Study: Limiting opioid Rx won’t reduce overdose deaths

Limiting opioid prescriptions will do little to reduce overdose deaths, study says – by Felice J. Freyer Globe Staff  February 01, 2019

This article is about a very important, and for us very encouraging, new JAMA study that just came out showing that prescription limits barely reduce overdoses. We pain patients have known this all along, but when it’s officially researched and published it will be taken more seriously.

The anti-opioid zealots will try to explain away its findings, but it will be a piece of hard evidence that saner minds can use to push back against these ridiculously ineffective prescription opioid limits.

When the death toll from opioid overdoses began to soar a few years ago… Policy makers naturally sought to put a lid on opioid prescribing.

But a study published Friday in JAMA Network Open finds that reducing opioid prescriptions will have little effect on the death rate over the next few years, now that the epidemic is dominated by heroin and illicit fentanyl.  

The study offers a countervailing view at a time when authorities are warning or even prosecuting high-prescribing doctors and numerous state and local governments are suing over the conduct of opioid manufacturers, including whether Purdue Pharma deceptively marketed the popular painkiller, OxyContin.

The projections showed that restrictions on prescription opioids would reduce opioid deaths by only 3 percent to 5 percent in the near future.

In many states, the vast majority of opioid-related deaths involve heroin or fentanyl, and prescription drugs account for only a small number. In Massachusetts in 2018, fentanyl was found in 90 percent of people who overdosed, while prescription opioids are present in only 17 percent of cases.

And opioid prescribing, although still high, has been decreasing since 2010. Larochelle said that restricting access to pills can drive people to more dangerous street drugs.

And opioid prescribing, although still high, has been decreasing since 2010. Larochelle said that restricting access to pills can drive people to more dangerous street drugs.

Dr. Andrew Kolodny

“The projections have already been disproven,” he said, pointing to federal data that show the number of opioid-related deaths leveling off nationwide in 2018.

The JAMA Network Open study instead projects the death toll to continue rising.

Kolodny also said the researchers based their work in part on a “misleading” study that suggested an increase in the number of people whose first opioid is heroin. 

In fact, the number is decreasing, he said. [??]

Kolodny often says things like this rebutting scientific studies, research, and data, but he never provides any references for where he gets his information and he is getting further and further away from the scientific and medical consensus.

The research team gathered data on the trajectory of the opioid crisis from 2002 to 2015, and used that data to project numerous scenarios for the years 2016 to 2025.

No matter how the epidemic played out in the different projections, including an optimistic scenario where deaths leveled off, reducing the misuse of prescription opioids still showed minimal impact, they said.

“Our study does not devalue the efforts to reduce misuse of prescription opioids, [but] these efforts in isolation will not bend the overdose death curve,” said Jagpreet Chhatwal, senior scientist at MGH’s Institute for Technology Assessment and the study’s co-lead author.

“Overprescription of opioids continues to feed this epidemic,” said Fugh-Berman, who directs PharmedOut, a Georgetown-based project that promotes evidence-based prescribing. “Opioids are still being prescribed at too high a rate to patients for whom the risks outweigh the benefits.”

There could be such patients out there, but we in the advocacy community never see them.

We could be working with just a slice of patients who legitimately require opioids, but for all we know, there might be many more out there just gobbling pills all day long.

They could be getting them from doctors who don’t care about their health and only want to charge for those monthly office visits and frequent (and highly profitable) urinalysis tests to which all opioid patients must submit.

Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.

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Here’s another article about these findings from MedPage Today:

Targeting Opioid Scripts May Have Little Effect on Epidemic – by Judy George, Contributing Writer, MedPage Today February 01, 2019

Dose limits, prescribing guidelines, prescription drug monitoring programs, and similar interventions will have a “modest effect, at best” on the number of opioid overdose deaths in the future, a mathematical model projected.

Lowering the incidence of prescription opioid misuse from 2015 levels would decrease overdose deaths only 3% to 5% by 2025, according to Jagpreet Chhatwal, PhD, of Massachusetts General Hospital in Boston, and colleagues, writing in JAMA Network Open

“If our aim is to bend the overdose death curve and fix the opioid overdose crisis in the near future, we will fail miserably by relying solely on controlling the supply of prescription opioids,” Chhatwal told MedPage Today.

In their analysis, Chhatwal and colleagues used data from the National Survey on Drug Use and Health (NSDUH) and the CDC from 2002 to 2015 to calibrate a systems dynamic model to project probable opioid outcomes to 2025.

They analyzed the trajectory of the opioid epidemic based on four scenarios: if prescription opioid misuse remained at 2015 levels (reference); if it fell by 7.5%, per year, based on patterns from 2011 to 2015; if it fell even faster at 11.3%; and a hypothetical situation of no new incidence of misuse after 2015.

Under all scenarios, reducing the incidence of prescription opioid misuse decreased overdose deaths by 3.0% to 5.3%

The projections echoed ones last year by Stanford University researchers, which showed that no single policy is likely to substantially reduce opioid deaths over 5 to 10 years.

Michael Barnett, MD, MS, of the Harvard T. H. Chan School of Public Health in Boston:

“Even if the exact magnitude and trends in opioid overdose may be different, I think the important point in this study is that reducing medical opioid prescribing will only have a modest impact on the national burden of overdose deaths,”

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And here’s the JAMA study itself, which I found very difficult to understand because it sounds like they’re doing their best not to just come out and say:

“Stop restricting opioid pain medicine –
it’s not helping the overdose crisis!”

Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States. | Physical Medicine and Rehabilitation | JAMA Network Open | JAMA Network – Feb 1, 2019

Question: 

What is the projected effect of lowering incident nonmedical prescription opioid use on the future trajectory of the opioid overdose crisis in the United States?

Here I notice that they are even focused on only the “nonmedical use” of prescription opioids, which already excludes all of us taking them for pain.

Findings: 

In this system dynamics model study, under current conditions, the opioid overdose crisis is expected to worsen—with the annual number of opioid overdose deaths projected to reach nearly 82 000 by 2025, resulting in approximately 700 000 deaths from 2016 to 2025.

Interventions focused on lowering the incidence of prescription opioid misuse were projected to result in a 3.0% to 5.3% decrease in opioid overdose deaths over this period.

Conclusions and Relevance :

This study’s findings suggest that interventions targeting prescription opioid misuse such as prescription monitoring programs may have a modest effect, at best, on the number of opioid overdose deaths in the near future.

Additional policy interventions are urgently needed to change the course of the epidemic.