What the CDC is missing about the opiate crisis

What the CDC is missing about the nation’s opiate crisis – NY Daily News by Dr. Pawan Grover, M.d. May 16, 2017

The opiate crisis might have started with the overprescribing of pain medications but now it is a growing heroin crisis.

According to the CDC, 75% of heroin users started with prescription drugs.

This belief is the underlying foundation of the CDC’s efforts to reduce potential heroin addicts by limiting doctors to prescribe pain meds in the first place.

As an example, New Jersey is limiting pain prescriptions to a five-day supply. Essentially, the thinking is that to win the war on heroin, you need to win the war on prescription opiates.  

Around 2012, federal initiatives with good intent regulated the actual supply of prescription opioids to pharmacies. With prior efforts to shut down pill mills, and with the trend of less prescribing by doctors, the street value of diverted prescription pain meds skyrocketed.

That ultimately led to an increase in the use of cheaper and more available potent street heroin.

Restrictions also led to patients with legitimate pain issues, who failed all other treatment modalities and were previously prescribed opiates in a responsible way, to turn to heroin if they were not able to get legitimate opioids from their doctor.

In the mainstream media, I keep hearing about patients turning to heroin, but this is simply not true.

The vast majority of pain patients wouldn’t have a clue how to get it because they don’t associate with the people that are involved with it.

The critical piece of information that the CDC is missing from their study:

whether heroin addicts obtained the pain meds from legitimate doctors in the course of pain treatment or from family and friends, pill mills or off the street.

Why is this important? Because the answer to that question is the key in determining the most effective way forward on this war on prescription drugs.

“This war on prescription drugs” is exactly what we don’t want to move forward on. We need to disassociate opioids prescribed for pain patients from heroin.

We must unlink these two extremely different situations:

  1. Opioids prescribed for and used by pain patients
  2. Illicit drugs and heroin bought on the black market

The National Survey on Drug Use and Health found that more than 75% of recreational opioid users in 2013-2014 obtained pain pills from sources other than doctors, mainly friends and relatives.

This tells us that we need to change tactics.

There has to be caution, however. If we continue to vilify doctors, they will stop treating legitimate pain patients out of fear.

Let’s look at that statistic by the CDC again: “91 people die every day from opiate overdose.”

This number can be misleading because the term “opiate overdose” includes prescription opiates and illegal heroin.

These numbers are skewed because it is challenging to document the exact cause of an overdose death. To compound this, heroin is metabolized to morphine in the body, so even according to the CDC, heroin deaths are underreported.

Why have heroin overdoses quadrupled the last few years?

The previous heroin on the market was sticky and tar-like; it was injected with needles directly in a blood vessel.

The new heroin on the market is more dangerous and in a potent powdered form that can be snorted, taking away the deterrent of people afraid of needles.

To compound problems, street drugs are being cut with fentanyl, which is a synthetic morphine 50 to 100 times stronger than morphine.

Fentanyl home labs, similar to meth labs, are popping up across the country. Ironically, this is shipped from overseas in the mail.

Authorities need to focus their resources on aggressive efforts to shut down pill mills and continue to curb heroin at its source along with cutting off the fentanyl shipments through the general mail.

Here, the author sadly falls into the same old pattern: 

using law enforcement and legal restrictions
to limit the supply
instead of
healing people from addiction
to decrease the demand.

And patients can make a significant differnce by locking up meds to keep them away from children, family and friends.

And if legitimately on pain meds, they should be careful of the combinations of pain meds, benzodiazepines, and the interaction with alcohol and other meds that have a sedative effect to prevent accidental overdoses.

Dr. Pawan Grover, M.D. (inovospine.net), is an interventional specialist who prides himself on being an advocate for patients. He believes in pulling back the medical curtain to explain how Big Medicine works, so patients can take the power of health care back into their own hands. Dr. Grover has more than 20 years of experience as a medical doctor, and has served as a medical correspondent for CNN, NBC, CBS and PBS.
Dr. Grover is a graduate of the UMDNJ-Robert Wood Johnson Medical School (Rutgers Medical School). He completed his residency at the Texas Medical Center, and did a special fellowship in Sydney, Australia, with professor Michael Cousins, who is considered the father of regional blockade and pain management for cancer and non-cancer pain. Dr. Grover has worked extensively with top neurosurgeons from MD Anderson Hospital in the Texas Medical center for cancer pain management.

 

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