Trump’s False War on Opioids Will Only Punish Patients in Pain | Opinion – By Josh Bloom and Henry I. Miller On 4/6/18
The ongoing battle to control opioid addiction has not gone well, to say the least.
Many of the government’s efforts, mostly from the Centers for Disease Control and Prevention (CDC), have been unproductive.
Some have been counterproductive, medically and scientifically flawed, punitive, and perhaps most frightening, have usurped control of patient care from physicians.
Our government is now, in effect, is dictating what constitutes acceptable prescribing of controlled substances, mostly opioid painkillers. That is both unprecedented and disturbing, and patients who need potent pain medications are suffering.
As Milton Friedman used to say to his colleagues, “only in government do we respond to a program that’s failing by throwing more money at it.”
The omnibus spending bill, signed by President Donald Trump, will provide an additional $3 billion specifically for the over-hyped “opioid epidemic.”
Faulty Policy Based on Biased Data Analysis
Misconceptions about the nature and extent of opioid addiction are common.
That’s a wild understatement about the major media players.
The CDC and those who accept its party line have steadfastly maintained that roughly 60,000 people die each year from drug overdoses.
But that isn’t true, as is evident from even a cursory look at the agency’s own data.
The 60,000 figure refers to overdoses of all drugs combined—prescription, over the counter, licit and illicit
Yet the agency continues to repeat this number, making little effort to clarify what it really means.
A recent article by four CDC staffers goes partway, stating that “63,632 persons died of a drug overdose in the United States; 66.4% (42,249) involved an opioid.”
This absolutely infuriates me. What are the flesh and blood humans, the people who are giving out and parroting this information, thinking when they spread information they know is misleading?
Even that number is greatly inflated, since it includes both prescription pills, such as Vicodin, and street drugs like heroin and illicit fentanyl and its analogs.
I’ve been complaining and trying to point out these errors for literally years here on this blog.
This is the CDC’s most egregious “accounting” error: Heroin and fentanyl together account for about two-thirds of the opioid overdose deaths, but these street drugs in no way belong in the same category as Vicodin—they are far more potent and dangerous, not to mention illegal.
By lumping together the two dissimilar groups, the CDC can technically claim that more than 40,000 people die each year from opioid overdoses, once again implying that this number refers to prescription medication. It does not. The real number is likely in the 10,000-15,000 range.
I’m so happy to see this denouncement of bogus figures appearing in a general news outlet for a change (Trump’s False War o Opioids Will Only Punish Patients in Pain)
But even that number is inflated. The CDC’s own data shows that in 2015 half of the overdose deaths involving prescription opioids also involved a benzodiazepine, such as Valium. Other published data has shown that alcohol and methamphetamine are often involved as well.
Thus, it can reasonably be assumed that the number of deaths from opioid pills alone is probably about 5,000, roughly as many people who die each year from bicycle and bicycle-related accidents
These distorted figures are important, and for reasons other than simple headline-grabbing.
Thank you, Josh, for calculating the real figures for us.
The headlines are amazingly wrong and don’t even seem interested in what is really going on. (this article is from Newsweek)
The Consequences of a Persistent but False Narrative
News organizations have unquestioningly repeated the CDC figures and thereby have helped shape the current narrative
This exactly what I’ve been trying to show all along.
Many high quality reviews conclude that the addiction rate even of patients who have required long-term opioid medication for severe pain due to injury or illness is less than one percent.
Addiction in pain patients is rare.
Today’s death toll from opioid use is largely the result of abuse, not medical use, of these drugs.
This is the message we must propagate anywhere we can.
One Size Fits None: Opioid Pharmacology
Clinicians know that individual patients differ significantly in their response to specific opioid analgesics such as codeine or morphine.
But this “clinician” knowledge is apparently completely unknown to the CDC, which has supposedly been “studying” the abuse/addiction crisis.
With the great resources of the NIH, they couldn’t find the studies I’ve been documenting in this little blog for the past five years?
Thus, the need for higher doses of opioids may not be drug-seeking behavior or tolerance from past use of opioids, but may be a function of innate biological differences between people.
I’ve posted often about this very issue:
- Individual variety in response to opioids
- Need for High Opioid Dose Linked to CYP450
- Genetic Defects Lead to High-Dose Opioids
- Defective Opioid Metabolism in Pain Patients
- Screening for Defects in Opioid Metabolism
- Pharmacogenetics of chronic pain management
That has important public policy implications, because new limitations on the amount of opiates that can be prescribed and dispensed could prevent such patients from getting the amount of drug they need.
Fighting the Wrong War
Since bureaucrats and elected officials discovered they were confronting an unwinnable battle against addiction, in the name of appearing to be trying to solve an insoluble problem they declared a new enemy: opioid pills.
This is partly because “addiction” or “chronic pain” cannot be objectively measured, so it’s complicated to determine whether things are getting better or worse.
Therefore, public pronouncements are all focused on the one number that can be extracted: milligrams of opioid medications.
That this is not what’s fueling the opioid crisis doesn’t seem to matter to the people making these unrelated numbers public.
Worse still, in an effort to appear “tough,” governors are tripping over each other to outdo one another.
This is sickening me. They are competing to see who can torture pain patients the most, while the real problem is injecting illicit fentanyl on the street.
Once the false narrative is peeled away, the policy flaws and the suffering they cause become evident.
Deaths from appropriate and responsible use of opioid pain medications are, in fact, relatively uncommon, but the politicians and bureaucrats soldier on.
Their one-size-fits-all legislative and regulatory remedies are doomed to fail and can inflict tremendous inconvenience and pain on patients along the way.
Author: Josh Bloom holds a Ph.D. in organic chemistry and is the Director of Chemical and Pharmaceutical Sciences at the American Council on Science and Health. Henry I. Miller, a physician and molecular biologist, is the Robert Wesson Fellow in Scientific Philosophy and Public Policy at Stanford University’s Hoover Institution.