opioid prescription rates near or above 100 Rx per 100 people.
Texas has remained relatively lower than these other states with an opioid prescription rate at closer to 58 Rx per 100 people, closer to the national average. How has Texas remained somewhat* insulated from the epidemic. According to Ernie Luce, Medicaid reimbursement for these drugs in the state of Texas leaves these drugs essentially uncovered so people get them at a lower rate than in other places. *I say somewhat insulated from the effects of this epidemic because I see this rate of prescriptions (as of 2016, 58/100) as too high and probably not the best medical care.
Opioids have a lower effectiveness than a combination of Tylenol# and ibuprofen# (#if the Tylenol and ibuprofen are taken together at the same time.) When taken together, they have an NNT value of 1.5. What that means is that if you give 3 people 500mg of Tylenol at the same time as 400mg of ibuprofen, within about 30 minutes, 2 of the 3 people would experience a reduction in pain of 50%, for dental pain. None of the opioid drugs comes anywhere close to that in terms of effective NNT. The traditional Tylenol No. 3 with Codeine and Tylenol has an NNT of 12.7, which means that if 13 patients are given Tylenol No. 3, 1 of the 13 will experience a pain reduction of 50% and 12 of the patients will not experience any meaingful reduction in their pain. Ibuprofen alone, is effective in 1 out of 2.5 patients at 600mg and 1 out of 2.7 patients at 400mg.
So, the takeaway message is that for moderate to severe pain a combination of Tylenol and ibuprofen is more effective than most opioid drugs.
