Trends in prescription opioid use and dose trajectories before opioid use disorder or overdose in US adults from 2006 to 2016: A cross-sectional study – Nov 2019
I’m not going to pretend to be impartial and scientific anymore – this obscene charade of drug-warriors fighting what they call an “opioid epidemic” has gone to such ridiculous extremes (no opioids after cutting open a woman’s abdomen to pull her baby out) that I can no longer restrain my outrage.
With governments’ increasing efforts to curb opioid prescription use and limit dose below the Centers for Disease Control and Prevention (CDC)-recommended threshold of 90 morphine milligram equivalents per day, little is known about prescription opioid patterns preceding opioid use disorder (OUD) or overdose.
Limiting opioid prescriptions never worked in the past, isn’t working now, and never will work. It cannot work because legitimate opioid prescriptions are not related to opioid overdoses. How long will it take these bureaucrats to figure this out?
I suspect they simply don’t want to know about the horrific outcomes of their policies (pain patient suffering and suicide) because there are no simple ways to prevent overdoses. Yet simple policies tied to arbitrary numbers are the only ones these intellectually limited people can imagine.
There just aren’t enough smart people at the helm of this ship.
The whole anti-drug movement is being run by fools and grifters, while the smart folks are ignored. Until the root causes of the misery driving people to mind-altering drugs are addressed, nothing will change. Oh, wait, of course, things will change: they will get worse.
And the worse the situation becomes, the more these fools will apply the same “solutions”.
Doing the same things over and over and expecting different results is the definition of insanity according to AA, so they are labeling themselves as insane.
This study aimed to determine prescribed opioid fills and dose trajectories in the year before an incident OUD or overdose diagnosis using a 2005–2016 commercial healthcare database.
In this study of US commercially insured adults with incident OUD or overdose, 35.1% had no opioid prescription fills in the year before diagnosis, and the proportion increased in more recent years.
Patients with OUD or overdose exhibited substantial heterogeneity in individual prescription opioid dose trajectories in the year preceding the diagnosis, with the majority receiving prescribed daily doses below the guideline-recommended high-risk threshold of 90 mg MED.
Our findings suggest that the vast majority of patients at risk for OUD or overdose will not be identified if solely relying on currently employed prescription-based metrics.
Further studies are needed that examine whether the absence of prescription fills was associated with overdoses from illicit opioids and the relationship between dose trajectories with incident OUD or overdose in this new era of decreasing access to prescription opioids.
What do these findings mean?
- The findings of this study suggest that an increasing proportion of patients with OUD or overdose could be missed by current programs solely based on opioid prescribed use and dose in this new era of limited access to prescription opioids.
- Further studies are needed that examine the relationship between absence of prescription opioid fills and overdoses from illicit opioids and the association of prescription opioid dose trajectories with incident OUD or overdose.
No matter how often we see calls for research into the outcomes of the hare-brained and destructive policies, there’s nothing forthcoming. I suspect it’s because no one darest to fund a study pointing out the damage being done in the name of “fighting the opioid epidemic” (which is actually an overdose epidemic from a changing mix of multiple drugs).
Reblogged this on The War on Chronic Pain Patients.
Lots of policies based on alternate facts. Of course they never collect data on the unintended consequences. The for profit market driven system has no use for facts. Not one agency or researcher has focused on the marketing, it is as if the Perdue campaign, never happened, and they want to avoid discussing any of this. Since day one the lies about Opioids have been profitable. Not one of these clever content marketers or shameless self promoters will look at how deceptive marketing and deregulation, are still contributing to these “overdoses.”
My state started a PDMP in 2011, and the death rate went up. In 2014, in the midst of high rates of heroin usage, they went after patients, to deny them care. No one collected any data on the thousands of people who lost their primary care physicians, or the number of people with underlying medical conditions that committed suicide. Our state epidemiologist, claimed we were “at the forefront.” He is clueless about the vaccination rates too. Our very own health department refuses to look at the lies, misinformation and alternate facts, promoted by health marketers. Not one of these people ever considered that deceptive health marketing could lead to deaths.
At least some health providers were able to profit, forcing patients to undergo surgeries, dangerous implanted pain pumps and steroid injections, as they peddled alternative medicine. No research was done on the outcomes, as our local media continued to lies, about all of it. One of the biggest advertisers is the same billion dollars out of state corporation, that forced their patients into neurosurgery, steroid injections and pain pumps, because they were terrified of opiates.
If we had Medicare For All, we would not have to deal with all of these lies, and nonsense.
No one wants to pay higher taxes for the social good. It’s all about me, me, me in this country now :-(
Medicare for ALL? Is a scheme that can never be paid for Even if the GOV. CONFISCATED the top 10% yearly earnings , along with ALL their savings and holdings and left them with nothing. Everyone would need to be taxed and WHO would be Paying for Medicaid for all? The YOUNG PEOPLE , because 50 n older start leaving the workforce and stop working. so Millennials would foot the Bill.
As far as war on the Disabled and the Elderly goes Its MIND Numbing NOW instead of seeing the DR. 4 x’s a year we have to go 12 x’s a year in order to get our pain pills. and who pays that MEDICARE and the poor patient
It is AWFULLY HARD to OD on Lortab. An avg. man would have to Take between 22-26 10/350 Hydrocodone pills.
Probably the SAME RETARDS who advocate for having “The GATEWAY DRUG” WEED Legalized so more folks are stoned and in an environment where Stronger Illegal drugs are used. How bought going after alcohol it causes more deaths than illegal Drugs do
GOD Forbid any one Hurts themselves in an accident an is to be in Debilitating Pain for Life, Because NOW I believe you would have to go to the DR. 1’x a week or every 3 days to get Medication with the NEW LIMITS. Unless you were medicated before a certain date, your basically going to have to go to the black market or make a criminal of yourself to get relief.
ITS ALL POLITICAL. Both sides are Guilty of this WAR on the Disabled n Elderly.
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Your anger is certainly justified – our society has driven itself into a situation that doesn’t work and there are no clear answers for how to get back out.
Personally, I blame it on the wealthiest few, who have squeezed the system for their own benefit since the 1980’s when the concept of shareholder primacy took root in corporate America. The rest of us have been relentlessly milked as profits were channeled up to the corporate C-suite.
It’s not doctors who are getting rich, their overlords in “management” and insurance execs and everyone else who takes a bite out of medical billing are the ones who profit from this pathetic medical system we have to deal with. It’s far too prone to influence from outside interests like the anti-opioid zealots.
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The experts on avoiding prescription opioid overdosing are the “responsible pain patients” (CDC May 2019) who never overdose or become addicted after years or decades of safe use.
How do they never OD or become addicted? We need to answer this question using perhaps, systematic in depth surveys of a random selection of these patients.
My humble background in science informs me that given the wide variation in 7.5 B humans on the planet, prescription opioid overdoses will occur for a multitude of reasons depending upon the circumstances of each person’s unique DNA and each individual’s unique life experiences.
My own experience tells me that prescription opioids are dangerous and patients need to keep healthy if they need these drugs for pain, using the Big Three basics: 1.) optimal diet- fresh foods prepared from scratch, 2.) optimal exercise relative to each person’s conditions/disabilities, 3.) optimal restful sleep. No alcohol, or cigarettes is number 4. Each patient will have to do their homework: what are my conditions, what treatments work for me?
Medical errors kill more people than all drugs so check your doctor’s work. I failed this point in 1995 and the medical mistakes crippled me after 22 months. Yes, I’ve been a chronic pain patient since 1997. Doctors are human, not Gods. They will make mistakes. Become your own best medical advocate by researching your conditions as extensively as possible. nih.gov has most medical information (National Institute of Health). And there are plenty of other reputable medical websites. Do your homework!
What works for one patient may not work well at all for another patient. I know some people who hate being touched as in massage therapy. This treatment works very well for me. Swimming works for my osteoarthritis and etc. It may not work for others. Find what works for you. Try to use an “integrated” pain reduction regimen using multiple methodologies.
Drug overdoses from illegal drugs are beyond my expertise right now. CDC has indicated in 2018 that 18,000 people died from overdosing on prescription opioids, BUT they don;t know how many of these people were taking the drugs illegally. We need to better differentiate data on drug overdoses. Putting 18,000/year into perspective, about 33,000 Americans die every year from one medical error alone- extubation. Google it. Almost twice as many die from these errors than die from prescription opioid overdoses. All medical errors are estimated to kill 250,000 to 400,000 a year. Why don’t we hear more about this- it’s the real medical epidemic. Or is it?
Risk and harm reduction are key for prescription opipid patients, including my Big Three above. Everything in life has risk: driving a motor vehicle, scuba diving, falls (30,000 seniors die every year from falls), firearms and the list goes on. We can teach and coach prescription opioid patients how to reduce their risks of overdosing. Most doctors have zero clue how to do this except “take only as directed”. We need better teaching of risk reduction for doctors and patients. What are all the other factor involved such as genetics and variable drug metabolism rates.
I’m quite curious– how do you reduce your risks of overdosing on prescription opioids?
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You are so right! How to reduce risk of overdose is to take as directed, eat right, exercise as tolerated, and sleep right. If you do all that, you won’t overdose.
I appreciate your pointing out that there’s a lot of individual variation and we have to “do our homework” too. We can’t expect a doctor to know everything about us; we are the experts on our own bodies and must take some responsibility for our own health. I like your thinking!
Thanks! I like to tell myself that an overdose can occur even if I follow all my rules. Kinda like Murphy’s Law: If something can go wrong it will go wrong and at the worst possible time. With old age, my body may be developing changes that make a prescribed dose lethal. I can’t eliminate the risk of overdosing, so I accept it, get training, follow my methodology and continue to learn. I have Norcan just in case and I’m not shy about calling 911. Everyone is different, it’s amazing. Therefore we need a “suite” of solutions. On a personal note, I finally got the Veterans Administration to prescribe a more reasonable dose for mwe. My 13 months of self-advocacy paid off. Keep up the exceptional work! Thanks again,Charles
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Congratulations! And thank you too – we’re in complete agreement.
I think your doctors must have noticed how responsible (and well informed) you were and realized they could trust you with these “dangerous” medications.
I bet there is a correlation between people that eat their vegetables, and not overdosing on opioids. OUD is not clearly defined, a pain patient who reports ongoing pain from an implant surgery could easily be accused of OUD in order to obfuscate the impact of corruption in the healthcare industry.
The entire opioid epidemic, is a result of the profit driven healthcare model. From Perdue’s marketing campaign, to the industries ongoing attacks on the regulatory agencies, it has been really profitable. They created denial about workplace injuries, and ergonomic standards for workplaces to protect the big corporations. They marketed “alternatives” that were not very effective, but they were profitable. The healthcare industry ensured that the ACA would not cover addiction treatment for the poor or under insured, by limiting the bed numbers. The AMA lobbied against physicians providing MAT, and made sure that it was more difficult to provide addiction treatment.
There was no regulation or data collection for the so called treatment industry, and it was touted as a good investment, in the financial pages. When people died after attending expensive resort style treatment centers, they continued to market them but blame the victims. Families were exploited out of hundreds of thousands of dollars, seeking treatment for addicted family members. In the US profits are more important than public health.
They have been counting the dead for decades, and misleading the public about all of it. It was more profitable for health providers, employers, and the insurance industry to ignore injured workers, the uninsured, sick people and even the children who are impacted. Just like the anti vaxx epidemic, or the obesity epidemic, these public health problems are profitable.
We are at the apex of rampant corporate greed as illustrated by a government that has been undermined by corporate interests. The so called War on Drugs only led to more drug use and deaths. Our nation has been at war for 18 years, and no facts are likely to stop the corporate profiteers. Other developed nations have functional healthcare systems, and better overall health care than the US. Liars and propagandists are pitting the angry against each other in order to protect corporate profiteering.
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I recently read an article from someone who explained why they had increasing hope of things getting better; since things have to get really bad before they are finally addressed and ameliorated, we’re rapidly reaching a state where the system is so badly broken (and easy to scam) that we’re getting closer and closer to it finally getting fixed.
Yes, there are certainly holes in that argument, but please don’t burst my bubble of tentative and fragile hope :-)
You have my attention however brief it might be. You folks are well educated and I’m but a simple creature setting here drinking my beer and eating a big ole double burger ;-) I have been in this debacle since 1978 and it’s been a real weiner! Your ideals are wonderful. If any one of these mongers have went though what I have I doubt they would treat anybody this was and that’s just trying to procure pain medication and not counting the continued pain. Paint my butt white and call me a flour. ;-)
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