The attack on opioid prescriptions for non-cancer chronic pain began to advance around 2010, and intensified thereafter. The crackdown coincided with—and perhaps caused—a rapid growth in heroin overdose deaths, and later, an explosion in illegal synthetic opioid deaths, primarily fentanyl, an illicitly manufactured substance added to or substituted for heroin to meet the increasing demand for illegal opiates. This pattern of events is illustrated in a graphic put out by the Centers for Disease Control (CDC).
Indeed, overdose deaths from commonly prescribed opiates increased rapidly from 1999 to 2010, but the chart doesn’t tell us how many of the victims legally obtained the opiates. The chosen scale also omits the fact that drug overdose deaths have been increasing at a fairly steady rate since 1979, with no obvious changes associated with the rise and fall of opioid prescriptions for chronic pain. The chart does show how overdose death rates from commonly prescribed opiates did not decline much after 2010, although legal prescriptions went down dramatically. This suggests that these deaths may have involved individuals who bought illegally manufactured opiates, or that the people who lost pain medication as a result of official actions were not the ones liable to overdose.
The increase in deaths of despair obviously merits some policy attention, but labeling it an “opioid crisis,” as is common nowadays, profoundly misstates its nature, timing, and likely causes and solutions. To justify restricting opioids for non-cancer chronic pain patients requires specific evidence that people prescribed opioids for pain are the ones dying of overdoses. There’s quite a bit of negative evidence on this score, but public health officials have seized on a few positive studies to support their claims.
One influential and heavily cited 2011 study published in the Journal of the American Medical Association, “Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths,” uses a classic prohibitionist tactic. The authors use a sample of 750 Veterans Health Administration (VHA) patients who received opioid prescriptions for pain and later died of opioid overdoses, and compare them to a random sample of 155,000 other VHA patients who received opioid prescriptions and did not die of overdoses.
Author(s): Aaron Brown
Publication Date: 11 Oct 2023
Publication Site: Reason