Argument Against Present Supply-Side Opioid Policy

New Study from American Action Forum Adds to the Argument Against Present Supply-Side Opioid Policy – April 12, 2018 – By Jeffrey A. Singer

On April 11 the Washington Post cited a new study from the American Action Forum that reinforces arguments I have made here and here, that despite a dramatic reduction in the opioid prescription rate—a 41 percent reduction in high-dose opioid prescriptions since prescriptions peaked in 2010—the overdose rate continues to climb, as nonmedical users have simply migrated to more dangerous substitutes like fentanyl and heroin while the supply of diverted prescription opioids suitable for abuse continues to come down.

four researchers working in the CDC’s Division of Unintentional Injury Prevention reported in the April 2018 American Journal of Public Health that the CDC’s method for tracking opioid overdose deaths have over-estimated the number due to prescription opioids, calling the rate “significantly inflated.”  

Many overdose deaths actually due to fentanyl are folded into the “prescription opioid” numbers since, technically, fentanyl is a prescription drug even though it is rarely prescribed outside of the hospital in a form suitable for abuse

It must be remembered that numerous studies throughout the 1970s, 1980s, and 1990s documented that patients were being undertreated for pain because of an irrational fear of opioids. In 1989, Charles Schuster, the Director of the National Institute on Drug Abuse, stated. “We have endowed these drugs with the mysterious power to enslave that has been overrated.” The “opiophobia” of the time gradually—and correctly—gave way to a more rational and humane approach to patients in pain.

Furthermore, numerous studies, including Cochrane systematic analyses in 2010 and 2012, as well as a report this past January in BMJ by researchers at Harvard and Johns Hopkins show that opioids have an addiction rate of roughly 1 percent or less in the medical setting.

And Dr. Nora Volkow, the current Director of NIDA, in a 2016 New England Journal of Medicine article, stated, “addiction occurs in only a small percentage of persons who are exposed to opioids — even among those with preexisting vulnerabilities.”

The National Survey on Drug Use and Health repeatedly finds that less than 25 percent of nonmedical users of prescription opioids obtain them from a doctor. Three-quarters obtain them from a friend, family member, or dealer.

Studies repeatedly show upwards of 90 percent of opioid overdose victims have multiple drugs on board

In New York City in 2016, 75 percent of opioid overdoses were from heroin or fentanyl, and 97 percent also were found to have multiple drugs in their system at the time—46 percent of the time it was cocaine.

These are nonmedical users seeking drugs in the illicit and dangerous market that results from drug prohibition.

Overdose deaths from methamphetamine and other stimulants have also been surging in recent years and now are at record levels. And recent reports from New England point to a surge in deaths from fentanyl-laced cocaine, the latest version of the “speedball.”

The reasons behind the rise in the illicit use and abuse of mind-altering drugs in the developed world is a subject worthy of serious investigation.

Yes, the “root cause” of all our drug crises is people’s urge to change their reality when reality becomes too awful to bear.

The causes are most likely multifactorial.

Yes, this is a systemic problem:

While overpaid rich people can enjoy increasing privileges, the increasing numbers of low-paid workers suffer from increasing coercion, intrusions, and burdens of their jobs into their lives.

Wages have not increased and jobs are demanding more and more “productivity”, so the leaders of corporations can reap higher and higher profits while they squeeze the very last ounce of work from their workers. T

When the worker finally collapses under the burden of their work, they are simply replaced with “fresh meat” and the cycle continues.

But policymakers need to disabuse themselves of the notion that the prescription of opioids to patients by doctors is at the heart of the problem.

That notion has made too many patients sufferneedlessly as the old “opiophobia” of the 1970s and 1980s has returned.

Original article: New Study from American Action Forum Adds to the Argument Against Present Supply-Side Opioid Policy  By Jeffrey A. Singer

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