Today’s Drug Abusers Did Not Derive From Yesterday’s Patients – By Jeffrey A. Singer – December 4, 2018
We learned last week that the 2017 drug overdose numbers reported by the US Centers for Disease Control and Prevention clearly show most opioid-related deaths are due to illicit fentanyl and heroin, while deaths due to prescription opioids have stabilized, continuing a steady trend for the past several years.
But the media and policymakers remain unshakably committed to the idea that the overdose crisis is the product of greedy pharmaceutical companies manipulating gullible and poorly-trained doctors into over-prescribing opioids for patients in pain and ensnaring them in the nightmare of addiction.
As a result, most of the focus has been on pressing health care practitioners to decrease their prescribing, imposing guidelines and ceilings on daily dosages that may be prescribed, and creating surveillance boards to enforce these parameters.
These guidelines are not evidence-based, as Food and Drug Administration Commissioner Scott Gottlieb seems to realize, and have led to the abrupt tapering of chronic pain patients off of their medication, making many suffer desperately.
An open letter by distinguished pain management experts appeared last week in the journal Pain Medicine criticizing current policies for lacking a basis in scientific evidence and generating a “large-scale humanitarian issue.”
Current policy has brought high-dose prescriptions
- down 41 percent between 2010 and 2016,
- another 16.1 percent in 2017, and
- another 12 percent this year.
Yet overdose deaths continue to mount year after year, up another 9.6 percent in 2017.
The data certainly support viewing the overdose crisis as an unintended consequence of drug prohibition: nonmedical users preferred to use diverted prescription opioids and, as supplies became tougher to come by in recent years, the efficient black market responded by filling the void with cheaper and more dangerous heroin and fentanyl.
Yet many defenders of the status quo believe the population of nonmedical users mostly derives from patients who were inappropriately prescribed opioids for a painful condition who becomes transformed into a drug addict.
This is the “opioid victim” story, ignoring the fact that the patient initially made the choice to take more than prescribed and then more and more and then heroin and then heroin with fentanyl and then they overdosed.
But the data do not support this.
The National Survey on Drug Use and Health has repeatedly found that less than 25 percent of nonmedical users of prescription opioids obtain their opioids from a doctor.
Three-quarters get them from a friend, a relative, or a dealer.
And a study of more than 27,000 OxyContin addicts entering rehab between 2004 and 2008 found
- 78 percent said the drug was never prescribed for them for any medical reason,
- 86 percent took the pills to get “high” or get a “buzz”, and
- 78 percent had a history of prior treatment for substance abuse disorder.
But if that isn’t enough to create doubt among those who still adhere to the theory that the population of nonmedical users is largely made up of former patients, then let’s return to the National Survey on Drug Use and Health.
Page 7 of the report examines “past month nonmedical use of pain relievers among adults aged 12 or older” and finds that rate essentially flat from the years 2002 to 2014.
Meanwhile, the volume of opioids prescribed between 1999 and 2015 tripled.
This sounds scary, but it’s because the population is aging and more people are living long enough to suffer from painful deteriorations and surviving previously deadly diseases with painful aftereffects.
Tripling the number of opioids prescribed did not appear to affect the rate of nonmedical use or prescription opioid abuse disorder.
So why have drug overdose deaths shot up so much in recent years?
“Death rates from drug overdoses in the U.S. have been on an exponential growth curve that began at least 15 years before the mid-1990s surge in opioid prescribing, suggesting that overdose death rates may continue along this same historical growth trajectory for years to come.”
The study’s senior author went on to say:
There is no regular or predictable pattern to the overdose rates for any of these drugs
when we plot the annual sum of all drug overdoses, we get a remarkably smooth, inexorable exponential curve.
An NBC News reporter summed up the study by stating:
“It [the overdose crisis] started before the availability of synthetic opioids, and may have only a little to do with the prescribing habits of doctors or the pushy habits of drugmakers the team at the University of Pittsburgh found.”
More and more people have been using licit and illicit drugs nonmedically since the late 1970s.
Some may be self-medicating in response to anxiety, depression, alienation, despair. And people are taking greater risks with their drug choices.
The root causes of the present-day overdose crisis are decades-long psychosocial/cultural trends intersecting with the lucrative opportunities offered by drug prohibition.