Only 1.3% of Overdose Victims Had Opioid Prescription
So this is a hot topic in today’s opiate conscience environment. According the CDC, opiate overdose rates:
70,237 drug overdose deaths occurred in the United States in 2017. The age-adjusted rate of overdose deaths increased significantly by 9.6% from 2016 (19.8 per 100,000) to 2017 (21.7 per 100,000). Opioids—mainly synthetic opioids (other than methadone)—are currently the main driver of drug overdose deaths (2).
The article discusses common belief that opiate prescriptions fueled the nation’s opioid crisis and play a major role in overdose deaths (1). That there is a correlation between opiate sales and overdose deaths. That having a opiate prescription is a risk factor for overdose death. The article references a new study (3) that compared opiate overdose toxicology reports with data from state Prescription Drug Monitoring Programs (PDMPs).
But a new study by researchers in Massachusetts has turned that theory on its head. Prescription opioids are usually not involved in overdoses. And even when they are, the overdose victim rarely has an active prescription for them – meaning the medications were diverted, stolen or bought on the street (2).
The study itself is called “The Contribution of Prescribed and Illicit Opioids to Fatal Overdoses in Massachusetts, 2013-2015 (3).” They examined opiate related overdose data in Massachusetts. They determined which opioid medications had been prescribed and dispensed and which opioids were detected in postmortem medical examiner toxicology specimens. The results of the study were:
“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 (3).”
The study seems to refute common belief which the article calls ‘myths’ about opiate overdose that “75% of all overdose victims were pain patients who died by taking their opioid medication as prescribed.” Prescription opioids were detected in only 16.5% of the overdoses. The article concluded:
“I think we can see that we don’t just have a prescription opioid problem. We have an illicit opioid problem. And I think our policy should reflect that.”
REFERENCES:
- https://www.painnewsnetwork.org/stories/2019/10/18/study-finds-only-13-of-overdose-victims-have-active-prescription-for-opioids
- https://www.cdc.gov/drugoverdose/data/statedeaths.html
- https://journals.sagepub.com/doi/abs/10.1177/0033354919878429?fbclid=IwAR2z8qq__1oyvqqOEkcYtE8zzFaNY1PbgdT_q5pti9DEVjPHe7HNS5Q5EL8&#articleShareContainer
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I would guess that to the extent us non pill mill doctors are culpable, it’s the second script that is the problem, not the first. But they want us to never treat acute pain even though a few days later we can reassess and if there’s no good reason or any hint of taking it for any other reason, not prescribe, or reinforce the goals of therapy and demand decreasing the use. Especially musculoskeletal pain, most is use related so using a prn round the clock instead of saving it for when you’re worst should be a red flag. Of course our measurement of pain is no help since it says nothing about how constant the pain is.
(If I get 2 seconds of 10/10 pain when I turn my head left all the way, I would not do that and choose a much lower number. Actually I can never really think of a good answer to that question. BCBS once refused to pay for physio because I didn’t pick a high enough number, completely unscientific use of the scale and not at all what it was designed for.)
The other reason people blame the doc who wrote the first script is because that is who every addict blames. What would you tell your mother if you developed a potentially fatal addiction to street drugs at a young age?
It just seems to me that there is still something missing out of these explanations. Dave Mittman references teen addicts in his post below – did they all just get T3 prescriptions for their wisdom teeth and now they’re addicts? That should be pretty simple to track.
People get addicted to illicit drugs besides opioids with no physician involvement all the time. Opioids are unique in that there are both prescription and illicit options, but opioid addiction was around way before prescription drugs – opium dens, etc.
I positively HATE the “rate your pain 1-10” scale question or how it’s used. If I give a low number nothing is done with it. If I give a high number, the doctor jumps to “I cannot give you narcotics because….”, and the reason for the pain is not addressed. If I give a mid-range number then try to discuss something with the doctor “this hurts”, the problem is not taken seriously – unless it’s an obvious infection on the skin, or if swollen. At best, it’s “Oh, it’s not that bad. You’re tough. And, don’t take any aspirin when it hurts.” It does not get addressed until or unless a fever results – then the talk turns to “Why didn’t you get this examined and treated before?” IMX, it doesn’t really matter if any symptom is pain. Nothing gets done until it is urgent, after the treatment is more complex and costly with a longer recovery time.
Look: When I appear in a clinic and complain of something painful, I want a diagnosis and treatment for it – I’m not looking for narcotic pain killers! I certainly do not need a lecture on them – I don’t take them. But, yeah, if something either acutely or chronically painful happens, it almost certainly would be easier to get drugs on the street – unless I’d like to at least hope the problem is addressed.
I think ALL drug laws, and the entire misbegotten “WAR ON DRUGS!!” should be abolished.
Let adults take whatever they want, and scramble their brains or die according to the choices they make. Physicians should be far more concerned for the individual, and therefore individual freedoms, than for arbitrary and coercive population controls. The alternative is for this crap to never end, and an ever-tightening noose of blame for physicians, and a continuing loss of their judgment to render their best care.
Sorry, but the inference is wrong. Many of the heroin deaths are because it’s way more accessible and way less expensive (sometimes $5.00) than oxycontin. It became very hard to get OC so the people (many teens and young people) went to heroin.
It IS a by-product of poor prescribing as they became addicted to opiates this way.
or cutting people off
The government is again fighting the last war instead of the current one. My state recently tightened up pain meds prescribing even further despite it now being a relatively minor problem. if the goal was to reduce narcotic overdose deaths, the government’s actions have failed miserably. Whatever else you can say about prescription opioids, they are predictable and you are much less likely to die with them than if you take an illicit opioid where the potency is unknown.
Some would say it’s still the doctors fault because we were the ones who started patients on the path to opioid addiction by treating their post-op pain, fracture pain, etc. Possibly there’s some truth to that but my feeling is there is something else going on here. Thirty years ago we were prescribing pain meds yet the great majority of patients weren’t turning into opioid addicts. Certainly prescribing accelerated in the late 90’s (with the full support of state medical boards and JCAHO) but the pendulum seems to have swung back too far with even small prescriptions for tramadol and lomotil being viewed suspiciously.
My take is the government isn’t very good at treating opioid addiction and not very good at controlling illegal opioids, but they are good at regulating doctors so that’s what they do whether it’s likely to work or not.
Once again, the government causes the pendulum to swing way far to the other side, leaving more mayhem in its path.