total misuse rate of 0.6 percent in over 560,000 patients prescribed opioids for acute and post-op pain between 2008 and 2016

Scapegoating opioid makers lets true offender get away

https://www.upi.com/Top_News/Voices/2019/04/24/Scapegoating-opioid-makers-lets-true-offender-get-away/6371556106270/

April 24 (UPI) — John Oliver is a brilliant comedian with a large platform, and he has been using it of late to demonize the pharmaceutical companies that produce opioids. Major targets of his attack are Purdue Pharma and its Sackler family principals, developers of OxyContin, which, until around 2010 was a drug of choice for non-medical users.

Like the tobacco companies in the 1990s, it is understandable to focus indignation at companies, driven by the profit motive, that purvey products that can cause harm and even death. It is reasonable to question and criticize their marketing ethics and aggressiveness.

But at the end of the day, extracting a pound of flesh from the Sacklers won’t stop the overdose rate from climbing. That’s because the standard narrative that overprescribing of opioids caused the overdose crisis is based upon misinformation — as is the belief that opioids have a high overdose and addiction potential.

Data from the National Survey on Drug Use and Health, as well as the Centers for Disease Control and Prevention, clearly show no correlation between the number of opioid prescriptions dispensed and “past month non-medical use” or “pain reliever use disorder” among adults over age 12. As high-dose opioid prescriptions dropped 58 percent from 2008 to 2017 and overall prescriptions dropped 29 percent in that time period, the overdose rate continued to climb. Decreasing the availability of prescription pain relievers for diversion into the black market only drives non-medical users to more dangerous heroin and fentanyl.

In 2017, heroin and fentanyl comprised 75 percent of opioid-related overdose deaths. Deaths from prescription pain pills also involved drugs like cocaine, heroin, fentanyl, alcohol and benzodiazepines 68 percent of the time. Less than 10 percent of overdoses from prescription pain pills in 2017 did not involve other drugs.

Opioids prescribed in the medical setting have been repeatedly shown to be safe. Researchers following over 2 million North Carolina patients prescribed opioids noted an overdose rate of 0.022 percent, and nearly two-thirds of those deaths had multiple other drugs in their system. A 2011 study of chronic pain patients treated in the Veterans Affairs system found an overdose rate of 0.04 percent. A larger population study found an overdose rate of 0.01 percent.

Researchers at Harvard and Johns Hopkins universities recently found a total misuse rate of 0.6 percent in over 560,000 patients prescribed opioids for acute and post-op pain between 2008 and 2016. Cochrane studies, highly regarded for their rigor, found addiction rates in chronic pain patients on opioids of roughly 1 percent.

People often mistakenly equate physical dependency with addiction. Physical dependency is seen with a variety of drugs, including antidepressants, anti-epileptics, and beta blockers. A person can be slowly weaned off these drugs. But addiction is a compulsive behavioral disorder with a genetic component featuring repeated use despite self-destructive consequences. The director of the National Institute on Drug Abuse points out in a 2016 paper that true opioid addiction “occurs in only a small percentage of persons who are exposed to opioids — even in those with pre-existing vulnerabilities.”

As researchers at the University of Pittsburgh recently demonstrated, non-medical use has been on a steady exponential increase at least since the mid-1970s and shows no signs of slowing down. The only things that have changed over the years are the drugs in vogue for non-medical use. It seems sociocultural factors are at play. In fact, young people seem more willing to engage in risky drug use than their predecessors. A 2017 study showed 33.3 percent of heroin users initiated with heroin.

At the end of the day, the drug overdose problem is the result of sociocultural dynamics intersecting with drug prohibition — and all the dangers that a black market in drugs present. Prohibition also presents powerful incentives to corrupt doctors, pharmacists and pharmaceutical representatives who seek the profits offered by the underground trade.

When Portugal decriminalized all drugs in 2001, it saw a 75 percent drop in its population of heroin addicts by 2015, and now has the lowest overdose rate in Europe, at 6 per million population (compared to 312 per million in the United States). Along with Portugal, most of the developed world has put an emphasis on harm reduction strategies over restrictionist, prohibitionist approaches, one reason they have lower death rates than the United States. These strategies include medication-assisted treatment with drugs like methadone and buprenorphine; safe injection facilities; needle-exchange programs; and making the overdose antidote naloxone more available.

None of this is meant to defend the conduct of a few pharmaceutical companies or those who work for them. It is meant to refocus energy and anger where it belongs.

The real villain is the war on drugs. Yet it’s getting off scot-free.

Dr. Jeffrey A. Singer is a general surgeon in Phoenix and a senior fellow at the Cato Institute.

6 Responses

  1. If I can figure out how to Steve,would you mind if I shared this on a “pain website?” I want your approval before doing something I might not be allowed to do without permission..Thank you

    • There is a hyperlink to any post that I do on my blog that references anyone back to the original article. Any text in GREEN is my comments Anyone is welcome to cut/paste anything on my blog and post it in another FB group and/or where ever it can be used to educate other chronic pain pts IMO.. the entire purpose of my blog is to educate and motivate chronic pain pts.

  2. It’s clear some doctors have become lying cowards. Pain management specialist must not have read the guidelines, they make it very clear there for primary care physicians not pain management. Jenny’s so correct, my pain doctor has yelled at me, told me to go somewhere else, flat will not listen to anything I say, could care less about any facts or that the CDC has done nothing but lie lie lie. And that folks is why you don’t let 10 addiction specialist right guidelines for pain patients. They get them killed. Why did the CDC stay silent for three years, as people died, suffered, doctors arrested without cause. And now HHS covers it up, doesn’t hold the CDC, FDA, DEA accountable for anything.

  3. It’s my understanding that Senator Lamar Alexander is pushing back on this, understanding this has hurt cpp, who have never been the real problem. He’s having hearings on this I think in July. This whole piece should be forwarded to his office, it might help our cause. Because Jenny is right, nobody’s listening, maybe he will. Thank you.

  4. How on earth do we get our pain Mgmt docs to listen to this REAL narrative? They won’t listen. They don’t want to listen. They argue w/us. They tell us to go elsewhere. They flat out disregard the truth. WHY is this still going on!? Who do we go to with this brilliant information that been under everyone’s noses since the beginning of this great fallacy?!!!

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