Pain Prescriptions Are Not Cause of Addiction

Opioid Addiction Is a Huge Problem, but Pain Prescriptions Are Not the Cause | Scientific American |May 10, 2016
Another insightful article by Maia Szalavitz:

Both the FDA and the CDC have recently taken steps to address an epidemic of opioid overdose and addiction, which is now killing some 29,000 Americans each year. But these regulatory efforts will fail unless we acknowledge that the problem is actually driven by illicit—not medical—drug use.

the simple reality is this: According to the large, annually repeated and representative National Survey on Drug Use and Health, 75 percent of all opioid misuse starts with people using medication that wasn’t prescribed for them—obtained from a friend, family member or dealer. 

And 90 percent of all addictions—no matter what the drug—start in the adolescent and young adult years. 

Typically, young people who misuse prescription opioids are heavy users of alcohol and other drugs. This type of drug use, not medical treatment with opioids, is by far the greatest risk factor for opioid addiction

In general, new addictions are uncommon among people who take opioids for pain in general.

A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care; a less rigorous, but more recent review put the rate of addiction among people taking opioids for chronic pain at 8-12 percent.

Moreover, a study of nearly 136,000 opioid overdose victims treated in the emergency room in 2010, which was published in JAMA Internal Medicine in 2014 found that just 13 percent had a chronic pain condition.

All of this this means that steps to limit prescribing opioids for chronic pain run a great risk of harming pain patients without doing much to stop addiction.

The vast majority of people who are prescribed opioids use them responsibly—recent research on roughly one million insurance claims for opioid prescriptions showed that just less than five percent of patients misused the drugs by getting prescriptions for them from multiple doctors.

If we want to reduce opioid addiction, we have to target the real risk factors for it: child trauma, mental illness and unemployment.

Two thirds of people with opioid addictions have had at least one severely traumatic childhood experience, and the greater your exposure to different types of trauma, the higher the risk becomes.

The final major risk factor for addiction is economic insecurity and poverty, particularly unemployment and the hopelessness, social marginalization and lack of structure that often accompany it.

…as long as there is distress and despair, some people are going to seek chemical ways to feel better.

Only when we can steer them towards healthier—or at least, less harmful—ways of self-medication, and only when we reach children before they develop this type of desperation, will we be able to reduce addiction and the problems that come with it.  

I’ve only annotated selected passages from Maia’s article here, but it’s worth reading in its entirety: http://blogs.scientificamerican.com/guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/