Prescription Drugs

'Opioid Epidemic' Myths

Prescription painkillers are not as deadly or as addictive as commonly claimed.

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Last week the House of Representatives approved what The New York Times described as "a mountain of bills addressing the nation's opioid abuse crisis." The 18 bills passed "by huge bipartisan margins."

A flurry of legislative activity like this usually materializes when the drug problem it targets is already receding. That seems to be the case with the so-called opioid epidemic, notwithstanding the fresh attention attracted by the recent death of Prince, which may have involved prescription painkillers.

According to the National Survey on Drug Use and Health (NSDUH), nonmedical use of opioid analgesics such as oxycodone and hydrocodone peaked in 2012 and has since dropped below the rate in 2002. Although the recent decline in prescription painkiller use was accompanied by an increase in heroin use, total opioid use was still lower in 2014 than in 2012.

Despite the decline in use, opioid-related deaths reported by the U.S. Centers for Disease Control and Prevention (CDC) continued to rise through 2014, when there were 29,467, a record number. An overwhelming majority of such deaths—more than nine out of 10, according to data from New York City—involve mixtures of opioids with other drugs rather than straightforward overdoses.

That pattern, illustrated by the untimely ends of celebrities ranging from Janis Joplin to Philip Seymour Hoffman, suggests that the most effective way to prevent opioid-related deaths is to discourage people from combining painkillers or heroin with other drugs, especially depressants such as alcohol and benzodiazepines. It also suggests that the inherent deadliness of opioids has been greatly exaggerated.

The CDC says "health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills." That year the CDC counted about 16,000 deaths involving opioid analgesics, or one for every 16,000 or so prescriptions.

Opioid-related deaths are rare even for patients who take narcotics every day for years. The CDC cites "a recent study of patients aged 15–64 years receiving opioids for chronic noncancer pain" who were followed for up to 13 years. The researchers found that "one in 550 patients died from opioid-related overdose," which is a risk of less than 0.2 percent. 

The risk of addiction also has been exaggerated. According to NSDUH, those 259 million painkiller prescriptions in 2012 resulted in about 2 million cases of "dependence or abuse," or one for every 130 prescriptions. A recent study by Castlight Health estimated that 4.5 percent of people who have received opioid prescriptions qualify as "abusers," and its definition, based on the amount prescribed and the number of prescribers, probably captures some legitimate patients as well.

According to NSDUH, only a quarter of people who take opioids for nonmedical reasons get them by obtaining a doctor's prescription. Hence the sequence that many people imagine—a patient takes narcotics for pain, gets hooked, and eventually dies of an overdose—is far from typical of opioid-related deaths.

The rarity of addiction to opioids should come as no surprise to the vast majority of Americans who have taken Vicodin or Percocet for pain. Maybe they enjoyed the buzz, but they did not continue taking opioids every day once their pain was gone.

The truth is that using such drugs regularly for their psychoactive effects appeals to only a small minority of people, which is one reason heroin has never been very popular even among illegal drug users. "We lose sight of the fact that the prescription opioids are just as addictive as heroin," says CDC Director Thomas Frieden. In other words, not very. 

Some of the legislative responses to the increase in opioid-related deaths, such as shielding people who report overdoses from criminal charges and making the opioid antagonist naloxone more widely available, are sensible. But the crackdown on painkiller prescriptions is bound to hurt bona fide patients while driving opioid users to black-market heroin, which is more dangerous because its potency is unpredictable—a hazard created by an earlier round of antidrug legislation.

© Copyright 2016 by Creators Syndicate Inc.

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  1. OK this is a good start but there is a lot of junk here. First of all, most overdoses are intentional suicides, so telling people how to mix drugs and alcohol to lethal levels probably won’t help. Instead, they should be recognized as suicide – obvious from the empty bottles of every drug in the house lying around the body and the nasty messages in the social network feed. Then, many of these deaths are caused by the suicide bullying at 12 Step groups, which is subtle but powerful, and which is why many people die soon after leaving them. E.g. Hoffman, Williams, Monteith. (12 Step groups are falling into disfavor – this will help.) Then, many people who are in pain are cut off by their doctors due to the crackdown, and so overdose intentionally, and this creates a self-perpetuating cycle of deaths followed by further crackdowns (e.g. Prince, who was told he had to stop using). Beyond that, most addicts don’t overdose and most people who overdose cannot be considered ‘addicted’ to the drug cocktail that did them in. Finally, the most common correlate to overdose is treatment – more than any other factor scientists have measured. Meaning, treatment probably causes overdose; meaning, stop trying to ‘treat’ drug addiction! (It’s really just indoctrination into their stupid religion – watch the latest episodes of Maron to see how it works.)

    1. most overdoses are intentional suicides

      Do you have something to back that up?

      1. It’s hard to prove, but people lean so hard in the direction of believing any particular death by pills is accidental that you should lean back in the other direction to have a chance of seeing the statistical truth.

        1. Sure, but he’s making an absolute declaration, not suggesting that maybe we shouldn’t assume that they are all accidental.

      2. If you look at research on Tylenol and NSAID overdoses, it is estimated that something like 50%-75% of them are suicide attempts. There is no reason to think opioids are any different.

        1. I think there is some reason to think they are different. People don’t generally try high doses of Tylenol for fun and that’s exactly why they push it with opioids. I’m sure plenty of people try to kill themselves with opioids, but there is good reason to believe that there are a lot more accidental ODs than with drugs that don’t get you high.

          1. The dosage is right on the fucking pill. It’s not like heroin where the dosage changes or it is actually fentynal

            1. while the dosage may be on the pill, an individuals ability to tolerate a specific dosage varies wildly, as does the subjective effects or high. further, the effects of combining multiple drugs tend to be synergistic, and often with substances that people dont know about. taking methadone with an SSRI can increase the metabolization of the methadone by over 200%. Grapefruit juice has a similar, but more limited, effect with certain classes of opiods. Doctors and methadone clinics frequently fail to disclose these dangers to patients – often because the prescribers are incompetent or rushed. And that is just for ppl getting their dope from actual doctors

        2. I’m skeptical of the idea that most Tylenol or NSAID overdoses are suicide attempts. Maybe there is a significant percentage there, but I also think that there are a lot of people out there who are using too much Tylenol or aspirin to treat unaddressed pain. The common mentality, I think, is, “It’s an OTC drug–how bad could it be?” And most people just don’t realize how bad liver failure really is.

          I’m open to being proved wrong by citations, though.

    2. It’s really just indoctrination into their stupid religion

      As stupid as the rest of your post is, you did put forth one grain of truth. Twelve step programs are indeed little more than religious indoctrination. “You are nothing. You are a worm. You have no self control. You are a slave to your addiction. But God can help you. Give yourself to God. Bask in his warm glow. Only through God can you have the strength to fight your addiction. Now let us pray…”

      1. There’s also no evidence 12 step programs work any better than any other program.

        1. AddictionMyth has to work on his resentments.

        2. By their nature, it’s almost impossible to collect evidence about whether it works. It works for the people it works for. But goddamn, those people can be annoying. Many seem to just be addicted to AA instead of liquor or whatever.

          1. Many seem to just be addicted to AA instead of liquor or whatever.

            That’s been my observation.

            1. That’s probably because studies have shown that “addiction” is more a function of the individual’s mind than of any, particular, substance they are supposedly addicted to.
              Though it is hard to quantify human reactions, because of the myriad variables, the “addiction rate” of almost every substance, that produces a physiological reaction, is about 10%.
              No matter who it is, if a substance is ingested for long enough, the body will react to that substance being withdrawn, but that is a function of being “habituated” rather than addicted. The difference being the return to the substance, or some other mind/body altering substance, once those effects have dissipated.
              I have known many people in 12 step programs, there is a component of being “addicted” to them, and some freely admit it.

      2. i would bet you have never attended a meeting.you speak mostly garabage

  2. The War in Afghanistan is wholly responsible for the record-cheap heroin over the past decade or so. Since the entirety of Afghanistan’s economy was based around cultivation of poppy plants to be processed for powder heroin around the world, they protected the crops. Year after year record yields of poppy plants were allowed, protected by western military forces. This isn’t some conspiratorial non-sense either, it was reported on by many various western media outlets. It was wholly ignored by the public in general. The most glaring aspects of the protecting of the opium trade is that 90% of the West’s heroin product is processed through Iran. So for years, we have basically been funneling dark money to Iran via opium. Good stuff.

    1. And in fact this heroin saves lives – of people who were cut off by their doctors. And as for the kids who are ‘hooked’ on it, well they were the ones who were told a million times “Don’t do drugs” but they thought “Hey one pill won’t kill me” and so they steal one from grandma’s medicine cabinet and then “got hooked immediately” and this created a disease in their brain whereby they must now do Afghan heroin straight up even though grandma begs them not to. The solution? Doctors must crack down on opiate prescriptions, of course, and we gotta increase the war on drugs in Afghanistan. That will solve everything.

      1. Your Grandma has heroin in the medicine cabinet?

        1. Grandma was a dirty hippie in the ’60s.

        2. I love his Grandma.

      2. “got hooked immediately”

        Speaking of myths.

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  4. For a great dose of common sense on the outrageously racist totally ineffective war on drugs, check out Dr. Carl Hart and his book, High Price. His discussion of this issue is also interesting.

    http://www.drcarlhart.com/doct…..education/

    He also has an excellent ted talk. Data, not political pandering should be driving this.

  5. So this is what it’s come to, conspiracy theorists and book shills. Shame.

  6. The addiction folks are way, way on the other side of this. Drew Pinsky loves to rail on doctors prescribing opioids. His take is anything over 2 weeks is criminal, and most cases should not be using opiates.

    My personal experience (in the home of the pill mill, Florida) is that doctors are loath to prescribe anything stronger than vicodin. And won’t fork over anything more than a handful of pills.

    So people who work with addicts are convinced that for some people, taking these drugs for even a short period is dangerous. And for people who are in bad situations, like cancer patients, etc. the issue is access to drugs that can help them have almost tolerable quality of life.

    1. Yeah, fuck Drew Pinsky.

      1. Only with a strap on! I would worry his insanity is contagious!

    2. My God! A self-promoting man who stands to make enormous profits from drug rehab demonizing opioid use? Never have I heard of such a thing!

  7. Elsevier Buys Open Access Academic Pre-Publisher SSRN

    Everyone involved, of course, insists that “nothing will change” and that Elsevier will leave SSRN working as before, but perhaps with some more resources behind it (and, sure, SSRN could use some updates and upgrades). But Elsevier has such a long history of incredibly bad behavior that it’s right to be concerned. Elsevier is not just a copyright maximalist (just last week at a hearing I attended involving the Copyright Office, Elsevier advocated for much more powerful takedown powers in copyright). It’s not just suing those who make it easier to access academic info. It’s not just charging insane amounts for journals. It also has a history of creating fake peer reviewed journals to help pharmaceutical companies make their drugs look better.

    And it also has a history of lobbying heavily against open access, while similarly charging for open access research despite knowing it’s not supposed to do this.

  8. In the absence of the welfare state, drug addiction would be a self-limiting problem.

    1. That’s what I keep saying. I don’t know why people have to be saved at all costs. Some people just need to be left to die.

    2. And if drugs were legalized, it would also be much less of a problem for people who are addicted and those who they might have victimized to pay for their illicit drugs. Opiates/opiods would be very cheap without prohibition.

    3. BINGO! Lost my sister and cousin to dope in the last couple of years. They where both on “disability” because of claims of depression and addiction. Both easy to fake and hard to disprove. So there you have it! Sit around your state-funded apartment, food, utilities and cable TV all paid for by we the tax-payers, nothing left to do but take our ETB cards down to the smack dealer for our daily fix for 50 cents on the dollar.

      The State literally killed my sister. I wonder if they are doing it on purpose. Can they be that stupid about how their policies are facilitating abuse?

  9. “That year the CDC counted about 16,000 deaths involving opioid analgesics, or one for every 16,000 or so prescriptions.”

    This is a pretty big number. I agree that the drug warriors are idiots for making a big deal out of this (if this happens with the US waging the drug war as hard as it is, then this provides evidence that the drug war doesn’t fucking work). However, 16,000 deaths from one drug is not a small number. I also think looking at deaths *per prescription* is a flawed metric. Why not look at deaths per person who received an opioid prescription? That number would be much higher and would provide a better measure of how dangerous opiods are.

    Of course, the CDC’s numbers could also overstate things because they say 16,000 deaths ‘involved’ opioid analgesics, which could mean any number of things. It’s possible a lot of those deaths weren’t actually caused by opioids.

    1. If someone takes a Percocet then shoots themself, they can chalk up two epidemic columns.

      1. If someone purposefully kills himself with opioids, that also counts. Given that the reason you’re taking opioids in the first place is because you’re in pain, it wouldn’t surprise me if people taking opioids were more likely to be suicidal.

        It’s hard to know what’s an accidental overdoes and what’s a suicide and it’s stupid to blame a suicide that uses opiods on the opioids, just like it would be stupid to blame a suicide involving cutting your wrists on the availability of razor blades

    2. What? NSAIDs (eg Ibuprofen) kill that same number every year too. No one is talking about banning over-the-counter painkillers.

      This war on opioids is driven by the pro-suffering nanny state, and is despicable. Most overdoses occur because of uncertainty in potency and tolerance. And these are a direct result of the criminalization of these drugs.

      1. Citation needed? NIH says about 10 deaths over a 2 year period from NSAID overdose. Acetaminophen overdose is much more common (Tylenol) since the LD50 isn’t too many multiples of the effective dose.

        1. I think you can manage google. Search “NSAID 16500”.

          1. Section 5.3 shows 16500 exposures, which means potential overdoses. It also shows 52 deaths.

            http://www.fda.gov/ohrms/docke…..oc18761780

            Overdose does not equal death. 52 people from NSAIDs, it’s about 300 for Acetometophen.

    3. I’ve used Percocet daily for chronic pain 10 years. I’ve also been on the same dose for that time. I’ve never gotten any buzz from them they just take the pain below a 5 so I can function most days.

      I’m also a recovering alcoholic with over 20 years of sobriety. I have a problem with the rehab industry but AA is the longest and most successful anarchistic organization that exists. I don’t believe alcoholism is a disease but alcohol does not agree with my mind and body. but I also don’t think AA is the only way or the right way it’s just what worked for me. And the people I connect with in AA understand my medicinal need for opiates. No one should be made to suffer in pain.

      Before the witch hunt of pain management doctors after the OxyContin debacle I could actually be honest about my sobriety. Smart doctors know that genetically different drugs affect people differently. 20% of the population gets no pain relief from codeine. Morphine does nothing for me but knock me out. But now I can’t tell my medical providers that in a recovering alcoholic or they would not be able to prescribe these life saving medicines to me. Now I’m lucky I have a smart doctor who understands but to protect themselves from our government I have to pay for random drug tests. And I certainly can’t try marijuana to see if it might help my IBS or work better for pain at night or I could lose access altogether.

      1. This is what the ill-informed public doesn’t understand. If you are in chronic pain, opioids simply ease the suffering so you can function, you’re not getting “high” unless being somewhat normal qualifies as being “high”. If it wasn’t for this life saving medicines, I know I wouldn’t working, I may not have even felt life was worth living…
        -20+ years of chronic pain.

    4. these are overinflated figures as there’s no way to tell in an autopsy whether the drugs were illicit or prescribed as they all metabolize into the same thing …it’s why having a poppy seed bagel can give you a positive drug test…also rhese figures don’t include if there was a mixture of medications like opiates and alcohol…it is the mixture of depressants that kill. Also improperly treated chronic pain often leads to intended overdose

    5. 16,000 deaths, out of 300 million population. That is less than .00534% Let’s look at the real numbers! Should we be wasting money on a “drug war” for this small segment of society, that seem to have a death wish, to begin with? Who does not know the risk of abusing opiates and overusing them? I know a lady who has been taking opiates for years without repercussions! That person has multiple problems that are alleviated by this “abuse”. But, the only way to get the needed medication, at an acceptable dose, would be using street drugs. The difference is, that person does not wish to harm herself, even though she does complain of chronic, unrelenting depression. Funny thing, her depression is alleviated, somewhat, by the lesser dose of pharmaceutical medication that she receives, legally, for chronic pain. Addicts don’t care about harming themselves. That is part of the definition…”using something, compulsively, in the presence of harmful results.”

  10. “Bipartisan” is derived from the Latin word meaning, “Grab your wallet and say goodbye to the constitution.”

  11. An opioid is a person with similar physiognomy and chromosome disorder of Ron Howard.

  12. One could be lucky like me, someone who any opiate makes projectile vomit. Instant addiction cure.

  13. After watching “In The Shadow Of Death” the CBS news series about this issue. It’s refreshing to actually see the facts.
    Yep “In The Shadow Of Death”. That’s the actual name.

  14. I don’t know, 18 bills passing with overwhelming bipartisan support and the NYT applauding might not be a crisis but it is one hell of a lot of abuse. And it doesn’t matter what problem you’re talking about. Anytime the government starts getting all frisky-like and the NYT applauds, you can be sure you’re about to get abused.

  15. “Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies.” Groucho.

    Every. Time.

  16. Most people who are addicted to illegal opioids purchased on the street BECAME addicted then their doctors wrote them prescriptions for pain pills. As someone who does HIV testing and counseling professionally, I have personally spoken with many such people who are trying to get clean. One young man I spoke with never had any problems with drugs or alcohol … UNTIL he got banged up in car accident and was given a 30 day supply of Vicodin. When the Vicodin ran out, he discovered heroin. And this sort of thing happens ALL THE TIME. Your brain doesn’t care if it’s a Fentanyl patch you got from your doctor, or a syringe full of heroin you got from another junkie.

    Too many doctors appears perfectly willing to dole out pain pills without considering that some patients may need a little help getting weaned off of them.

    1. Sorry, the word “then” in the first line should read “when.”

    2. “Too many doctors appears perfectly willing to dole out pain pills without considering that some patients may need a little help getting weaned off of them.”

      That is another myth. The people that develop addictions have mental problems that contribute to their addiction, mostly mental. Many have history of drug abuse and depression. Likely more than 99% of the people prescribed opiates for pain, never develop an addiction. It is being blown out of proportion by ignorant politicians and the poorly informed media!

  17. the writer has never known a person who has become addicted, there is alot more than death involved

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  20. Opioid abuse is a self correcting problem. I am not ill-informed nor callous. I lost three very close people to me recently including a sibling because of it. There’s no talking sense to a junkie, they got to fix it themselves or it don’t happen.
    Sadly, Niel Young’s the line in “every junkie is like a setting sun” from the song “the needle and the damage done”, is as true today as it was 45 years ago.

    Instead, ask why is the desire to escape reality is so powerful? Does the world really suck that bad that escape is the only answer? Answer that question and you’ve answered the drinking and drugging problem.

    1. There have also been some interesting studies done suggesting that antisocial personalities are much more likely to abuse and become addicted to drugs.

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  24. Opioid addiction has become the biggest public health threat more than 100 people die of opioid overdose everyday. Government is working on setting guidelines for opioid prescription, people are getting hooked to opioids. Ban on the drugs will hurt the needy people, awareness can help in reducing the abuse. Naloxone program is a hit and has saved many lives but government and medical bodies need to come up with some permanent solutions.

  25. Check out this article about the present state of bills around the US pertaining to the War on Drugs and another overview of the issue. It gives great context to the current state of this war in US legislation.
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