I realize that every time I discuss the opioid crisis with someone, I find that they often don’t know all the facts. And maybe, neither do I. But I try.
So, my goal here is to present all the stuff that I’ve read recently, with links. And I quote the articles, extensively, so you can see what I see, and not depend on my words alone.
But I must note: this article below is biased. The sources I’m using were sent to me by people upset by the media narratives regarding opioids. So the perspective here is not “fair and balanced,” but rather balancing the other narratives already out there.
Am I 100 percent certain that all of this is correct? Nope.
But I think it’s important to hear the other side, before we start punishing the wrong people.
So here are the facts:
As opioid prescriptions decline, deaths related to opioids spike.
“The opposing trends show the folly of tackling the ‘opioid crisis’ by restricting access to pain medication,” writes the great Jacob Sullum, in Reason Magazine. Sullum offers the reader a graph, showing that death does not decline with a drop in prescriptions. “To the contrary, it has risen sharply in recent years, driven by dramatic increases in deaths involving heroin (orange) and illicit fentanyl…”
“The crackdown on pain pills not only has not reversed the upward trend in opioid-related deaths,” adds Sullum, “It is contributing to it by driving nonmedical users into the black market, where the drugs are more dangerous because their purity and potency are inconsistent and unpredictable.”
Opioid use isn’t the problem. Drug abuse, involving multiple drugs, is.
Check out this fact: the California Department of Health & Human Services published a paper looking at toxicology data from Marin County -- particularly those people who had died from any drug. And the average number of drugs found in all overdoses was six. Not one… but six!!
In short, deaths from opioids often involve other substances. Meaning, this is about chronic abuse of multiple drugs – not a cancer or pain patient trying to get through the day.
What this also means, is that the numbers you often hear about opioid deaths aren’t really as large as you think. If you remove illegal drugs like heroin and fentanyl, the new numbers may be much lower. How low? Hard to tell, since the reporting is so murky.
Roughly only one percent of patients become addicted to painkillers
If you listened to politicians and the media – an overdose begins with a construction worker who injures his neck. He has surgery, and then is put on pills. Quickly he becomes a junkie, runs out of pills and turns to street drugs. He’s found dead.
Not really. Fact is, pain patients rarely become addicted. According to Reason Magazine, “A 2018 study found that just 1 percent of people who took prescription pain medication following surgery showed signs of "opioid misuse," a broader category than addiction.”
And the mag adds, “Even when patients take opioids for chronic pain, only a small minority of them become addicted. The risk of fatal poisoning is even lower—on the order of two-hundredths of a percent annually, judging from a 2015 study.”
And here’s this from Politico, which has a slightly higher percentage of addiction: “According to a 2016 national survey conducted by the Substance Abuse and Mental Health Services Administration, 87.1 million U.S. adults used a prescription opioid—whether prescribed directly by a physician or obtained illegally…Only 1.6 million of them, or about 2 percent, developed a “pain reliever use disorder,” which includes behaviors ranging from overuse to overt addiction.”
Still, despite these facts, we hear “opioid epidemic,” which might serve to hurt cancer and pain patients, by restricting access. The “epidemic” label scares doctors with threats of investigation, monitoring of pharmacists, while creating limits on how many pills can be given. This, potentially, punishes the lawful.
Does this remind you of anything? Yep – the debate over guns. Friends of mine who are gun rights advocates will demand a drug ban. They can’t see their own hypocrisy. Whether its guns or medications (both products with inherent risks), you don’t punish the lawful, for the lawless. Instead you try to tag the abuser or the criminal, and leave the law-abiders alone.
Take a look at another piece from CATO, which suggests the war on “drugs,” is really a war on “patients.” And we’re letting it happen because we’re so used to blaming, rather than fixing.
Here’s the nugget: “A January 2018 study in BMJ by researchers at Harvard and Johns Hopkins examined 568,000 opioid naïve patients prescribed opioids for acute and postoperative pain from 2008 to 2016 and found a total “misuse” rate (all “misuse” diagnostic codes) of just 0.6 percent. And researchers at the University of North Carolina reported in 2016 on 2.2 million residents of the state who were prescribed opioids, where they found an overdose rate of 0.022 percent.”
Reformulating prescription pills doesn’t help either.
Roughly 8 years ago, the popular opioid OxyContin was remade to make it harder to abuse. What happened?
Heroin use soared. Between 2001 and 2010, there were roughly 2000 to 3000 deaths by heroin. But then it shot up to 10,000 from 2010 to 2015. Implication: the overdoses were not caused by pills, but perhaps a scarcity of pills.
“During the ensuing five years, OxyContin abuse dropped and the strict restrictions we now see on opioid pills began to take hold. The result? Between 2010-2015 opioid overdose deaths in the US increased by 65%, roughly 13,000. And…that increase was entirely due to injectable drugs like heroin or fentanyl. “
Equating the potency of opioids with heroin creates hysteria that hurts patients
It’s true that basic opioid pills and heroin actually hit the same brain receptors. But heroin doses used by addicts packs way more punch than opioids. And while it’s practically impossible for one hydrocodone pill to kill you – a heroin user can die from one injection. By conflating these two types of drugs, we make it sound like pills are as immediately lethal as what comes from the syringe.
They may belong to the same class of drugs, and “drug overdose deaths” groups these drugs together, but it’s a messy classification.
To quote ASCH:
“All opioids together (including heroin) killed 30,000 people. The number of deaths from prescription opioids—the target of the current crusade— was about 17,000— half the number killed by accidental falls. Are we having an "accidental fall epidemic?" Why not?”
“Prescription pain medicines are much more difficult to get than 7 years ago, and the only result has been suffering by pain patients and no benefit.”
The best way to save lives is for patients to be able to predict the potency of the drug delivery system.
When I drink wine, I know when to stop. The modulated alcohol delivery creeps up on your own system, giving you time to slow down, and stop.
When I used to smoke, I understood what I needed to get me to “that point.” How many cigarettes did I need to make me feel good? Generally, one or two. The fact that nicotine was divided into 20 uniform delivery systems (a pack of cigs), allowed me to figure out how far I wanted to go, before getting nauseous. By reducing prescriptions of opioids, you force people into the wild west of street meds, where no one knows what potency they’re getting. One pill could end it all, for you, on the street (but not from the pharmacy).
As Reason puts it, the increases in deaths are “related to heroin and illicit fentanyl, which are more dangerous than legally produced opioids because their potency is unpredictable.”
The CDC and others are exaggerating the numbers of overdoses by pills.
I’ll just quote this from Circa: “According to a recent article written by CDC officials in the American Journal of Public Health, death certificate data does not always differentiate between illegally and legally obtained drugs, so a fatal overdose involving illicitly manufactured fentanyl could have been counted as a legal opioid prescription death.
Because of this, the total deaths from prescription opioids would have appeared to be over 32,000 in 2016, but the numbers were probably closer to about 17,000, and the CDC said they changed their method of calculating these deaths in 2015 to account for the increased availability of illicit fentanyl.”
Inflated numbers have created a panic about prescription opioids, leading to an environment where chronic pain patients are targeted.
Pain patients are committing suicide because their paid meds are being taken from them.
"I've seen a published list that heavily emphasizes publicly reported events, which includes between 20 and 30 suicides," says Stefan Kertesz, associate professor of preventive medicine at the University of Alabama.”
“"Widespread suicidal ideation should be seen as a signal of a major risk," he says.”
The government is now running interference between doctor and patient.
Currently, 17 states have laws that restrict opioid prescriptions; there are more to come. Florida Gov. Rick Scott just proposed a three-day limit on prescribed opioids; Massachusetts limits patients to a 7-day supply, and so on.
This is not entirely logical, when you consider surgical recovery. All post-surgical pain is different — as is patient response to meds.
This is from the Las Vegas Review-Journal: “For example, the effect of a drug on an individual is directly related to the weight of the patient. No dose of any drug will produce the same effect in a 100-pound woman as in a 300-pound man.”
Even more, drug metabolism differs. “It has been shown that the metabolism of opioids can vary as much as 15-fold from one individual to the next. This means that the same dose of a medicine could be too high for one person while at the same time being too low for another, regardless of weight.”
The New York Times is just making it worse.
In a recent piece, the paper says that the only people who should have access to opioids, are those who are going to die anyway. Forget anyone with gunshot wounds, broken legs, or surgery pain! Nope, you can only have the drug, if you’re doomed. I’d swear right now, but it would only make work for the copy editor.
So, as boring as this article might be -- I tried to corral research you might not have seen, and slapped it together, so you can at least hear the other side.
It’s not an elegant piece. It’s not funny. But I hope it’s helpful.
I also realize that there are people who are gaming the system – using legitimate meds to feed a recreational addiction.
If you create something effective, there will always be an accompanying, corrupting influence. You create a currency, there will be counterfeiting. Humans are like that. There are a great many drugs that could help so many people, but we ban them because we fear abuse (MDMA is one such substance – one that could help in a number of conditions). So let’s focus on targeting the problems, and not the patients.