The Changing Opioid Epidemic: Not from Rx

Turning the Tide or Riptide? the Changing Opioid Epidemic – Stefan G. Kertesz – 18 Nov 2016

This rigorously sourced paper illustrates the absurdity and futility of the crackdown on prescribed pain medication.

Dr. Kertesz meticulously lays out the facts (backed by 50 references to scientific research) proving that opioid prescriptions to patients are not the primary driver of the increasing numbers of overdose deaths.

Restricting such prescriptions has only caused a crisis of untreated pain while doing absolutely nothing to treat the addiction and abuse at the root of most overdoses.

The US opioid epidemic has changed profoundly in the last 3 years, in ways that require substantial recalibration of the US policy response.

This report summarizes the changing nature of overdose deaths in Jefferson County (home to Birmingham, Alabama) using data updated through June 30, 2016.

Heroin and fentanyl have come to dominate an escalating epidemic of lethal opioid overdose, while opioids commonly obtained by prescription play a minor role, accounting for no more than 15% of reported deaths in 2015.  

Such local data, along with similar reports from other localities, augment the insights available from the Centers for Disease Control’s current overdose summary, which lacks data from 2015–16 and lacks information regarding fentanyl in particular.

The observed changes in the opioid epidemic are particularly remarkable because they have emerged despite sustained reductions in opioid prescribing and sustained reductions in prescription opioid misuse.

• Among US adults, past-year prescription opioid misuse is at its lowest level since 2002.
• Among 12th graders it is at its lowest level in 20 years.

while opioid prescribing by physicians appears to have unleashed the epidemic prior to 2012, physician prescribing no longer plays a major role in sustaining it.

The accelerating pace of the opioid epidemic in 2015–16 requires a serious reconsideration of governmental policyinitiatives that continue to focus on reductions in opioid prescribing.

The dominant priority should be the assurance of subsidized access to evidence-based medication-assisted treatment for opioid use disorder.

Such treatment is lacking across much of the United States at this time. Further aggressive focus on prescription reduction is likely to obtain diminishing returns while creating significant risks for patients.

What caused the epidemic and what sustains it today, however, are not the same.

Neglecting this distinction invites responses that could fail to protect persons most at risk, including both patients with addiction and patients with pain.

Opioid prescribing has been in decline since 2012, and misuse of prescription pain relievers has fallen in tandem over several years. Despite favorable trends in prescribing and painkiller misuse, opioid overdoses have risen precipitously.

The epidemiologic shift raises the question of whether the ongoing public campaign against opioid prescriptions fails to advance more relevant policy solutions crucial to ending an accelerating epidemic, while creating new risks to patients who receive opioids for care of pain.

This is only the abstract – here is the full text of the report: 
http://www.tandfonline.com/doi/full/10.1080/08897077.2016.1261070

Dr. Kertesz meticulously lays out the facts (backed by 50 references to scientific research) proving that opioid prescriptions to patients are not the primary driver of the increasing numbers of overdose deaths.