Massachusetts Study Confirms That People Rarely Die After Using Opioids Prescribed for Them

Illicit fentanyl and heroin accounted for the vast majority of opioid-related deaths, while only 1 percent of cases involved drugs for which people had prescriptions.


Although prescription pain medication is commonly blamed for the "opioid epidemic," such drugs play a small and shrinking role in deaths involving this category of psychoactive substances. A recent study of opioid-related deaths in Massachusetts underlines this crucial point, finding that prescription analgesics were detected without heroin or fentanyl in less than 17 percent of the cases. Furthermore, decedents had prescriptions for the opioids that showed up in toxicology tests just 1.3 percent of the time.

Alexander Walley, an associate professor of medicine at Boston University, and five other researchers looked at nearly 3,000 opioid-related deaths with complete toxicology reports from 2013 through 2015. "In Massachusetts, prescribed opioids do not appear to be the major proximal cause of opioid-related overdose deaths," Walley et al. write in the journal Public Health Reports. "Prescription opioids were detected in postmortem toxicology reports of fewer than half of the decedents; when opioids were prescribed at the time of death, they were commonly not detected in postmortem toxicology reports….The major proximal contributors to opioid-related overdose deaths in Massachusetts during the study period were illicitly made fentanyl and heroin."

The study confirms that the link between opioid prescriptions and opioid-related deaths is far less straightforward than it is usually portrayed. "Commonly the medication that people are prescribed is not the one that's present when they die," Walley told Pain News Network. "And vice versa: The people who died with a prescription opioid like oxycodone in their toxicology screen often don't have a prescription for it."

Since the researchers considered only active prescriptions, it's possible that other decedents had been prescribed pain medication at some point. It is also possible that some of them were introduced to opioids through medical care and became addicted to them, later switching to the illicit drugs they took before their deaths. But that pattern does not appear to be very common.

A 2007 study found that 78 percent of OxyContin users seeking addiction treatment reported that they had never been prescribed the drug for any medical reason. Other studies have found that only a small minority of people treated for pain, ranging from something like 1 percent of post-surgical patients to less than 8 percent of chronic pain patients, become addicted to their medication. A 2015 study of opioid-related deaths in North Carolina found 478 fatalities among 2.2 million residents who were prescribed opioids in 2010, an annual rate of 0.022 percent.

That unusual scenario nevertheless figures prominently in discussions of opioid abuse and in criticism of pharmaceutical companies accused of causing the problem by exaggerating the benefits and minimizing the risks of their products. The focus on pain pill prescriptions is clearly disproportionate given their actual role in opioid-related deaths, and it has led to policies that deprive bona fide patients of the medication they need while pushing nonmedical users toward black-market substitutes, which are far more dangerous because their potency is unpredictable.

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  2. What have these facts got to do with banning stuff and taking over people’s lives?
    If the socialists want to rule us, how can you let a few facts get in the way?

    Welcome to the revolution.

    1. So, you want the socialist laws repealed so doctors can freely prescribe opioids of all types, but also uppers to give opioid users a boost when needed, getting back to the drug laws for white people in the 50s and 60s?

      It’s ironic that GOP president wives who got addicted to “mommies little helpers” before the 80s were really big advocates of the socialist big government draconian drug laws hitting white conservatives so hard today.

      Today’s drug laws were targeted at non-whites, liberal elites, hippie freaks with Trump’s view on war, based on the 14th amendment not applying to white conservatives using the same drugs.

      The author doesn’t even call for legalizing prescribing drugs on a lifelong basis for medically diagnosed drug addicts, much less authorizing prescribing drugs to anyone wanting the psychoactive experience of drugs by visiting a doctor feel good.

  3. Well DUH.

    A prescription makes you a responsible drug user.

  4. Since I’m tired of these articles and already agree with drug legalization, I only skimmed the article. I’d question whether a correlation between opioid addiction and prescription was fully made. I have consistently refused to use them for pain management in order to avoid any risk of addiction. While deaths might be due to non-prescription drugs it is still worth digging into how frequently addiction is acquired through legally prescribed drugs. Is it really a wrong move to reduce our reliance upon opiods for pain management? Is it wrong to try to limit people from exposure to a drug that has high rates of dependency and addiction? I’ll agree that doing so through law is the wrong move, but if we’re really concerned about deaths then a good place to start is limiting addiction

    1. Keep in mind that TOTAL drug legalization would includes all pharmaceuticals too

      I’m tired of @Reason pushing these partial legalizations as simply legalization of marijuana

    2. There is no correlation between doctors of medicine prescribing legitimate chronic severe pain sufferers and overdose death, well there is but it is less than %1. True addiction is rare. 996 in 1000 new to an opiate will never true addict. It is from from the ranks of inexperienced youth that overdoses on street products come from. Most prescription medicine goes to folks over 50 and they aren’t addicted or overdose. My friends are dying and being kicked out of hospitals no matter there amount of real severe pain.

    3. What’s wrong with drug addiction?

      Billions of people are supposed to take drugs daily even when they make people feel worse, like drugs to control blood pressure, control HIV, and hundreds of other medical conditions.

      How is taking several drugs daily for the good of society, eg HIV/AIDs spread prevention, not the same as addiction to opioids?

  5. The only reason the government is going after legal manufacturers of opioids is because they are easily located, and have deep pockets.
    You can’t reach Chinese Fentanyl manufacturers, and when you can find the users here in the U.S. they have no money.
    The shame is that the media is shamelessly promoting the story that legal manufacturers are responsible for the ‘epidemic.’

    1. Nailed it – it pays for the ones hyping it to hype it. What more explanation do you need?

    2. Plus, Evil Orange Man says one of the reasons we need the wall is to stop the drug traffic.
      If we conflate legitimate drugs, made in America, with those illegal ones, it distracts from his reasons to secure the border.

    3. The only reason opioids are illegal is Chinese, blacks, hippies used them. As long as white conservatives were using them, police, politicians, voters were all happy.

      Except for the Christian evangelicals who seek political power to control how everyone thinks and acts, including white women, but not so much conservative white men like them. They tried to make even coffee and tea illegal along with opioids, coca, alcohol, tobacco.

  6. I think if they did a longer term study, they’d find that *everyone* who takes prescription opioids dies. Likewise everyone who *doesn’t* take prescription opioids.

    1. I knew it was the fault of prescription opioids!

      1. Ha Ha Ha Ha !

  7. Not really a shock to me after the vaping “crisis”

    1. 15 people die from a bad batch out of Milwaukee and the entire nation is turned on its head.

  8. If you are trying to leave the impression that 99% of decedents never had an opioid prescription, I’m not buying it.

  9. What are the rich doing for their pain? This isn’t about health or healthcare at all, …is it? Lots of people need that medicine. My friends are dying and being shoved out of hospitals as we speak.

  10. I’m not sure I understand why the federal government is involved in this matter. Doctors and pharmacies can’t do their jobs anymore out of fear of the feds. Better 10 people abuse a drug than one person who needs it can’t get it.

    1. Thanks to Nixon, Reagan, Newt, Bush, and the GOP and their drug wars that was supposed to target only non-whites, liberals, anti-war actives, but absolutely not white men and especially not redneck truck drivers.

  11. I have been responsibly using opioids for twenty plus years. the dose never increased. I used only enough to make life bearable. Every so often I would wean myself off and just take Tylenol and a muscle relaxer, just to give my system a break and not have to adjust the levels of pain meds. Now my medication that has allowed me to have a life has been cut by two thirds. I no longer get out I am a shut in. So, what has the beaurocracy done to me? They have completely taken away any quality of life, that’s what they have done.

  12. When is “Reason” ever going to address the utterly tyrannical bullshit that are “prescription laws” aka being forced to get a government permission slip from a government-sanctioned man in a white coat?

    There is absolutely no such thing as “heroin overdose”. That is, taking so much heroin (diamorphine) that you die.

    Not even on purpose.

    When are you going to address that these “overdose statistics” include anyone that died in a car crash with opiates in their system?

    Oh, and when someone eats a shotgun because prohibition has ruined their life, that counts as an “opiate overdose” too.

    Re-legalize ALL drugs over-the-counter just like sugar, tomatoes, or anything else.

    You know – an actual free market in medicine.

    Or is that too “libertarian” for this magazine?


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