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Feb
18

The prescription opioid crisis is far from over

There’s still lots of money in the peddling of opioids, and lots of misinformation out there about opioid control efforts going too far.

Correlated? You tell me.

The American Medical Association sent a letter to the CDC claiming  “the nation no longer has a prescription opioid-driven epidemic...the AMA urges governors and state legislators to take action [to] remove …. arbitrary dose, quantity and refill restrictions on controlled substances.” [emphasis added]

In a letter sent to the AMA that was also published in the British Medical Journal, Physicians for Responsible Opioid Prescribing took the AMA to task, noting the AMA’s position is misguided at best:

 There is compelling evidence that many of those currently struggling with opioid dependence and addiction were introduced to opioids through use of medically prescribed opioids used to treat chronic pain. Medically prescribed opioids remain a common gateway to illicit opioid use and are themselves frequent causes of opioid addiction and overdose, even if illicit opioids currently cause the greater number of deaths.

PROP’s letter goes on to state:

Suggested dose and duration restrictions are not “arbitrary”, they are based on considerable evidence of when harm far exceeds benefit.

I do not know why the AMA is mischaracterizing the CDC guidelines. I do know opioid manufacturers are very, very good at working the levers of power, expert at manipulating government officials, and extremely generous in their political contributions.

The AMA’s anti-opioid guideline stance is kind of bizarre, bizarre as in Through the Looking Glass. On the one hand, it is mischaracterizing and decrying CDC guidelines that have been instrumental in mitigating the opioid disaster.

On the other, the AMA is claiming credit for reducing opioid use, deaths from overdoses, and various other positive trends, stating “the [AMA Opioid] task force’s recommendations have led to significant progress…”

That’s rather bold, considering:

And, of course, those CDC guidelines have been widely adopted by states, and are widely credited with reducing the damage done by opioids.

At times the guidelines have been misapplied, doctors have arbitrarily applied them, and patients have been abruptly cut off. That is NOT the fault of the guidelines, that are just that – guidelines. Rather, it is the fault of those mis-applying them to patients.

What does this mean for you?

The opioid crisis is far from over.

Controlling inappropriate use of prescription opioids is as important today as it has ever been.


15 thoughts on “The prescription opioid crisis is far from over”

  1. It’s like everyone is spinning around in the middle of the room, saying “What problem?” As a Registered Nurse who also suffers from chronic pain, the pain issue is not being addressed. Until effective pain management is available, people will do what the have to do to try to get some relief from unrelenting pain. Simply saying opioids are bad and offering no substitute for the chronic pain patients experience is clearly shown in the current rise in overdose deaths. We have to do better.

    1. Thanks for the note Denise.

      My take is there’s a lot of acknowledgement that chronic pain is a major issue – and opioids are seen as not much of a solution.

      I haven’t seen any data indicating the rise in overdose deaths is due to chronic pain; fentanyl and heroin (less now than a couple years back) appear to be the primary drivers. If certainly could be a driver; if you have any data or reporting on this please share.

      be well.

      Joe

  2. Leave the distribution of legal medications between a Doctor and their patient. The level of pain management should be monitored by the physician according to patients ongoing care. The AMA and CDC have both stated Opiods for Chronic Pain Patients SHOULD NOT be part of the equation. Overdose is primarily due to illicit fentanyl and opiods sold on the streets. I dont know of any Dr. that would continue writing pain medication prescription if their patients were not taken as directed. Want to save more lives? Go after the illicit drugs and stop destroying Doctors and Patients rights and life.

    1. Hello Stef – thanks for the comment. A few observations.
      – yes overdoses are “primarily” from illicit opioids – but thousands are due to prescription opioids.
      – while you may not know of any Dr. that would write scripts for patients weren’t taking as directed, research clearly proves many docs are poor judges of patient behavior, AND far too many Drs still write scripts for patients that are not taking as directed.
      – “Leave the distribution of legal medications between a Doctor and their patient.” – Are you suggesting NO regulation or controls? If not, then we disagree – there should be controls over prescribing and dispensing of opioids. Reality is if physicians hadn’t over-prescribed opioids, we wouldn’t be in this mess. Ending smart regulation would lead to a return to the crisis days, a fate we should avoid at any cost.
      be well – Joe

      1. Hi Joe. I had to wait a few days to comment as I can’t believe the AMA’s stance on this. An AMA Issues Brief, published on 2/2/21 noted that opioid mortality increased in over 40 states! Were a number of these deaths due to illicit drug use? Sure. But many of these users started because of a prescribed opioid. And the fact that it’s a “burden to physicians” to get additional training is far less than the burden that families have due to overdoses and deaths.

  3. At what point does one declare the opioid crisis over? People have and will continue to use opiates until the end of time. Should we stop prescribing any drug that causes physical dependence and withdrawal? How about benzodiazepines or stimulants? Yet those drugs aren’t stigmatized like opioids are despite being addictive. According to the National Survey on Drug Use and Health 87.2 percent of people who take prescription pain relievers do not misuse them. Prescription opioids are at a 20 year low while overdose deaths remain at an all time high. So why do we continue to focus on them? When will we wake up and realize the real killer is prohibition!

    1. Hello Ken – welcome to MCM. Allow me to address your points in order.
      Should we stop prescribing any drug that causes physical dependence and withdrawal? – Of course not. No one is suggesting we should do so.

      How about benzodiazepines or stimulants? Yet those drugs aren’t stigmatized like opioids are despite being addictive. Actually these are scheduled drugs and some can be addictive. Not sure how you measure degree of stigmatization, but most are not as dangerous as most opioids, aren’t associated with a fraction of the deaths, and haven’t been lied about and marketed like opioids have.

      “The real killer is prohibition” – No one is talking about prohibition, so I don’t know what you are referring to. Moreover, how “prohibition” – I assume of opioids – would be the “real killer” is beyond me. That’s just nonsensical. Perhaps I misunderstand what you are trying to say, if so my apologies.

      be well – Joe

  4. The treatment of pain (acute or chronic) should be btw Dr & Pt. The Govt has NO place dictating or secretly publishing ‘Guidelines’ to be followed re; prescribing. Leave Healthcare to the educated professionals. What works for some, doesn’t help others & limiting strength, dose or frequency of legitimately prescribed opioids is NOT the answer or solution to this media overhyped opioid crisis. People in pain are SUFFERING >> All the while OD’s continue to rise. Govt should focus more on the Illicit/ illegal opioid flow from other countries & STOP attempting to practice medicine without a license!

    1. Hello Ms Smith – thanks for your comment. I’ll respond in order to your statements.

      First, Unfortunately the rampant overprescribing of opioids by physicians and dentists has directly caused hundreds of thousands of deaths, devastated millions of families, and grievously harmed our country. If guidelines were not in place the deaths, devastation, and broken families would be even greater.

      Second, the guidelines were NOT published nor developed in secret. I don’t know why you said that, but that is not true.

      Third, I could not disagree more with your categorization that the prescription opioid crisis is one that is “media overhyped”. That is just completely wrong and misguided and dismisses the pain and suffering of millions of families dealing with OUD.

      Finally, Overdoses due to prescription opioids are declining – as I’ve noted elsewhere.

      Be well – Joe

  5. Where is the data on antidepressants and over perscribing to young adults that has caused severe mental decline and dangerous emotional issues. How many deaths and suicides where caused by these drugs but seem to be the all so savior of the opioid patient. Five years have gone by with heroin and illicit drugs being the killer of young people. WE can not continue to blame opioids when there have been many avenues the drug addict can take but refuses to . The revolving door of rehab for a drug addict will continue. What is the rescue for people who suffer in pain on a daily basis suicide. For people to continue to say opioids are the reason for going to heroin is a joke thanks to comments such as this and pain patients no longer able to access their life saving pain medication YES people will go to the street and die. Stop the insanity! Can you honestly say that every VETERAN who recieved opioids during combat is now a drug addict. During war and on the battle field morphine was a part of a soldiers supplies. Are you going to say they all soldiers have turned into drug addicts? The young spoiled useless brats we have this generation need to point fingers for everything that has gone wrong in their lives and its has gone to far. Take responsibility grow the hell up

    1. Ms Hansen – thank you for your comment.

      Several observations.
      This post wasn’t about anti-depressants or non-opioid or opiate medications so I won’t speak to your comments on that issue.

      No one ever suggested all veterans that received opioids or opiates are drug addicts. I don’t know why you would insinuate otherwise.

      I don’t agree that “we cannot continue to blame opioids…” Prescription opioids still kill people – fortunately the death toll has leveled off at about 4 deaths per 100,000 people, thanks in large part to much greater awareness on the part of prescribers and state regulations and legislation. Eliminating these controls would absolutely lead to an increase in deaths. It is also clear that for many, prescription opioids are the gateway to illicit opiates and opioids. This is not a joke, this is reality.

      Fentanyl, tramadol, and other synthetic opioids both illicitly manufactured and prescribed are now the deadliest drugs, killing about 2.5 times more people than commonly-prescribed opioids.

      be well – Joe

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Joe Paduda is the principal of Health Strategy Associates

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