Drugs

People Rarely Die After Using Opioids Prescribed for Them

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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 cases. Furthermore, just 1 percent of decedents had prescriptions for the opioids that showed up in toxicology tests.

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 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."

Since the researchers considered only active prescriptions, it's possible that other decedents had been prescribed pain medication at some point in the past. It's 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 reported in The American Journal of Psychiatry 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 just 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. 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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  1. The on-going War on Opioids will have the same result as the War on Poverty, the War on Terror, the War on Drugs. Failure.

    When used under physician supervision, opioids are the most effective pain reliever out there. The government should not be stepping into the r’ship between a physician and a suffering patient. I once had a very severe GI issue, went to the ER, and was administered morphine. Let me tell you, the pain went away like turning off a light. Thank God it was available. Later had major surgery (for the same issue) and thank God Dilaudid was available, post-op.

    If the problem is illicit fentanyl, then go after that. But keep the government out of the physician/patient r’ship.

    1. “But keep the government out of the physician/patient r’ship.”

      You’re about two decades too late.

      1. Still, it must be said: There is zero reason or role for the federal government to come between a suffering patient and their physician caregiver. That simple truism gets lost in the larger discussion.

      2. “You’re about two decades too late.”

        Try five.

        But, let’s not pretend that this was a one way street. When the Feds were writing the CSA is was the AMA, and other physician lobbying groups that proclaimed they were the only ones fit and capable of handling the responsibility of overseeing the use of these drugs.

        Physicians sold their glorified ‘patient relationship’ down the river of rent seeking in order to obtain a monopoly. In the absence of any real competition they quickly developed characteristics of most every monopoly – sloppy, lazy, inefficient, and often ineffective.

  2. They should only come in tobacco and menthol flavors. That will solve the problem.

  3. “People rarely die after using opioids prescribed for them.”

    Only once for the most part, I’d suspect.

    1. I’d say people always die after using opioids prescribed for them. They’re not a font of immortality, after all.

      Badly written headline, that.

    2. “People rarely die after using opioids prescribed for them.”

      Oh, Duh.

      (1) Opioids are very useful for acute pain (while healing after accident or surgery); I was prescribed opioids after a fall (bruissed ribs) and hernia and sinus surgeries. Took them only temporarily. So I did not die from opioids.

      (2) I have relatives who were prescribed opioids for chronic pain. I feel that is a misuse of opioids and that the long term effect was to worsen their health by getting them addicted. Long term opioid use is really hard on the liver. COD is usually listed as liver or pancreas failure, not as opioid overdose.

      Big Pharma produced and distributed opioids in quantities beyond needs for acute pain cases. Opioid pain medicines were a high profit item and the companies were lax in monitoring diversion.

      (3) Pill mills use bogus Rx rubber stamped by unethical doctors to sell large quantities to people who then take them to other localities and distribute them to addicts who use them to get high. The addicts die of opioid overdose. Of course they do not have Rx scripts, do they?

      “People rarely die after using opioids prescribed for them.” Again, Duh.

      Jeff Bobo, “Reputed Hawkins County drug kingpin sentenced to 150 months”, Kingsport Time-News, 26 Apr 2013
      “Laing, a part-time Beech Creek resident, opened the Liberty Wellness Pain Clinic in Norcross, Ga., in 2010 and began using the clinic to obtain oxycodone for distribution in East Tennessee. In April 2012, the federal Drug Enforcement Administration in Georgia raided the clinic and shut it down.”
      Following that the drug overdose rate in the affected area “dropped off to almost nothing.”

  4. So, people aren’t OD’ing on prescribed opioids. I’m curious how many of those dying from fetanyl became addicted to opioids through prescribed medication. I would like this question answered before the claim that prescription drugs aren’t at least contributing to the deaths

    1. “So, people aren’t OD’ing on prescribed opioids. ”

      Yes. They are.

      It’s just that, in comparison to the total number of people who take such drugs in any given time frame few of them die. (And as Jerry notes they only die once, while those who live can continue to repeat their positive experience.)

      But consider also that the vast majority of all people who receive medical care each year do not die from it. Yet it would be foolish and ignorant to say that “people are not dying from medical care.” Because about two hundred and fifty thousand people die each year from faulty medical care. (Other estimates place the number closer to 400K.)

      https://www.npr.org/sections/health-shots/2016/05/03/476636183/death-certificates-undercount-toll-of-medical-errors

      And yes, a portion of those people die from too much opioid, or too much opioid in combination with other agents.

    2. Or how many are dying from fentanyl because their attending physician refused to prescribe sufficient opioids to address their pain management needs and they turned to self-medication.

      I seem to recall there used to be somebody right here on this board that frequently argued that addiction is a myth. Claiming your lack of will-power is a disease is a direct rebuke to the millions of people who stop smoking, quit drinking, kick their drug habit, resolve to stop over-eating, stop gambling or cheating on their wives with anything in a skirt, in short, straighten up and fly right. Whatever crutch you have to use to help you walk the straight and narrow, claiming you’re a helpless victim of a disease you’re in no way to blame for is an off-road power scooter enabling you to avoid even thinking about finding the straight and narrow.

      1. “Or how many are dying from fentanyl because their attending physician refused to prescribe sufficient opioids to address their pain management needs and they turned to self-medication.”

        That is exceedingly rare, almost a unicorn. Pssudoaddiction is a term sometimes used by the pain management people. It describes a person with under treated pain who then displays the sorts of drug seeking behaviors (multiple docs, multiple ER visits, etc.) exhibited by non-medical users who can’t control their habit (ie. addicts.) They do exist and, between the combination of the newer restrictions and lots of prescribers being mostly lazy, and unwilling to jump through all the added hoops, are growing.

        But, by and large, these people are not risk takers. Not to the point where they will ingest mystery substances bought from strangers on the street. Pain is bad, but pain alone rarely makes one that self destructive. What they often do is turn to other agents or treatment modalities they may not have tried in the past. Sadly it seems CBD has largely been a disappointment for this group. Lastly, what they do is (tragically) kill themselves. But they usually do this in more obvious and reliable ways than mystery drugs.

    3. “I’m curious how many of those dying from fetanyl became addicted to opioids through prescribed medication. ”

      Most, if not nearly all. My wife was a substance abuse counselor and she said all of her patients got addicted to prescription opioids, then switched to heroin when their doctor cut them off and they became too expensive on the street

      1. I do not doubt they told her that. And is is apparent that she believed them. That said, it’s hogwash.

        People with legitimate pain recognize their problem as being legitimate. As I noted above when they are under treated they often do things that begin to appear (to medical people) as if they are addicts/abusers – this can lead to them being misdiagnosed or mislabeled as a problem and being denied medication.

        But remember that these people think themselves not to be the problem. The very last thing they are going to do, when being called an abuser, is confirm that label by going out and injecting street heroin.

        That.
        Makes.
        No.
        Sense.

        What you describe is a common behavior of all abusers/addicts (don’t care what the substance is) – to a person they are all people who are in denial about their own agency and how it got them to the place they currently are.

        1. I think if I were in bad enough pain and couldn’t get the needed analgesics, I’d turn to street drugs. If nothing else, I think they’d give me a sense of independence and mastery over my condition.

          1. You’d accept a very real risk of death, or other serious harm in order to reduce your sensations of pain?

            Really?

            1. People will do that.

              Think of surgery. People will undergo surgery to relieve pain even if there are risks.

      2. The thing is, just as most people who drink don’t go on to become alcoholics, most people who use opioids for pain relief don’t get hooked on them. The effects just aren’t that attractive to the average person. Most people would be OK even if heroin were OTC.

        What we really need isn’t a war on opioids. What we really need is a good test to distinguish people subject to that addiction from ordinary people, BEFORE they’re given opioids. Then they’d know to avoid them, and the rest of us could have effective pain relievers.

        1. Indeed they were OK when heroin was OTC.

          1. YES! People forget that. They’ve been made to forget that: Drugs used to be legal. And it wasn’t a horror show compared to today.

            Just like the Prohibition on alcohol made things much worse, so did the Prohibition on other drugs. The difference is that we called a halt to alcohol prohibition fairly quickly, and instead doubled down on drug prohibition.

        2. ” What we really need is a good test to distinguish people subject to that addiction from ordinary people, BEFORE they’re given opioids. ”

          That would be nice, but there is no indication that we will get one any time soon. We can’t even agree on the nature of the problem, much less predict it.

          What I strongly recommend is that people doing pain management adopt the approach taken by the addiction management field. That is: Close monitoring and supervision of the patient’s total well being. Pain management historically has focused solely on the physical state of the patient – keeping the pain tolerable (and maybe a bit on functionality) but almost nothing on everything else (e.g. work, home, family, etc.)

          That is what most ‘addiction treatment’ does – provides maintenance doses of drug to reduce withdrawal (and drug seeking behaviors) while helping the patient re-establish and maintain all the other aspects of a healthy and functional life. It’s not ideal (drug free and/or self control would be the ideal) but it works for a lot of people.

          Pain management people need to add those elements, and in doing so the risk of those patients dying from drug use will be greatly reduced (but can never be fully eliminated.) The main barrier to that approach is time/money.

          1. Bullcrap. Most Rx opioid users have just fine family & work lives, & the gross intervention of pain management folks into those aspects of a person’s life that you suggest is a violation of privacy. It’s just like the government already butting into too many corners of the public’s lives. If you’re under the care of a pain management specialist, s/he knows by constant interviewing about pain control how much your personal life is influencing their protocol. They don’t need to intrude any more than they already do.

      3. Respectfully, I completely believe your wife but I completely do not believe the addicts she was treating. Drug addicts are some of the most habitual liars on the planet.

        Having known a few drug addicts very well, including a few who overdosed, the patients, if they ever had a prescription, were probably already addicted to something when the got that prescription. They probably sought out the prescription specifically go get a “legitimate” source of a high-quality, safe drugs. The rest were just flat out lying.

        Are there some very corner cases where someone comes in for severe pain, gets addicted to prescription opioids, gets turned away and then switches to black market substitutes, sure, but those cases are the vast minority.

      4. The plural of anecdote is not data.

    4. “I’m curious how many of those dying from fetanyl became addicted to opioids after being cut off from their prescribed medication through prescribed medication.

      An even better question.

      1. become addicted to opioids by not taking them?
        my “street” experience is people become addicted to opioids by taking them.

  5. It should only available in tobacco and menthol flavors. Best way to solve this problem.
    https://www.hindiyaar.in/

  6. “A 2007 study reported in The American Journal of Psychiatry found that 78 percent of OxyContin users seeking addiction treatment reported that they had never been prescribed the drug for any medical reason.”

    So the people dying from prescription drugs are taking drugs that were prescribed for someone else. That… doesn’t remotely undermine the case that the prescription of these drugs is leading to deaths.

    “Since the researchers considered only active prescriptions, it’s possible that other decedents had been prescribed pain medication at some point in the past.”

    Yeah, you kinda buried the lede there.

    1. That’s the primary point of the clampdown on narcotic analgesics: making sure the patients have none left over after taking what they need for pain. But it’s hard to assure that without some patients not getting enough. I think both sides acknowledge that, and then it’s a matter of how much under-prescription or over-prescription they think occurs, and then their relative valuation of adequate pain treatment versus curtailing non-medical use and toxicity. Plus a third factor: how much time and effort doctors need to fine-tune patients’ needs and avoid both sides of the problem.

      1. Yep, the pendulum has swung from tolerating some overtreatment to tolerating undertreatment. The goal was to save lives by limiting the excess quantities that were making it into the secondary market.

        Some would have you believe this has caused additional deaths, that I find that claim both unsupported and unbelievable. However I do not think it has saved any lives either, and largely for the same basic reason – supply will rise to meet demand, and the most reckless and likely to overdose are also those with the strongest demand.

  7. You are all missing the point here. The Trial Lawyers can’t make any money suing the providers of illegal heroin and fentanyl. They can make money from the Drug Companies. It’s the current playbook. Take a so called crisis and find an angle that implicates the deep pockets and then get the media to hype the shit out of it and then sue.

    1. PERFECTLY SAID.
      Who else has the power to run even ethical doctors of medicine through kangaroo courts and and scare the living crap out of what remains? ‘opioid things’ is NOTHING more than a DOJ/AG money grab with a taste promised to all of their satellite investors including certain mainstream media. Prescribing is down now they will congratulate themselves about, …but overdose over-all are still rising. It was never a manufacturing or doctor prescribing issue.

  8. Last night on Jeopardy, a contestant said that 70,000 Americans die each year from opioid abuse. Alex said “we must do something more aggressive” to stop the crisis. The CDC puts the opiod deaths (2017) at about 48,000 with the higher figure being deaths from overdoses of all kinds of drug abuse.
    Has there been any statistics done on the % of those who die from o.d. after their physician “cuts them off” from opioids and the user turns to street drugs? If it is, say, 50%, then it might be better to allow doctors to continue Rxing the drug. But if it is that high, why are users chancing street drugs instead of facing the music and
    getting treated before the addiction becomes more firmly rooted?

    1. “Has there been any statistics done on the % of those who die from o.d. after their physician “cuts them off” from opioids and the user turns to street drugs?”

      That would be almost impossible to put together. Most street drug users are also prescription drug users, so the questions would include ‘which doctor – the first or the last?’ Because it is entirely possible they’ve seen multiple prescribers for both legitimate medically reasons (broken bone, dental work, whatever) and also to obtain recreation or withdrawal abaiting doses.

    2. SMH. MAYBE 15k from all sources were opiate only.
      Prescription involved overdoses are near 500 (five-hundred) persons. Most of them young, illicit users having stolen the medicine. Most are multi-drug and alcohol. We do not really know what these died from.
      LEGITIMATE pain sufferers encounter overdose or opiate use disorders %0.6.

  9. I predict that everyone who uses opioids is going to die. I make a similar prediction for everyone who *doesn’t* use opioids.

  10. I knew most opioid deaths happen to dumb fucks who never learned basic human physiology and think they can mix the pills with booze and meth in the same binge. What I didn’t know was that this isn’t plain to everyone else.

    1. Yes. What I call the ‘fatally clumsy’.
      Now 20 Million, in just the worst way, are cut-off or dangerously reduced and succumbing to secondary complications like heart failure, others are suiciding in desperation from UN-treated severe pain

  11. With prescription drugs and anything else in medicine everything is a risk/benefit calculation.

    It is probably true that the risks of outpatient prescription opioids were underestimated and marketed that way by the pharm industry. Now the benefits side is being underestimated as the media,legal profession, and government push in the opposite direction.

    Most docs just don’t want to deal with it. Send you to pain management is better than risking a lawsuit or the state medical board coming after you. Don’t see how anyone can blame them.

  12. Thank you for an accurate report.
    Many are dying and super-sick for this shameless money grab by the DOJ/AG.

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  13. As a practicing physician, I can tell you that the hysteria against prescription opioids is leading to under treatment of pain.
    Post surgical and chronic pain patients are both needlessly suffering.
    As was pointed out by others, for most of U.S. history all drugs were legal.
    And the country did not have the problems we have now with crime and addiction.
    I think it was better when we assessed patients for pain and we did what we physicians thought was in the patients” best interest

  14. I don’t much care if adults use (including overdose and die) drugs illegal or prescribed. As long as they make the decision to use, with or without consulting a “medical care professional”, it is none of my business. Oxy, heroin, fentanyl, marijuana, meth, bourbon, vegan bullshit, I just don’t care. These are adults. Let them do what they like. If a few unfortunates buy the farm due to bad concoctions or incontinent imbibing, whose responsibility is that? Mine? Yours? Our collective (read “government”) responsibility? I think not. It is the responsibility of the individual, maybe his or her family to a point. We are either adult citizens with rights and responsibilities particular to ourselves, or wards with no rights at all. We may lose a few unfortunate citizens along the way, but that sure beats turning us all into wards. Or does it?

  15. “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 cases.”

    People do become addicted to opioids as a result of hospital treatment for painful injuries and operations. I’ve known at least one person this has happened to and he will probably never get off it as he lives in England and gets his Fentanyl free. He has tried to get off it, but it would take a year of constant low-level pain to get unaddicted. Were he living in the US, the cost of Fentanyl would probably lead him to heroin. Eventually he will die after a Fetanyl-shortened life, but the cause of his death will be listed as something else.

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