Contribution of Rx Versus Illicit Opioids to Overdoses

The Contribution of Prescribed and Illicit Opioids to Fatal Overdoses in Massachusetts, 2013-2015 – Oct 2019

Massachusetts is only an example of what we’d find in other states if they were more concerned with finding out what’s killing people who overdose. Instead, it’s often not tested adequately to find the real culprit because it’s already assumed that any sign of any opioid makes it a “prescription opioid overdose” to be added to those inflated numbers.

Objectives:
Opioid-related overdoses are commonly attributed to prescription opioids.

Whether true or not, our “public service” coroners just follow the path of least resistance and fall into the false confidence of their predetermined ideas. 

We examined data on opioid-related overdose decedents in Massachusetts. For each decedent, we determined which opioid medications had been prescribed and dispensed and which opioids were detected in postmortem medical examiner toxicology specimens.

This is obviously much more work and, with the low pay most “workers” receive these days it’s no surprise they’d want to wrap it up quick and call it a “prescription opioid overdose” because that can be done very quickly and won’t be questioned.

Methods:
Among opioid-related overdose decedents in Massachusetts during 2013-2015, we analyzed individually linked postmortem opioid toxicology reports and prescription drug monitoring program records to determine instances of overdose in which a decedent had a prescription active on the date of death for the opioid(s) detected in the toxicology report.

We also calculated the proportion of overdoses for which prescribed opioid medications were not detected in decedents’ toxicology reports.

Results

Of 2916 decedents with complete toxicology reports,

  • 1789 (61.4%) had heroin and
  • 1322 (45.3%) had fentanyl

detected in postmortem toxicology reports.

Of the 491 (16.8%) decedents with ≥1 opioid prescription active on the date of death, prescribed opioids were commonly not detected in toxicology reports, specifically:

  • buprenorphine (56 of 97; 57.7%),
  • oxycodone (93 of 176; 52.8%), and
  • methadone prescribed for opioid use disorder (36 of 112; 32.1%).

Of these, two are prescribed almost exclusively for opioid addiction, and it looks like people are selling those instead of taking them.

Only 39 (1.3%) decedents had an active prescription for each opioid detected in toxicology reports on the date of death.

Conclusion

Linking overdose toxicology reports to prescription drug monitoring program records can help attribute overdoses to

  • prescribed opioids,
  • diverted prescription opioids,
  • heroin, and
  • illicitly made fentanyl.

I’m so glad to see that someone is noticing this, that someone cares enough to investigate these often sloppy toxicology reports after overdoses.

It also shows that it’s entirely possible to determine which drugs a person was taking and whether they were prescribed for that patient, something the CDC has tried very hard NOT to do because it would upend their easy storyline about prescription opioids being the problem.

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