Reducing opioid prescriptions has shown little payoff in reducing overall opioid deaths, according to a forthcoming study in Addiction, the official journal of the Society for Addiction Studies.
The study, entitled A Crisis of Opioids and the Limits of Prescription Control: United States, argues that the amount of opioids prescribed is not the sole factor leading to the rise in opioid deaths, nor even necessarily the most prominent one.
“No data supports forced opioid reductions as safe or effective,” wrote the study’s authors, Stefan Kertesz of the Birmingham School of Medicine at the University of Alabama; and Adam Gordon, of the University of Utah School of Medicine and Informatics.
The amount of overdose deaths involving prescribed opioids has remained constant since 2010, despite a reduction in the amount of opioids being prescribed. This “lack of return” is grounds for developing a new approach to the crisis, the study says.
According to the study, a major roadblock to developing a feasible plan to prevent opioid overdoses is a “policy monopoly” that prevents some voices and ideas from being heard. A 2016 report from the Centers for Disease Control and Prevention (CDC) outlined some of the primary issues and effects of prescribing opioids for chronic pain, but the nuances in the CDC’s findings were glossed over, Kertesz and Gordon wrote.
For example, the CDC report did not directly call for an end to prescribing opioids to pain sufferers, but instead recommended a “cautious reevaluation” in determining larger dosage levels.
Nevertheless, the authors wrote, the CDC’s report was “weaponized,” and the nuances in the recommendations were lost on policymakers.
“Some authorities avowed that patient deaths, if regrettable, were necessary,” the report said. “One said, ‘we knew that this was going to be an issue, that we were going to push addicts in a direction that was going to be more deadly…but you have to start somewhere.’
“The zeitgeist might be phrased: ‘do something, anything, and we’ll discuss the consequences later.’”
Although the authors believe it likely that “some people will be protected if they never touch opioids,” they do not consider prescription control a primary deterrent to opioid-related deaths.
The authors cited a survey from the National Survey on Drug Use and Health states showing that 80 percent of respondents aged 12-49 who reported at least one episode of heroin use in the last year also reported one prior non-medical use of prescription pain relievers.
But people who misuse opioid medication often aren’t the ones obtaining the prescription, the authors wrote.
Even where opioid prescription control has seen some success, heroin usage has been on the rise. The authors cite the U.S. National Survey on Drug Use and Health, saying that there has been a continuous increase in persons with heroin-use disorder from 2008 to 2016.
In order to effectively combat the crisis, the needs of those who use opioids as a pain treatment should be considered more strongly.
“A tide of anecdotes details suicides, health decline, broken health care relationships and — occasionally at least — overdose among abandoned pain patients who have resorted to the illicit market,” the study says.
“We don’t believe anyone would approve sacrificing innocent lives in the service of addressing addiction.”
Marianne Dodson is a TCR news intern. She welcomes comments from readers.