Opioid Death Rates Are Not Correlated With Prescription Rates Across States

More reason to doubt that pain pill restrictions will save lives


Efforts to reduce opioid-related deaths by restricting access to pain medication seem to be backfiring by driving people toward more dangerous drugs. Two analyses published today provide more reason to be skeptical of this approach, showing there is no clear relationship between pain pill prescriptions and drug poisoning.

In a short piece published by the American Council on Science and Health, pain treatment activist Richard Lawhern compares opioid prescriptions per 100 people and opioid-related deaths per 100,000 people in each of the 50 states and the District of Columbia. He includes deaths involving both legal and illegal opioids. Based on data for 2016, Lawhern plots the two rates against each other, with prescriptions on the x-axis and deaths on the y-axis, and calculates a trend very close to zero. "Opioid OD death rates had no apparent relationship to opioid prescription rates from state to state," he writes. "Any effect of medical prescribing on OD deaths was literally 'lost in the noise' of other factors."

Richard Lawhern / John Alan Tucker

A new WalletHub post by John Kiernan reinforces the point that states with high opioid death rates do not necessarily have high opioid prescription rates, or vice versa. In 2016, Kiernan reports, the jurisdictions with "the most overdose deaths per capita" were West Virginia, Ohio, New Hampshire, D.C., and Pennsylvania, in that order. The states with "the most opioid prescriptions per 100 people" were Alabama, Arkansas, Tennessee, Mississippi, and Louisiana. Although D.C. had the lowest prescription rate, it had the fourth highest death rate. Alabama had the highest prescription rate, but its death rate was middling. Arkansas had the second highest prescription rate but ranked around 40 in opioid-related deaths. Pennsylvania had a higher death rate than many states with higher prescription rates.

Despite that messy picture, Kiernan includes a state's opioid prescription rate as a component of its "Drug Use & Addiction" score, meaning it automatically counts as part of the problem. "These state to state outcomes suggest that the US is dealing with not one national opioid crisis but many local crises," Lawhern concludes. "In 2016, medical prescribing contributed almost nothing to these crises."

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  1. Wow it’s almost like everything we thought we knew about addiction is wrong.

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  2. I have a question. When can we stop caring about people who die from drug overdoses?

    1. I’m trying to remember when we started caring.

    2. When the government isn’t enforcing jack-boot policies that push drug users into more dangerous situations.

      1. Two separate issues.
        1) jackbooted policies are bad and I’m all for opposing them
        2) drug users “pushed” to worse situations aren’t my concern – they make choices.
        Personal note – I’ve been taking adderal for 10 years and it’s been legitimately necessary/helpful for depression and focus. I recently moved and haven’t arranged new doc, so no refill forthcoming. Annoying, but maybe good. I just started a new job and stopped addy at the same time. Difficult? Somewhat. But I made a choice to go without it for a while. I also made a choice to never try heroin. If you make the choice to try heroin, you’re responsible for the outcome. It’s harder to get? Too fn bad; deal with it

        1. what a bizarre rant

        2. “I have been taking meth for 10 years and its been great!”

          “you like to take heroin? Lol fuck you loser!”

    3. when the government stops trying to criminalize and control what people ingest in their bodies. When government stops stealing money to both enforce and punish people for putting the wrong kinds of plant or chemical derivatives in their bodies. When the government stops trying to enforce the right and wrong ‘kinds’ of happiness and how it is achieved.

  3. The states with “the most opioid prescriptions per 100 people” were Alabama, Arkansas, Tennessee, Mississippi, and Louisiana

    Fuck flyover country. Amirite?

    1. YUP! But, Arkansas has already been in their own physician war for decades! I was one of their victims!

  4. If restricting access to pain medication is driving people toward more dangerous drugs, shouldn’t there be a negative correlation with prescription rates?

    1. You would think that these people would realize it. But, they prefer to work in caves, with nothing from the rest of us considered legitimate. The prescription rate has been forced down. Many “pain doctors” are happy about this. Now when they lie to Medicare and tell them “all avenues of treatment have been attempted” (Mine did! And he had not tried accupuncture, TENS treatment, or one of many others non-invasive treatments available to patients, that have better trained pain doctors.) But, then again, they would not acknowledge the training received from my certificate course in pain studies from a university, or the American Academy of Pain Management out of Colorado, of which I was a fellow!

      They will more easily get to put that dorsal comumn stimulator or pain pump in a patient, and all of their inherent risks. But, the money is more important to most of those anesthesiologists. They barely got out of the OR, fifteen years ago! The money was the reason. It was also influenced by the decreasing payments that the insurance companies, and the governement, were willing to pay for their services in the OR! The turf battles everywhere!

  5. “He includes deaths involving both legal and illegal opioids. ”

    The lack of correlation would also indicate that the restrictions on access to prescription opioids have not increased deaths due to street drugs either.

    Or, maybe relying on just one year’s data isn’t exactly a good methodology for identifying trends,

    1. Several years of State data,where one could also know when any added restrictions were imposed, run through a two way ANOVA test, might get you somewhere.

    2. Considering that heroin is diacetyl-morphine, they are very misleading! Those are mophine deaths that should not be classified with the chronic pain patients, who rarely die, or rarely beome addicted! But, that is the way the media, and the ignorant, want things! Most of the deaths are the result of clandestinely produced Fentanyl, too. But, that is rarely mentioned in any of the damned news reports, either! Sadly, too many physicians like feeding at the trough! They are rewarded for remaining ignorant!

  6. Last time by wife gave birth was 3 1/2 years ago. Hospital prescribed her oxycodone as a matter of course.

    Fast forward to a couple of weeks ago. My sister-in-law gave birth in the same hospital (without an epidural), and they refused to give her any sort of opioid to deal with the pain. She had to advocate for herself and be an obnoxious squeaky wheel for a couple of days before the hospital finally relented and prescribed her what she needed. Hard to blame the hospital though, since they can only give a certain number of these prescriptions before it triggers an audit from the state. Can’t imagine how many people just go without since the hospital’s focus has switched from patient care to staying under the regulators’ radar.

    Thanks, opioid crackdown!

    1. ” My sister-in-law gave birth in the same hospital (without an epidural), and they refused to give her any sort of opioid to deal with the pain.”

      Did they refuse to provide an epidural, or did she decline it? Obstetric epidurals usually contain a mixture of a local anesthetic and an opioid.

      There is a reason obstetricians prefer using the epidural method of administration – the drugs tend to stay in the spinal column. Which minimizes side effects and risks for both mother and baby. Also, the baby tends to not have any drugs on board at birth, which otherwise might interfere with the APGAR score.

      The reticence likely had nothing to do with fear of audits, and everything to do with a patient that was requesting care that deviated from the usual accepted practices.

      1. Do’h! Commented instead of replied. Reply is below.

      2. Sounds like one of the trough feeders who thinks they can treat someone without ever meeting them! Making that many assumptions leaves me wondering about the wisdom of such a person.

  7. I believe she declined the epidural. But she was seeking pain medication after the delivery – not before. I’m not aware that oxycodone is contraindicated at that point. This hospital has definitely changed its practice, and it has nothing to do with patient care.

    I also have a friend who’s a dentist, and she has stopped doing certain procedures altogether because she does not want to deal with the scrutiny that now comes with prescribing opiates.

    To clarify, this is in Maryland, which is currently undergoing a particular hysteria related to prescription pain meds and has recently enacted some draconian rules about it, which I do not claim to understand fully. It is my understanding, however, that it has drastically lowered the bar for when a doctor’s opioid prescription writing will trigger a review.

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