Trump’s claim of ‘amazing’ success in cutting opioid prescriptions
The president earns Three Pinocchios.
“One year ago, we pledged to cut nationwide opioid prescriptions by one-third. Already during my time in office, we have reduced the total amount of opioid prescribed by 34 percent. That’s a pretty amazing number.”
— President Trump, speaking at a drug abuse summit in Atlanta, April 24, 2019
During a recent speech on the administration’s efforts to ease the opioid crisis, President Trump asserted that his administration had already achieved its goal of cutting nationwide opioid prescriptions by one-third.
Trump’s original goal, made on March 19, 2018, was to reach this target within three years. So obviously we were curious about whether the claim about already reaching the milestone within a year was valid.
Here’s what we found out. It’s an interesting tale of how data generated in the administration loses its nuance the closer it gets to the president’s lips.
The Facts
The president, after noting the goal to cut prescriptions by one-third, framed this achievement in personal terms: “Already during my time in office, we have reduced the total amount of opioid prescribed by 34 percent.”
But a White House fact sheet, issued the same day, pitched this less as an administration achievement and mentioned no goal, though it kept the time period: “In the first two years of the Administration, we saw a 34 percent decrease in the total amount of opioids prescribed.”
Finally, the agency that generated the statistic, the Department of Health and Human Services, was even more careful in its own fact sheet. It cast the percentage decline as tentative and requiring additional research: “From the President’s inauguration in January 2017 through February 2019, initial market data suggests that the total amount of opioids being prescribed monthly has dropped by 34 percent. While we need more data to confirm this snapshot, it shows we may have succeeded in meeting this [three-year] goal already.”
As you can see, it is a bit like a game of telephone, with the accuracy of the statement getting diminished with each retelling. Our eyebrows went up when we saw that the statistic apparently was based on monthly data points.
An HHS spokeswoman provided the numbers. The data reflected the nationwide prescribing of opioids measured in MMEs (morphine milligram equivalents — a measure of opioid amount/intensity), drawn from the IQVIA National Prescription Audit, a database for retail pharmacy and mail pharmacy channels only.
January 2017: 13,627,002,271
February 2019: 8,967,556,436
(Technical note: These numbers are not comparable to prescription data on the Centers for Disease Control and Prevention’s website because it does not include controlled long-term care environments — nursing homes and skilled-nursing facilities — or prescriptions for buprenorphine, which is primarily used for patients in treatment.)
That’s certainly a decline of 34 percent. Experts said that using an MME measure is probably the most useful (though a prescribing rate rather than raw numbers might be more informative).
But there are several problems.
First, two monthly data points are not especially useful to measure long-term progress. We were able to review all of the monthly data, though not publish it. February in recent years for some reason appears to experience big drops, and that happens to be the end point. A three-month rolling average shows a decline, though not as stark as 34 percent.
“Measuring the decrease using monthly prescriptions is absolutely legitimate,” said an HHS spokesman. “We focus on leading indicators to help us better and more quickly respond to this crisis, rather than waiting a year to evaluate what we are doing.”
But, more important, time did not start with the Trump administration. Opioid prescriptions have been declining for years, having reached a peak in 2010 or 2012, depending on what data set you use. The declines especially began to accelerate after the CDC in March 2016 issued new guidelines for prescribing opioids for chronic pain — 10 months before Trump took the oath of office.
HHS has published quarterly fiscal-year data for MMEs dispensed since the second quarter of fiscal year 2013. It shows that decline really sped up in early 2016, about the time the CDC guidelines were issued. The number of MMEs dispensed has fallen about 30 percent from the second quarter of the 2016 fiscal year (January-March) to the end of 2018.
Just looking at second quarter of fiscal year 2017 through the end of fiscal year 2018 — essentially Trump’s first two years — the decline amounts to 22 percent, from 41 billion MMEs a quarter to 32 billion MMEs.
Finally, we would argue that the president’s pledge was to reduce opioids by one-third in three years dating from his speech in March 2018, because he said: “We’re going to cut nationwide opioid prescriptions by one-third over the next three years.” We reviewed administration briefings after the speech and news coverage and can find no indication it was anything other than a three-year goal starting in 2018. Reporters identified 2021 as the end date.
That would mean at least a reduction of 12 billion MMEs — from 35 billion MMEs a quarter at the time of the speech to 23 billion. Backdating to the start of Trump’s presidency seems to be moving the goal posts, as the decline in MMEs on a monthly scale since Trump’s speech is about 20 percent, not 34 percent.
Asked whether progress should be measured from March 2018, the HHS spokeswoman replied: “While the March 2018 date marks the release of ‘President Donald J. Trump’s Initiative to Stop Opioid Abuse and Reduce Drug Supply and Demand,’ efforts to combat the opioid crisis were already well underway. The opioid epidemic has been a top priority for the Trump Administration since taking office in January 2017.”
Experts in the field said the decline in prescriptions is less impressive than it sounds because the trend significantly predates the Trump administration — and because the more important metric is reducing overdoses.
“By itself, the number of prescriptions is not a public-health outcome,” said Joshua Sharfstein, vice dean for public health practice and community engagement at the Bloomberg School of Public Health at Johns Hopkins University. “You can’t say mission accomplished because the number of prescriptions has gone down.”
Sharfstein noted that even as prescriptions have begun to shrink in recent years, overdoses have soared. (Recent 12-month rolling provisional CDC data touted by the administration indicates the overdose increase may have plateaued and even begun to decline.) The reasons for this disconnect are the subject of dispute among medical professionals, with some arguing that cutting back on opioid prescriptions may have led some people to switch to heroin or synthetic opioids. Other experts say the data does not support that analysis.
In any case, they said, Trump is wrong to suggest this is an administration success story, even if it has taken steps such as pushing for a reduction in opioid manufacturing.
“I don’t think the Trump administration deserves credit for the more cautious prescribing of opioids,” said Andrew Kolodny, co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University. “The reduction in prescriptions began in 2012 and improved a bit in 2016. Everything we are seeing is trending in the right direction, but no other country prescribes as much as we do.”
The Pinocchio Test
There are several problems with the way the president framed this statistic. He should have indicated the data was tentative, as HHS responsibly did, but instead he suggests a goal has already been achieved. (As we noted, the goal posts also appear to have been moved.) Moreover, he once again takes credit for a trend that started in the Obama administration, in part because of actions taken under that administration.
The president earns Three Pinocchios.
Filed under: General Problems
It was almost unanimous that all congress “men” jumped on the opioid crisis train without having their staff research the real nature of the “crisis”. I still talk to people, often strangers who do NOT have to deal with continuous pain, un managed pain now and they have been programmed to believe that prescription medication is the root of a perceived ” opioid crisis”. Those of us those of us that have pain for life whether disease or injury have “followed” the rules by an overwhelming majority with using opiate medication, vastly the majority of us have jumped through the hoops to get the ONLY and last method of pain management which is opiate medication and have used our personal ,education as we should. No abuse, no diversion, documented…. as doing so but this information is blindly disregarded. It has cost jobs, dissolved marriages, caused family stress, and lastly but probably most important death by self infliction. Dot/gov cut all pain management medications which are on record as the LAST POSSIBLE method to manage pain efficiently without offering an alternative avenue to manage our pain. BLIND, programmed Americans without continuous pain are all aboard the opiate prohibition without knowing the facts. CDC with DEA forcing our trained pain management physicians and our general practitioners to cut our medication OR discontinue prescribing against their better judgement yet, it continues at the cost of destroying otherwise productive lives. One step closer to socialism which is one step from communism. My take on the “opioid crisis”……. it IS all about the savings of money!
Forget what “political side” you are on if any. I think one important part this article they missed is – Trump wants to and is trying his best to decrease prescriptions by 1/3’rd. Whether he made it isn’t as important as how much he wants to halt prescription medication that we depend on.
This administration’s goals are hurting people in pain. Manufacturing has been cut by 30% not only hurting prescriptions but also causing nationwide hospital IV shortages – totalling 50%. Obama’s original 20% in 2016 + Trump’s 30 % =50 %. Sessions started the witch hunt on prescribers true, but not only has it continued since he left, it has escalated. Severely. Look at those awful videos he made of people hurting themselves to get pain medications. Just terrible videos. Very proudly he often describes the good those are doing. If you watch the April 24th 2019 Atlanta Rx Drug Summit you can watch him on video telling everyone about most of these “accomplishments “. Plus the boarder.
Obama needs to pay for what he did absolutely. But we need to do more to Counter what is happening in the present administration instead of looking at the past one, IMO.
We already know prohibition fortifies black markets, provides a lure to ‘want it’, provides addicts so triggered from among those previously healthy and denies legitimate users their freedom to pursue lawful happiness (or stop or relieve a painful, debilitating disease).
Thanks for censoring my comments. You clearly do not tolerate anyone posting ANYTHING critical of our current administration or the GOP.
Ironic someone whining and complaining about the unfair heavy-handed Fed crackdown on legitimate providers and patients alike supports such an authoritarian administration.
You sir will no doubt gutlessly remove this comment and is within your right to do so. But to quote a certain actor with initials J.N. “YOU CANNOT HANDLE THE TRUTH”! And are a disingenuous hypocrite IMHO.
I say you were intensely cheer-leading for a ‘side’. We don’t discuss politics here past what is needed to fight for the recovery of adequate severe pain control. This is specifically understood by everybody even though they only needed to generally understand this. We try extra hard to stay on topic because of the seriousness of the foremost issue. Besides we can’t find any side except ‘ours’ and ‘theirs’ regarding opiates, …and ‘they’ do not even have a political ‘side’, they are just deceived or willfully ignorant.
your welcome.. I have had to deal with the Controlled substance act which our 37th President (Nixon) signed into law in 1970 .. the year I became a licensed pharmacist. As a point of interest.. .the Harrison Narcotic Act 1914 was passed by a Democratic controlled Congress and the Controlled Substance act was passed by a Democratic controlled Congress. I have tried to be up front about my blog and perhaps you should read this post https://www.pharmaciststeve.com/?p=26390 which has been locked as second post on the blog for almost a year.. I do accept constructive criticism … I have been critical of this administration and the previous administration(s). I have tried to be fair for those who have come across with posts on the far side of either side of the political spectrum. I have three options… ignore their posts that could offend some/many of my readers, I can delete the offense post or I could just be a hard ass and just ban those who make offense post from posting in the future. I have dealt with the DEA from both a healthcare professional and having a chronic pain wife for nearly 50 yrs.. I don’t make a penny off of my blog.. I just try to educate and motivate those in the chronic pain community. My page views are up >50% from last year which was a record year.. so banning a few individual may be more beneficial to all my readers than letting a single – or few – potentially offensive persons and their posts to remain… for some/many of my readers may decided that I condone what they are saying and how they are saying it.
To F1 Rocket Man I say living in today’s body politic involves digging a little deeper mentally than just ascribing something someone posts/says they do not want to hear to “taking a (political side)”…”EVERY ISSUE IS A POLITICAL ISSUE”-George Orwell. He wrote 1984 if you are familiar with one of the most classic novels of the 20th century…FYI. P.S. It is about a DYSTOPIA. Look in a dictionary if you need help to see past truly becomes prologue.
To the owner of this blog…I do not mean anything personal…BUT…
To censor one’s comments delegitimizes a “blog” a.k.a. “forum”. Quite to the contrary THE OWNER are the one “taking a political side”.
Sorry it is painfully obvious you are a Trump fan.
I have just one observation and question should you not delete my post…”Blaming” (or shaming) today’s Democratic party for an attempt at preventing poisoning in 1914 or preventing drug abuse in 1970 is as appropriate as holding the late Japanese Emperor Hirohito responsible for the Takata airbag deaths. The political parties are QUANTUM LEAPS different now in our country than in 1914 OR 1970 for that matter!
And…Do you have the intestinal or testicular fortitude to state the present Trump administration is not born of authoritarian principles to the point of cult-like status?
There is so much ignorance in this country regarding substance abuse (which is using a substance solely for recreation, not medicinal need), and addiction – both are which NOT caused by substances. (There is also a great deal of ignorance regarding chronic physical pain, but I’ll address that in a minute). If abuse and addiction were caused by substances, most of us here in the US would be alcoholics, as I can guarantee most of us have ingested alcohol – a potentially-abusable and potentially-addictive substance and still the #1 potentially-intoxicating substance of abuse in this country – at one point in our lives.
Substance abuse is often caused by underlying emotional issues (and the inability to cope in a healthy manner) where one feels the need to escape from their reality. Often, they are “self-medicating” emotional pain, attempting to “forget” horrible memories of traumatic events, undiagnosed and/or untreated mental health illnesses (personality disorders, mental health disorders which cause impulsive tendencies, etc), etc. Chronic substance abuse (again, using a substance for recreation only) of a substance is what leads to addiction. Period! (I’ll also add that most substance abusers do not go on to develop an addiction. Please know I am NOT recommending anyone to abuse a substance. It’s dangerous).
By the time a substance abuser develops their addiction (which is NOT the same as physical dependence), they continue a vicious cycle that is very complex and difficult to treat. Physical dependence is NOT what sends people to the streets; however, untreated continuous severe pain can make one so desperate for pain relief, they will take the risk of using alcohol and/or illicit street substances with strong pain relieving properties (counterfeit pain pills and/or heroin – both of which are often tainted with illicit analogs of fentanyl). Physical dependence can occur without the presence of addiction while addiction can occur without the presence of physical dependence (ever hear of a “dry drunk?”).
We are seeing a skyrocketing rate of overdose deaths (usually caused by illicit fentanyl analogs) because so many people suffering from untreated and undertreated continuous severe pain has been cut off (or cut down) on REGULATED, SAFE medication that is causing so many to become desperate enough to use illicit substances with strong pain relieving properties. (Might I add that the suicide rate in this country has also skyrocketed and is now at an all-time high?) I can’t blame anyone desperately needing relief from pain from going to the streets or taking their own lives.
All living, breathing creatures – including humans – can only take so much physical pain for only so long before they become desperate and begin to crack. Hell, I’m lucky enough to only have moderate pain; however, I will flat out tell you that even untreated and undertreated continuous moderate pain with no end in sight can rid one of their ability to function and their quality of life. My heart truly goes out to those in severe never-ending pain who are untreated or undertreated.
The cause of so many overdose deaths is due to so many people – whether they’re afflicted with chronic physical pain or they’re burdened with addiction – NOT having access to REGULATED substances with KNOWN ingredients created in a lab with good health & safety standards. In other words, our government bureaucrats and their little minions have the blood of both pain patients who were desperate for relief from severe, unrelenting pain and addicts who were desperate for relief from emotional pain and/or the need to escape an unhappy existence on their hands.
(Don’t even get me started on the dumbasses who comment crap like “we don’t need opioids” – blah, blah, blah. I seriously wonder how in the hell they even manage to breathe). I swear our society is being dumbed down as I speak — too stupid to apply common sense and critical thinking to these very subjects. Very few within society (including our elected bureaucrats, regardless of what party they’re affiliated with) will understand what it’s like to live with physical pain that impairs one’s ability to function and have some quality of life UNTIL they are in those very shoes (and that can’t come soon enough for many, including the greedy Klondike idiot). *Rant over*
“I don’t think the Trump administration deserves credit for the more cautious prescribing of opioids,” said Andrew Kolodny, co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University. “The reduction in prescriptions began in 2012 and improved a bit in 2016. Everything we are seeing is trending in the right direction, but no other country prescribes as much as we do.”
Kolodny deserves credit, I guess that’s what he is saying. What no one else is saying:
Why seek credit for destroying the most comprehensive pain management system, the envy of the world?
Let’s give ISIS credit for destroying museums in Iraq. Not a gift to the culture.
The last Administration started this WAR against opioids not against drugs that stated in the early 1900’s but got a huge push again in the 1970’s. As for Lies? They’ve all lied about this but just as bad in the beginning a lot of pain patients put out more false stories. Most people complained about the doctors and wouldn’t speak to any physician about the reason behind the “war.” There are plenty of liars in all of this and I will say it again…. a court of law is the only way every pain patient wins.
Or congressional hearings