CDC Over-Counting Rx Opioid Overdose Deaths

From the American Journal of Public Health comes a document that admits that the CDC has overcounted “prescription opioid deaths”  because they have been lumped together with “illicit opioid deaths” to create a huge number of total “opioid deaths”.

Quantifying the Epidemic of Prescription Opioid Overdose Deaths | AJPH | Vol. 108 Issue 4  

I can only access the first page of the article and it’s only an image, so I typed most of the text into this post by hand:  

In 2016, 63,632 persons died of a drug overdose in the US; 66.4% (42249) involved an opioid. Opioid-involved deaths include

  • prescription opioid analgesics (e.g. morphine, oxycodone),
  • illicit opioids (e.g. heroin, illicitly manufactured fentanyl (IMF)),
  • or both.

Why on earth would someone add together deaths from legal versus illegal drugs and then call them all “prescription opioid deaths”?

Perhaps because they were trying to brand all pain patients taking opioids as addicts in need of their recovery-program services.  A guaranteed stream of customers for the recovery industry, led by PROP.

Although prescription and illicit opioid overdoses are closely entwined, it is important to differentiate the deaths to craft appropriate prevention and response efforts.

This is an admission that the conflation of all opioid overdose deaths has misled efforts to prevent the worsening of the “epidemic”.

Countless tax dollars have been wasted, countless pain patients’ lives have been lost, but it looks like someone in the government is finally waking up to this travesty.

Unfortunately, disentangling these deaths is challenging because multiple drugs are often involved.

This is an admission that overdose deaths are usually caused by multiple drugs, not just opioids.

Additionally, death certificate data do not specify whether the drugs were pharmaceutically manufactured and prescribed by a health care provider, pharmaceutically manufactured but not prescribed the person, or illicitly manufactured.

The Changing Opioid Overdose Epidemic

The united states has seen rapid changes in the illicit opioid supply. Availability of illicitly manufactured synthetic opioids (e.g. fentanyl) that traditionally were prescription medications has increased. This has blurred the lines between prescription and illicit opioid-involved deaths.

From 2013 to 2014, fentanyl submissions increased by 426%.The increases were strongly correlated with increases in synthetic opioid deaths but not with pharmaceutical fentanyl prescribing rates, suggesting that the increases were largely due to illicitly manufactured fentanyl.In a recent report, fentanyl was detected in at least half of the opioid overdose deaths from July to Dece3mber 2016 in 7 of the states examined.

Traditionally, the CDC and others have included synthetic opioid deaths in estimates of “prescription” opioid deaths.

How can there be a tradition for any of this? The CDC followed PROP’s guidance to combine illegal and legal drugs, to create one huge number to scare everyone and mislead the efforts to address the crisis.

I find this deliberate confounding of data downright criminal.

However with IMG likely being involved more recently, estimating prescription opioid-involved deaths with the inclusion of synthetic opioid-involved deaths could significantly inflate estimates.

More Conservative Estimation Approach

A new, more conservative estimation of prescription opioid-involved deaths is proposed to better differentiate deaths involving prescription (pharmaceutically manufactured) opioids from deaths involving illicit opioids (heroin, llicitly manufactured fentanyl).

This is stated like a brilliant new idea when it’s just a correction of a deadly mistake.

Pharmaceutically manufactured opioids are considered prescription opioids for estimation purposesbecause more persons misusing them reported obtaining them in a way that originated with a prescription (misusing own prescription or obtaining from friends or relatives).

Here is their lame excuse for combining such different deaths.

Only 4.9% bought opioids from a drug dealer or stranger, and 5.6% reported obtaining them by stealing from a doctor’s office, clinic, hospital, or pharmacy or in some other way.

The National Vital Statistics System multiple cause-of-death mortality files record drug overdose deaths, which are identified with the ICD 10, according to the underlying cause-of-death codes.

Among deaths with drug overdose as the underlying cause the type of opioid is indicated by the following ICD 10 multiple cause-of-death codes: opium, heroin, natural and semisynthetic opioids, methadone, synthetic opioids other than methadone, and other unspecified narcotics.

Under the CDC’s traditional method of calculating prescription opioid overdose deaths with NVSS, deaths involving natural and semisynthetic opioids and synthetic opioids as well as methadone are included.

In other words, they counted any opioid death whatsoever as a “prescription” opioid death.

Under a more conservative method, deaths involving only natural and semisynthetic opioid and methadone are included.

Deaths involving synthetic opioids are removed and calculated separatelybecause of the high proportion of deaths that likely involved ilicitly manufactured fentanyl.

This is stating what’s been obvious to us for years by now.

I wonder what prompted this to be published just now…

With the traditional method, an estimated 32,445 prescription opioid-involved deaths occurred in 2016.

Yes, when the traditional method added together street drugs like heroin and illicit fentanyl with our prescribed opioids.

With the more conservative method, 17,087 prescription opioid-involved deaths occurred in 2016.

This isn’t just a slight correction: it’s only about half of the earlier total.

Longitudinal trends indicated a rapid increase in death rates involving synthetic opioid from 2013 to 2016 (annual percent change = 87.7%), whereas death rates involving natural and…

This is where the first page ends, but the main points have been made already.

The CDC miscounted, overcounted, and misrepresented the “opioid crisis” to obscure the real culprit: illicit drugs, not prescription pain relievers.

Could this reckoning be related to the recent news that the Human Rights Watch is Investigating U.S. Pain Treatment?

I think we’re seeing the first cracks in the dam of lies. The truth is starting to leak through and, as with real-life earthen dams, even a tiny leak can set off a torrent of complete destruction.

I hope to see this leak precipitate a flood of further truths that will erase all traces of this deliberate blockage of facts.


Update 3/20/18 from Twitter:

Stefan Kertesz @StefanKertesz – March 18

Fact: There were 12,303 deaths involving prescription-type opioids in 2016, once you remove the over 5000 where fentanyl or heroin was found in the same person who died. I can’t wait till the CDC catches up with its own data.

Richard Lawhern @lawhern1 – March 20

And when we factor in the Massachusetts PDMP data we learn that of the 12,303 deaths, probably 10,000 involved DIVERTED prescription drugs, not opioids given to a patient by a doctor.

This leaves a much more realistic number of about 1,200 prescription overdose deaths per year.

27 thoughts on “CDC Over-Counting Rx Opioid Overdose Deaths

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