The official numbers for opioid-related deaths in 2017, released by the U.S. Centers for Disease Control and Prevention today, demonstrate once again the folly of trying to tackle this problem by reducing access to prescription pain pills. The volume of opioids prescribed for American patients has been falling since 2010, while the upward trend in deaths involving opioids has accelerated, reaching a record number last year.
Of the 47,600 opioid-related deaths the CDC counted in 2017 (the black line on the chart below), 60 percent involved the drug category that consists mainly of illicitly manufactured fentanyl and its analogs (the red line). Just 30 percent involved the category that includes the most commonly prescribed pain medications (the blue line), and some of those deaths also involved fentanyl or heroin (the yellow line), which was implicated in one-third of the opioid fatalities. Last year's 13 percent increase in opioid deaths was due almost entirely to a 47 percent increase in deaths involving fentanyl and its analogs, since deaths involving heroin and pain pills stayed about the same, while deaths involving methadone fell.
Allowing for deaths involving multiple opioids, the CDC's numbers indicate that pain pills account for less than 30 percent of these deaths, and the actual number is probably considerably lower. A 2017 analysis of opioid-related fatalities in Massachusetts found that heroin or fentanyl was the deadliest drug in 85 percent of the cases.
The Trump administration nevertheless wants to reduce opioid prescriptions by a third during the next three years. But opioid prescriptions, measured by total morphine milligram equivalents (MME) sold, have already fallen by almost a third since 2010, as indicated by the green area in the chart (with units, in billions of MME, on the right axis). During that period, opioid-related deaths more than doubled. Does this seem like a winning strategy?
Far from reducing deaths involving opioids, the crackdown on pain pills has pushed nonmedical users into the black market, where the drugs are much more dangerous because their potency is highly variable and unpredictable. "Synthetic drugs tend to be more deadly than prescription pills and heroin for two main reasons," The New York Times notes. "They are usually more potent, meaning small errors in measurement can lead to an overdose. The blends of synthetic drugs also tend to change frequently, making it easy for drug users to underestimate the strength of the drug they are injecting. In some parts of the country, drugs sold as heroin are exclusively fentanyls now."
Meanwhile, patients suffering from severe pain are finding it increasingly difficult to obtain the medication they need to make their lives bearable. Many people with severe chronic pain who have functioned well on opioids for years have seen their doses dramatically and arbitrarily cut as a result of government pressure, including the CDC's own supposedly voluntary but increasingly mandatory prescribing guidelines.
Even people with agonizing terminal illnesses are not immune from the imperative to reduce opioid prescriptions. Barbara McAneny, the president of the American Medical Association, recently described a patient with metastatic prostate cancer who tried to kill himself after he could not get the medication he was prescribed for his bone pain because a suspicious pharmacist called his insurer, which denied coverage. While "I share the nation's concern that more than 100 people a day die of an overdose," she said, "my patient nearly died of an underdose."