Misperceptions about ‘Opioid Epidemic:’ Exploring Facts

Misperceptions about the ‘Opioid Epidemic:’ Exploring the Facts – ScienceDirectPain Management Nursing – Feb 2020

Here is the full article I posted about yesterday:

A plethora of statistics and claims exist concerning the rise in prescription opioid use and the increase in opioid-related deaths.

Eleven misperceptions were identified that underlie some of the growing national concern and backlash against opioid use.

Misperceptions include

  • the number of opioid overdose deaths,
  • the quality of government-sponsored data and guidelines,
  • the impact of opioid dose escalation on overdose risk,
  • postoperative opioid use associated with long-term use, and
  • the link between prescription opioid use and heroin initiation.

Implications for research, practice and education include  

  • a call for improvement in data recording,
  • unbiased and clear reporting of information, 
  • a call for health care providers to ask critical questions when presented with data, and
  • a call for policymakers to avoid unnecessarily restrictive practices that are founded in fear and
  • may cause unintended harm to patients in pain. [“may”?]

– – – end of abstract – full article continues below – – – –

Much has been published recently about the opioid epidemic, both in the professional and public literature. As concern broadens and emotional intensity rises, data that are quoted to raise awareness and determine causes of the opioid epidemic can become clouded and statistics can become confusing or conflated.

The risks in the charged atmosphere regarding overdose (OD) deaths involving opioids are multiple, including

  • minimizing the cost and prevalence of the chronic pain crises affecting 23-25 million persons at a cost of up to $635 billion/year
  • misunderstanding the overdose problem by data inaccuracies or oversimplifications; and
  • designing solutions that are either ineffective or cause unintended harm in arbitrarily limiting access to opioids for chronic pain patients.

These are the reasons we can legitimately condemn the media amplification of information on opioids that is simply not true.

This barrage of media misperceptions about opioids doesn’t just cause pain patients to suffer more pain (which no one seems to care about anyway).

The deliberate confusion sown by PROP’s message that the overdoses are from our “heroin pills” has wide-ranging and costly negative social effects, even as it does nothing to address the real overdose problem from tainted street drugs.

The worst aspect of this tsunami of misinformation from the media is that it’s also coming from government agencies and even the CDC, with its unrealistic, scientifically unsupported, pain damage denying, pain patient stigmatizing guideline for opioid prescribing.

Opioids remain a necessary and effective agent for pain control.

If there’s any doubt about that I suggest breaking some ribs.

Rib pain is notoriously long-lasting, severe, and utterly unavoidable if we want to breathe. The pain increases for the first 10 days before it even starts getting better and then lasts for many weeks or even months.

I’d like to see one of these anti-opioid folks turn down a few weeks’ worth of opioids after such an injury. Just 7 or 10 or even 20 pills won’t do the trick.

So the folks advocating for a 3-day limit on opioids after an injury could expect to get themselves back to the doctor to request refills several times during the long course of healing. They’d have to drag their broken bodies to one or more pharmacies to stand in line and wait until another opioid prescription is filled for them – every 3 days according to the anti-opioid doctrine.

Doing this with broken ribs still healing would be so excruciatingly painful that following these ridiculous opioid rules would be almost impossible.

Many current assumptions that are buoyed by statistics about prescription opioids are ill founded and can further fuel an already charged atmosphere and cloud the facts.

The purpose of this review is to investigate a number of common misperceptions pertaining to opioid use/misuse and ODs and replace them with facts and data.

Misperception 1: Deaths Reported as “Prescription Opioid Deaths” Indicate That Prescribed Opioids Are the Direct Cause of Death

Fact: Prescription opioid-related deaths are deaths where prescription opioids are present at the time of death but may not be the cause of the death.

Misperception 2: The United States Is the Biggest Consumer of Opioids, Indicating Opioid Overprescribing Is Unchecked

Fact: The data supporting the idea that United States is the biggest consumer of opioids are misleading because they are taken out of context.

Misperception 3: Prescription Opioid OD Deaths Continue to Escalate and Cause the Majority of Opioid-Related Deaths

Fact: Illicit opioids are primarily driving the current rise in opioid-related OD deaths, whereas prescription opioid OD deaths declined after 2011, with small rises since 2014.

Misperception 4: More People Die from Prescription OD Deaths Than from Motor Vehicle Accidents

Fact: Prescription OD deaths continue to be fewer than motor vehicle accidents (MVAs), even though all opioid OD deaths have exceeded MVAs

Misperception 5: The Long-Term Use of Opioids Is Not Supported by Evidence for Either Benefit or Safety.

Fact: Although there many studies showing opioid effectiveness in short-term trials (<12 weeks), there are very few randomized controlled trials (RCTs) conducted for 1 year or more on opioid AND nonopioid analgesics as a result of multiple limiting factors.

Misperception 6: The Statistics Published by the CDC Are Always of the Highest Quality and Should Be Used Without Question

Fact: Some data published by the CDC are based on less-than-high-quality data and can be misleading and lack transparency in how it is calculated.

Misperception 7: Opioid Prescribing Continues to Increase and Decreasing Opioid Prescribing Will Decrease the Overdose Death Rate

Fact: Overall opioid prescribing has been in multiyear decline beginning in 2012, with modest increase in 2016. There is a nonlinear relationship between opioid prescribing rates and opioid death rates.

Misperception 8: High Doses of Prescription Opioids Based on Morphine Milligram Equivalents per Day Significantly Raise the Risk of OD, and Dose Limits Are Necessary to Lower OD Events.

Fact: Opioid ODs can occur at any dose and are influenced by multiple factors, not just dose alone.

Misperception 10: Prescription Opioids Used Postoperatively Often Lead to Long-Term Opioid Use and Potential Addiction

Fact: A small percentage of patients use opioids long-term postoperatively, and this is influenced by multiple risk factors and chronic postoperative pain.

Misperception 11: Prescription Opioid Use Often Leads to Heroin Initiation

Fact: Prescription opioid use infrequently leads to heroin initiation.

I’m thrilled to see this science-based published article pointing out the same flaws to which we pain patients have been trying to draw attention ever since the “opioid crisis” started when too many people started overdosing on illicit opioids bought in the streets.

I’ve also created a separate page listing only the misperceptions and facts without my comments so you can print it out for your doctor if they are trying to force-taper you: Misperceptions about the ‘Opioid Epidemic’

Thank you, thank you, thank you, Cathy Carlson, PhD, APRN, FNP-BC, RN-BC!

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