New Survey Data Confirm That Opioid Deaths Do Not Correlate With Pain Pill Abuse or Addiction Rates

Nonmedical use of prescription analgesics did not become more common, but it did become more dangerous.


New data from the National Survey on Drug Use and Health (NSDUH) provide further evidence to support a counterintuitive conclusion: The dramatic increase in deaths involving prescription analgesics since 2000 cannot be explained by a dramatic increase in misuse or addiction rates, because there was no such increase.

Prior NSDUH data showed that rates of past-month "nonmedical use" and past-year "pain reliever use disorder" barely changed from 2002 (when the survey began in its current form) through 2014, even as deaths involving these drugs rose by 175 percent. The survey questions on these topics changed in 2015, so the more recent numbers are not comparable. But we now have four years of data with the new wording, and they tell a similar story.

According to NSDUH, the rate of "prescription pain reliever misuse" fell in 2016 and 2017, even as deaths involving those drugs continued to rise. The rate fell again in 2018, and that year deaths may also have declined, judging from preliminary CDC data. The rate of "pain reliever use disorder," meanwhile, fell in 2016 and 2017 but stayed the same in 2018.

The lack of correspondence between deaths involving prescription analgesics and illegal consumption or addiction rates suggests that patterns of use changed in a way that made fatal outcomes more likely. If nonmedical users started taking prescription narcotics more frequently, in higher doses, or in more dangerous combinations with other drugs, those shifts would help explain the increase in deaths.

In 2017, just 30 percent of opioid-related deaths involved prescription analgesics, and the records compiled by the CDC indicate that 68 percent of those cases also involved heroin, fentanyl, cocaine, barbiturates, benzodiazepines, or alcohol. The role of drug mixtures is probably even bigger than those records suggest. In New York City, which has one of the country's most thorough systems for reporting drug-related deaths, 97 percent of them involve more than one substance.

The evidence does not favor a simple narrative in which more opioid prescriptions led to more abuse and addiction, which in turn led to more deaths. The "opioid crisis," which seems to be part of a long-term upward trend in drug-related deaths that began in 1979, might more accurately be described as a problem of increasingly reckless polydrug use, a problem that cannot be solved—and may be worsened—by demanding wholesale reductions in pain pill prescriptions.

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  1. Facts be damned! More laws! More restrictions!!

    1. Yes! You’ve captured the “Zeitgeist” that rules the brains of WAAAY too many power pigs!!!

      “The more punishment, the better! The more punishment, the more justice!!!”

      (And yes of course, more laws can justify more punishments! System completed!)

    2. I am making 10,000 Dollar at home own laptop .Just do work online 4 to 6 hour proparly . so i make my family happy and u can do

      ……. Read More

    3. Well, I was hoping “Reason” would have enough Reason to play Human Society instead of tic-tac-toe.

      The simple chain of logic in these events…..

      1. Perdue Pharma creates propaganda (like the above) to convince doctors that opiates are safe.
      2. Our medical system, which must be quick and profitable, gives them out like candy.
      3. Caught in the act, the medical system and pill mills stop giving them out as easily.
      4. Heroin steps in to replace Pills
      5. Heroin takes up too much room, so the free market makes Fent. in labs everywhere – 10X or more as strong.
      6. People die from Fent. – usually mixed with other drugs (most Americans are on something or another)…..

      What part of this is so hard to understand? While I think opium and light opiates should be OTC or rec. legal, the article above does zero good as far as telling the truth. This is yet one more example of the “forbidden fruit” thing – easy enough. Why try to manipulate stats which are AFTER the switch to Fent. came along? only to fool people? or does the author not know things??

      1. 1, The report was written by SAMHSA, part of HHS.
        2. Bullshit.
        3. Bullshit. Government passed laws restricting access. Not just to the opiates, but to treatment for those who become dependent.
        4. Hey, you got something right!
        5. See item 3. Government created a demand for illicit drugs. US companies are not in the business of creating street drugs. Traffickers added fentanyl to heroin. Not Perdue pharma (I guess they’re the new Monsanto).
        6. Hey, you got something right! The increase in drug deaths increased as fentanyl-modified heroin use increased.

        Get up off your knees.

        1. Yeah fetanyl is not a desirable recreational drug. Very dangerous, apparently undesirable high, and short lasting. If it was desirable it would not be a cutting additive ; it would be the primary product. Fetanyl was not a outcome of the free market – it was a response to policing. It is cheap and powerful, so only a small amount needs to be smuggled. Almost impossible to stop. For example, 2 pounds could kill the entire city of Baltimore.

          1. *orders 2 lbs of fentanyl*

      2. We have been saying this for almost 2 years now. Opioid abuse and Overdose have nothing to do with people prescribed opioids for chronic pain. I find it disturbing how many people have picked up the unsubstantiated “proofs” of what will continue to be found as a completely false narrative. I hear and read these false statements about opioids and chronic pain patients a lot. Also, a couple of different organizations have latched onto this false narrative, such as churches and some Christian organizations. The term “rehab” is bandied around as what has to be seen as a marketing tool.
        I am thankful for your reporting
        JACOB SULLUM and for a well written, evidence supported article. I have shared this article out to the groups I advocate for.
        Thank you

      3. Even though the politicians created the problem we have now with Opioids, by pressuring doctors not to prescribe what they think is right, and our idiot politicians knowing better about medicine then doctors creating a Chilling effect on prescriptions, which led to heroin/fentanyl where OD’s went from 10,000 to 70,000, where it really wasn’t a problem until they got involved, and has led to massive under prescribing for real pain management patients, why in all of this do we never hear anything about an alcohol or tobacco epidemic, which are both legal drugs and kill far more people every year then opiods? I’ve had two members of my family die of lung cancer and cirrhosis of the liver, and do you have any idea how horrific those deaths were? But we don’t hear one word about tobacco epidemics or alcohol epidemic’s, which are far more deadly and ironically completely legal. Is it the tobacco and alcohol lobbies? I don’t know. But I do know that the news goes crazy over anything involving opioids. Why? Is there something sexy about it? I’m serious I don’t get it. I remember getting drilled in health class about tobacco and alcohol and it scared the daylights out of me and I never really touched either. All the carcinogens in cigarettes Scared the crap out of me. Why don’t we hear about these drugs which are killing five times as many people every year, at least.?

  2. If there is a car accident and someone involved had alcohol in their system, then it will be deemed “alcohol related,” even if the sober party was at fault.

    Makes me wonder if someone being dead and having these drugs in their system means it is automatically considered to be “opioid related,” regardless of the actual cause.

    It’s not like the people pushing the narrative are like honest or anything.

    1. You hit the nail on the head!

      There was a confirmed case exactly as you described that started an actual investigation.

      A young lady was a passenger in a car when it was struck by another vehicle, she died from her injuries. Neither driver were impaired, it was just a fluke accident. The passenger that died was taking pain medications per doctor’s orders, and had been for a decade.

      That passengers death was counted as ‘opioid related’ even though her appropriate medical use of pain medications had absolutely zero to do with another driver striking the car she was riding in!

      Because of that incident coming to light, they are now reviewing all opioid and drug related deaths to find out how many actually belong to that category. I am expecting they find many of these types of deaths miscounted in order to increase the death toll. Without a high enough opioid death rate the states risk losing certain new funding from the government.

      Another thing that has come to light is when a patient comes into the hospital because of a drug exposure they try very hard to tie it to opioids even if that person has never touched opioids. The most recent example was teenager huffing paint. They asked him a dozen times about opioid abuse or even use. When he continually insisted that he had never taken opioids in any way, they became much less interested in helping him. He was released from the hospital even though he was requesting help for his addiction. Since his addiction wasn’t opioid related, it didn’t pay well enough to help him.

      This is what financial incentives directed at one disease or one class of people does, the ones that can make changes to help the whole population will focus only on what is most lucrative, ignoring the real problems!

  3. In 2017, just 30 percent of opioid-related deaths involved prescription analgesics, and the records compiled by the CDC indicate that 68 percent of those cases also involved heroin, fentanyl, cocaine, barbiturates, benzodiazepines, or alcohol.

    I honestly thought that the “rise in opioid deaths” was related to the rise in people injecting a substance cooked in a spoon in a back alley. Or in our fair city’s case, on the steps of the county courthouse.

    1. The key here is that if the person shooting up on the courthouse steps also took a lortab or suboxone in the days prior to their overdose it would show separately on their tox screen and be counted in that 30%! That is how they have managed to keep the numbers artificially high enough to increasing funding and justify further reductions in prescribing!

      1. If they had taken suboxone in “the days prior to shooting up” it’s not likely they would overdose. Suboxone does a damn good job of completely monopolizing opioid receptors so that if someone takes any opiate (including fentanyl and heroin) while suboxone (buprenorphine) is in their system it will be unable to bind to the receptors and have no effect. And suboxone has an extremely long Half-Life so will be in someone’s system for at least 5 days. If someone has been using it regularly for awhile it can be in their system about 10 days!

      2. The key here is that over the last two decades, these Fent. and Heroin users started on legal opiate pills….and when they were taken away or the price became too high, the “invisible hand” stepped in with a better product at a lower cost…that kills

  4. “The lack of correspondence between deaths involving prescription analgesics and illegal consumption or addiction rates suggests that patterns of use changed in a way that made fatal outcomes more likely. If nonmedical users started taking prescription narcotics more frequently, in higher doses, or in more dangerous combinations with other drugs, those shifts would help explain the increase in deaths.”

    Personally, that is where I think the answer ultimately lies; changing patterns of consumption, and dangerous combinations. People get stupid, sometimes terminally so.

    These state level (with Federal encouragement) prescription restrictions on opioids for pain relief are getting totally out of hand. No way a chronic pain patient should have to suffer, if there is no viable alternative for pain relief. That is just barbaric.

    1. “Personally, that is where I think the answer ultimately lies; changing patterns of consumption, and dangerous combinations.”

      Or, as I like to put it, “Leave that shit alone”.

  5. There is a correlation to rising government ‘fixes’ to any problem, and rising deaths attributable to that problem.

  6. Jacob batting 1000 today. Myths and misinformation regarding prescription opiods are prevalent.

  7. As I wrote in May 2018 on the American Council on Science and Health, the US faces not one opioid crisis, but many. The primary source of our opioid overdose issues is clearly not prescriptions made by doctors to legitimate patients. Corporate diversion of prescription drugs to pill mills seems to have played a role prior to 2010. This diversion by large drug distribution companies (McKesson et al) should have been completely obvious to the DEA which had the numbers and did nothing with them.

    With FDA-mandated reformulation of Oxycontin in 2010, mortality from heroin tripled in four years. Market incentives were created for importation of illegal street fentanyl and adulteration of both fake pain killer pills and heroin supplies.

    As suggested by epidemiologist Nabarun Dasgupta and others, the primary sources of our opioid “crisis” may be socio-economic. Overdose mortality rates vary across a 400% range from US State to State, and they don’t track with prescribing rates — and never have. The hollowing-out of rural and rust belt communities due to structural unemployment, poverty, and out-migration also play a central role, particularly since the economic crash of 2008.

    We are dealing with a crisis not of medical exposure, but of hopelessness and economic stagnation. And correction of this crisis may require a major revision of tax policy to reduce income inequality and promote reinvestment in infrastructure jobs.

    The war on drugs has been turned into a war on pain patients. National legislation may be required to force DEA and State drug enforcement authorities to stand down from their persecution of doctors and their patients.

    1. Hello Red! Reason readers, I offer you my sane and entertaining essay “It’s a Fentanyl Crisis, Stupid!” which has 26 footnotes and quotes Dr “Red” Lawhern and Jacob Sullum.
      “It’s a Fentanyl Crisis, Stupid!” by Kaatje Crippled Comedy https://link.medium.com/wjgXkFZTlZ

    2. You’re characterizing emigration as a cause of the problems of rural and rust belt communities. Isn’t it actually an effect and part of the solution? Tax policies to promote reinvestment in certain fields are likely to simply delay the necessary readjustment and prolong the problems.

      What you say regarding self-destructive use of drugs (narcotic and otherwise) is consistent with what Stanton Peele and others have observed for many years. You see a lot of other devil-may-care behavior too by people who don’t have much to live for; I think even the lower levels of stock car racing may fill that role for some. It’s just that now the geographic correlation has come to the fore.

      1. Robert, as you suggest, out-migration may be a symptom of the underlying socio-economic crisis rather than a cause. Ripple effects within families broken up by unemployment or drug involvement are hard to assign uniquely. But we also know that drug abuse is more common in the families where a head of household has issues with alcohol, marijuana, or other intoxicants.

  8. Truth is most docs do not really want to deal with chronic pain patients. There is little or no training in it. Medical training focuses on diagnosis and treatment of disease and that is what they signed up for.

    That is why it was often poorly managed by non specialists. Purdue really did oversell and market oxycodone convincing many docs that they could safely and effectively do this in their practice. Then you also had the pill mill ones who saw this as an easy way to make money.

    I do think the states and guidelines have gone too far. Medical organizations and practitioners need to push back against that.

    1. “Truth is most docs do not really want to deal with chronic pain patients. There is little or no training in it. ”

      Docs are in danger of losing their licenses if the federales think they are prescribing too many pain meds–training or not.

      1. That also.

      2. Just to add. It is not mostly the feds. It is more the State medical boards doing the monitoring.

    2. Oxycontin really did have good technology for reducing the type of “abuse” of narcotic analgesics that authorities were then saying was so dangerous: pain patients getting “hooked” involuntarily. Purdue Pharma really did cook up Oxycontin to the order of government authorities, and told doctors just what those authorities were telling them according to the incorrect model the authorities had as their ideal. I don’t blame Purdue at all.

    3. There seems to be a good case that Purdue did over-market opioids. But the remarkable thing is that there is little evidence that their mis-behavior actually “caused” our crisis. Wider avialability of opioid analgesics didn’t create more addicts. Under active medical management, opioids are safe for all but a small number of people who are predisposed to addictive behavior (alcoholism, smoking, heavy marijuana use, medical or non-medical stimulants, etc.) long before they encounter opioids.

      As I wrote in a white paper a couple of years ago, “A 2018 study reported in the British Medical Journal examined outcomes among more than 586,000 patients prescribed opioids for the first time after surgery. Less than 1% continued renewing their prescriptions longer than 13 weeks. 0.6% were later diagnosed with Opioid Abuse Disorder during follow-up periods averaging 2.6 years between 2008 and 2016. Likelihood of diagnosis increased with the length of prescriptions, but rose only modestly as dose levels increased from under 20 to over 120 MMED.’

      “It is quite possible — even likely — that the diagnosis of Opioid Abuse Disorder in many of these patients was incorrect. The diagnosis is typically made by treating physicians without recourse to accepted definitions of the disorder such as the American Psychiatric Association Diagnostic and Statistical Manual, 5th edition. Many doctors who diagnose patients with abuse are general practitioners who lack sufficient training in addiction and have little experience evaluating the behaviours that actually define drug addiction. Likewise, some physicians confuse patient reports of emerging chronic pain – caused by failed surgery — for potential opioid abuse. ”

      “During the period of the study, doctors increasingly became concerned with being sanctioned by law enforcement authorities for their use of opioid doses high enough to reliably manage pain. Thus they may have diagnosed drug abuse to protect themselves – not their patients, who were often summarily discharged. “

      1. My question.

        Post op analgesics and anesthesia either operative or for moderate sedation are one thing.

        Chronic pain given in an outpatient setting is another. I have not had the opportunity to read your paper and would like to discuss it further.

        I do not think ADSM is very helpful in medical cases of chronic pain. Agree with that.

  9. Just my personal experience, everyone I’ve known (and seemingly the majority of celebrity cases you hear about) that have overdosed, whether they died or not had taken benzodiazepines with their opiates. I really feel doctors need to be much more careful in being sure if they’re prescribed together the patient understands the risks of taking them together. And the public should be made more aware that because they are both such central nervous system depressants taking them together is very dangerous. A friend of mine that overdosed woke up very surprised because he had taken the same dose of opiate as usual, but that time he had taken ativan (benzo) as well!

  10. I’ve always thought that the “opioid crisis” was mostly about the states getting lawsuit money from opioid producers and distributors.

  11. Some great points, and some others that add to the confusion..people take drugs for two main reasons: To increase pleasure, and relieve pain (psych and/or physical) . Free reign for big pharma , it’s a no no… We all know that they buy some doctors and co, and i’s a slippery slope. Like some people point out here, some mixes are fatal… And we are still surfing the symptom, and not the root causes..Please refer to the two main reasons above…Why didn’t the numbers did not keep going down in 2018??? Because the anxiety rates went up! That’s why.. Look at two main reasons again, I hope this is not complicated, if anyone needs a drawing, please let me know. I have a good size presentation about this topic, which shows the root causes of the problem in more detail. thank!

  12. The nightly music post nobody else cares about.

    Been getting into country and too sentimental lately.

    The Stones. While it is still up and the discussion of drugs got me thinking about Kieth Richards and his struggles with that.

    My favorite from them was this song. Lisa Fisher, what can I say, the band is just doing Ok and she shows up and makes it happen. Watts is always right there to keep it together with that left hand on the snare but she gets Jagger to work it.

    So Gimmie Shelter.


  13. very very cool article thanks for sharing with us…

  14. Lotta people are so busy dying, they have no time to live. Die already then.

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