The ‘Phony War’ Against Opioids: Some Inconvenient Truths

Print More
ddrugstore

Photo by OttawaTekkie via Flickr

Anyone who watches TV news will know that America has a major public health problem concerning drug addiction and opioid overdose deaths. In this context, we sometimes hear terms like “prescription opioid epidemic” and “over-prescribing” thrown about indiscriminately.

Hidden inside the hype and misinformation are several inconvenient truths. Public policy on the drug crisis cannot be remotely effective until we embrace such truths and act on them.

The largest and most ignored truth is that our present opioid crisis has very little to do with prescription drugs─and data published by the CDC prove it. People with addiction disorders and patients treated by doctors for chronic pain with opioid pain relievers are largely separate demographic groups.

This is worth saying again. As recently noted in The Crime Report, when medical opioid prescribing rates per hundred population are plotted against opioid-related deaths per hundred thousand, we get what is a “splatter pattern.”

There is no trend in this data, no correlation, and certainly no cause-and-effect relationship. None.

The contribution of medically managed opioid analgesics to opioid mortality is lost in the noise. Our death toll is instead dominated by street drugs─heroin, imported fentanyl, diverted methadone and morphine─not prescriptions written by doctors for their patients.

The number of opioid prescriptions written in 2016 was the lowest it has been in 10 years, while overdose deaths continued to climb.

[SEE TABLE 1]

table

Table 1 courtesy Richard Lawhern

If over-prescribing of opioid analgesics was a major cause of our ever-increasing overdose-related deaths, then we would expect demographic groups with the highest rate of prescriptions to also display the highest mortality. But this is clearly not happening.

The next chart [TABLE 2] is a plot of US national prescribing rates per hundred population versus age group, using data from the Centers for Disease Control and Prevention (CDC) 2017 Annual Surveillance Report of Drug Related Risks and Outcomes. Predictably, the data show us that opioid prescribing rates among minors and young adults are lowest among all age groups, while prescribing among seniors is highest.

table

TABLE 2 courtesy Richard Lawhern

Now compare opioid prescribing rates with overdose mortality over time, extracted from the CDC Wonder database and aggregated by age group. Mortality for youth and young adults has soared since 1999 and is now six times the mortality in seniors over age 50.

After an initial rise in 1999 to 2006, mortality in people of middle age (36-50) leveled off into a narrow range. Tellingly, overdose death among people over age 50 remained stable throughout this 17-year period. The group most often exposed to medical opioids and who benefitted most during the 1990s from easing of prescription policy and treatment of pain as “the fifth vital sign” has shown no increase in mortality risk.

But you will almost never hear this inconvenient truth from anti-opioid partisans.

table

TABLE 3 courtesy Richard Lawhern

The US Congress is currently debating hundreds of bills which claim to “solve” various aspects of our opioid crisis. But much of this frenetic activity is a mad dash down an “Alice in Wonderland” rabbit hole that will solve nothing and instead make conditions much worse for both addicts and people in pain.

Most of the proposed legislation derives from the false narrative that “the problem” was caused by over-prescription and can be solved by reducing medical opioid supply. This narrative is untrue, and the medical evidence of the charts above confirms that it is untrue.

What is actually occurring in our public life is that misdirected opioid policy is killing thousands of patients by driving them into disability, medical collapse, and increasingly suicide.

Richard Lawhern

Richard A. Lawhern

Public policy has become a war against pain patients, not against drugs.

It is time to declare a ceasefire in this phony war, and to reexamine the medical evidence on cause and effect in addiction and opioid-related deaths, before our legislators do even more harm.

Richard A. Lawhern, PhD, is co-founder and corresponding secretary of the Alliance for the Treatment of Intractable Pain. A non-physician patient advocate and writer with 20 years of volunteer public service, he has written for The Journal of Medicine, National Pain Report, Pain News Network, and other online media. His wife and daughter are pain patients. He welcomes comments from readers.

14 thoughts on “The ‘Phony War’ Against Opioids: Some Inconvenient Truths

  1. Sadly, despite the news from BC….doctors can no longer deny opioids to pain patients…it appears the Federal Government, Health Canada, as in the US…wants to continue the war on pain meds. And most of the media here in BC, including taxpayer funded CBC, has not carried that story about BC doctors. Most of our media are ‘addiction lobbyists’ and do not carry anything FOR pain patients; in fact the most recent CBC article on opioids, June 19th, shows the federal government only intends to go after prescription opioids. The Canadian federal government appears to live in the same echo chamber the American government does and it remains to be seen what the reality will be for pain patients in BC and Canada. [this comment has been condensed and edited for space]

  2. It’s time for Representatives in every State to stop this abuse of people’s rights…against pain patients …stop the Doctors from being threatened,they’re the ones with the medical degree. Jeff Sessions needs take aspirin; step down or be fired, CDC needs to STOP lying Nobody should be dying or suffering in such pain when it’s clear they’ve been treated successfully for years without any abuse or problems or their conditions,even cancer patients are being denied pain meds. [this comment has been edited and condensed]

  3. Outstanding article! Truth! “Our death toll is instead dominated by street drugs─heroin, imported fentanyl, diverted methadone and morphine─not prescriptions written by doctors for their patients”. 100% true and it’s high time to recognize that inflicting pain suffering and desperation on innocent chronic pain patients has *nothing* to do with ODs and deaths from illicit fentanyl and heroin. The media is in a hysterical and misinformed feeding frenzy with ‘opioid crisis’ not to share the truth, but to scare the public and peddle fear and bad news in an effort to sell papers and air time. The real national crisis is that of undertreated pain!

  4. Richard, thank you so much for your advocacy and well-researched articles. If anyone who stumbles upon this and has no idea as to how ridiculous this “war” on opioids (aka war on chronic pain patients and their human rights) has become, let me tell you a recent true story:We’ve spent billions on the “war” in the past many years. What have we got to show from this “war?” Many of our injured veterans, elderly, chronically and terminally ill suffering severe pain – so much so that they are having heart attacks, strokes, etc and/or committing suicide. The very few opioid-prescribing doctors are now risking their licenses, reputations, business and personal assets and freedoms simply because they’re doing their job – healing and/or reducing pain and suffering. [this comment has been condensed for space]

  5. I watched my elderly, completely disabled, chronically ill dad with too many serious health illnesses to list – on oxygen and confined to a wheelchair 24/7 and on 19 to 20 different medications for those ailments (not one of them for pain, which was very severe for him) – get denied pain-relieving medication while hospitalized just one week prior to being placed in hospice care, three weeks prior to his death. The nurse stated the “doctor” (aka hospitalist who didn’t know his a** from his elbow) “was afraid he’d become addicted” (yes, her exact words). My mom has been an in-home caregiver for the elderly for the past 10 years. She usually gets assigned to one person at a time. She cares for them like she would if it was her own parent. It is absolutely despicable the way her past elderly “clients” (who quickly become part of her “family) are forced to suffer.

    Did the forced, needless suffering of my elderly, disabled, chronically-ill dad prevent one from abusing an opioid (prescription or illicit), becoming an addict, or dying from an opioid overdose? Nope! In fact, I’m sure those who wished to continued to find substance(s) to abused, those burdened with addiction continued to find their substance(s) and/or overdosed (living or dying afterwards) while these two humans suffered pain that many don’t believe exist. [this comment has been condensed for space]

    • Very sorry about your father. Never easy to lose a parent, but to watch them suffering at the end is barbaric.

  6. Before this “fake opioid crisis” began, my wife , who is in serious chronic incurable pain, was able to live a limited active life. Able to shop in the supermarket with the aid of a driving cart, able to drive the car occasionally, does some light cleaning, cook occasionally, attend family birthdays, etc. But then they started to reduce her very effective pain medication, eventually to 1/3 of the original amount.

    The result? She’s now confined to bed for 95% of the day and in constant pain. She can no longer do any of the above – she even has problems taking a shower. All chronic pain patients, the old, the sick, the disabled – the most weak in our society knew that they were going to have to go through hell as a result of the mistaken policy.

    Chronic pain patients are committing suicide – my wife has thought of it too. Of course, what would you do if you were in her place?

  7. Dave Roberts, you’ve just described me! Not to mention now I’m being used as a guinea pig for alternative meds, one of which nearly killed me. Lol just was given a med for muscle spasms hmmm yeah that’ll work on arthritis SMH

  8. Thanks to all who have chosen to comment on this article. Be advised that this work is prominent among published articles offered to Robert Rose in his pending action in Federal Court, seeking a preliminary injunction against the Department of Veterans Health Affairs and the CDC, to force withdrawal of the 2016 Guidelines and suspension of the VA “Opioid Safety Initiative” which denies effective pain management to millions of Vets.

  9. Have been weaned down after 4 yrs of compliance !! Now pain is going put me in a noncompliance role. Is this on purpose.
    Take a man doing 1/3 of what he could do on his meds down to 1/3rd of his pain meds. They just put me in bed permanently !! Oh that’s a improvement in the opiate crisis. NOT !!!!

  10. There is a sinister, sadistic and financial agenda behind this entire “opioid crisis” and the solution being implemented thus far in the U.S. As usual, what the public is being told and what is actually the truth are very far apart. The lies are obvious in the real stats revealed. The lies about what causes addiction is propaganda for the masses. The lies about simply removing opioids from the needy will be a great remedy for the crisis.
    What is the real purpose of this issue? We are well aware that over the past decade the numbers of addicts has grown. Almost every family knows of someone within the family who has a drug addiction problem. These people got their first “fix” from buying or being given a drug at school. Better known as street drugs, these were the only drugs young people were able to get to enable their newly formed habit to keep growing. There is no doubt that what the CIA did in the 1950’s and ’60’s in putting the LSD and other psychedelics on the streets has just carried over the to opiates being put on the streets.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.