Opioids

The Surge in Drug-Related Fatalities During the Pandemic Highlights the Root Causes of Addiction

The crackdown on pain medication made drug use more dangerous and did nothing to address the factors driving "deaths of despair."

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The Centers for Disease Control and Prevention (CDC) recorded more drug-related deaths in 2019 than ever before, and the latest preliminary data indicate that record was broken again in 2020—by a lot. The CDC estimates that more than 90,000 Americans died during the 12-month period ending in September 2020, up 29 percent from the previous 12-month period. The COVID-19 epidemic probably had a lot to do with that striking jump, an explanation that highlights the faulty premises underlying the government's response to the "opioid crisis."

These drug-related deaths mainly involve opioids, overwhelmingly heroin and illicit fentanyl. "Synthetic opioids other than methadone," the category that includes fentanyl and its analogs, accounted for 73 percent of opioid-related deaths in 2019, up from 14 percent in 2010. "Natural and semisynthetic opioids," the category that includes commonly prescribed analgesics such as hydrocodone and oxycodone, were involved in 24 percent of those deaths, but half of those cases also involved heroin or fentanyl.

According to the CDC WONDER database, three-quarters of the deaths involving pain pills in 2019 also involved illicit opioids, alcohol, barbiturates, benzodiazepines, cocaine, or methamphetamine. Pain pills by themselves (i.e., not combined with other drugs) accounted for less than 6 percent of opioid-related deaths and no more 4 percent of all drug-related deaths.

Yet President Joe Biden still wants to "stop overprescribing while improving access to effective and needed pain management," which is code for continuing to discourage and restrict opioid prescriptions. That strategy already has deprived bona fide patients of the medication they need while driving nonmedical users toward black-market substitutes that are far more dangerous because their potency is highly variable and unpredictable. The results can be seen in the ever-rising number of opioid-related deaths, a trend that not only continued but accelerated after the government succeeded in driving down prescriptions for pain medication.

Deaths involving pain pills rose more than fivefold between 1999 and 2017, then fell by 18 percent as of 2019. Meanwhile, deaths involving the category of drugs that includes fentanyl rose 50-fold, and total opioid-related deaths sextupled. That does not seem like a good tradeoff.

The attempt to reduce opioid-related deaths by making pain pills harder to obtain failed because it was based on the misconception that exposure to these drugs causes addiction. That is clearly not true.

Data from the National Survey on Drug Use and Health (NSDUH) indicate that about 2 percent of people who had used prescription opioids in the previous year (for medical or nonmedical purposes) might qualify for a diagnosis of "substance use disorder," a broad category of drug-related problems that includes what used to be called "substance abuse" and "substance dependence." By comparison, according to the latest NSDUH results, about 8 percent of past-year drinkers experienced an "alcohol use disorder."

Exposure to opioids obviously is not a sufficient explanation for opioid addiction, just as exposure to alcohol is not a sufficient explanation for alcoholism. What other factors are important? The experience with the COVID-19 pandemic suggests a few.

While opioid-related deaths were already rising, The New York Times notes, "the pandemic unquestionably exacerbated the trend, which grew much worse last spring: The biggest jump in overdose deaths took place in April and May, when fear and stress were rampant, job losses were multiplying and the strictest lockdown measures were in effect." The Times cites a study by Brendan Saloner, an addiction researcher at Johns Hopkins University's Bloomberg School of Public Health, who found that many drug users had increased their consumption during the pandemic. They also were more likely to take drugs on their own, which increases the risk of a fatal outcome, and most reported consuming mixtures of drugs, "another red flag."

In other words, pandemic-related isolation, psychological stress, and economic difficulty help explain last year's surge in drug-related deaths. The pandemic magnified the problems that make drug use more attractive, but it did not create them. Reducing opioid prescriptions does nothing to address those problems; it merely encourages people who experience them to use other, more dangerous drugs.

Contrary to the conventional narrative, which blames the "opioid crisis" on an oversupply of pain pills, "drug-related deaths have been rising since the late 1950s," as a 2019 report on "deaths of despair" from the Joint Economic Committee noted. The increase in opioid-related fatalities is the latest manifestation of that long-term trend. When it comes to drug-related "deaths of despair," the root problem is the despair, not the drugs.

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  1. It only didn’t work because we didn’t do it hard enough. Do it again, but this time with feeling!

    1. Is it racist that I read the last sentence in “Fistfull of Yen” accent?

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  2. >>(CDC) recorded more drug-related deaths in 2019 than ever before

    “could that guy spell ‘drug’? count it.”

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  3. WaPo ‘fact-checker’ Glenn Kessler gets fact-checked.

    Cliffs: Ahead of his giving the Official Republican Response to Biden’s address, Kessler takes aim at Sen. Tim Scott and his “Cotton Fields to Congress in 2 Generations” biography. Glenn, the son of a Proctor and Gamble VP, suggests Sen. Scott is a lying hack who comes from privilege, because his grandfather may have dropped out of 4th grade instead of 3rd grade (isn’t dropping out of 4th grade ‘3rd grade education’? Anyhoo…) and was able to scribble his own name legibly on a land deed.

    So someone does some research into Glenn’s Dutch family, who were in the oil and steel business. And by that I mean his great-grandfather founded Royal Dutch Shell, and leadership passed to his sons. During WWII. they were Nazi Collaborators, using slave labor for the war effort. Someone posts a picture of Glenn’s grandfather, and his response is, “nun-unh, that’s my Great Uncle”. He says his grandfather didn’t collaborate with his great-uncle, and cites a Wikipedia article, edited by Glenn Kessler, as his source.

    https://mobile.twitter.com/GlennKesslerWP?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor

    The ratio and replies are epic.

  4. I feel bad for pain patients, but the fact is they could stop this hysteria just by attending their local AA/NA meetings. There they would meet the scoundrels pushing addiction propaganda. They would discover the motivation for doing drugs is just mischief, not an unbearable compulsion as we are told. Also they would discover that most overdoses are intentional not “Oops I just wanted to get high and took one too many.” They would learn that their lives are being sacrificed so that drug users can have fun and be irresponsible and then ‘make amends’ for it later in life (and brag about their exploits). Working together, they could disrupt the network that rationalizes the drug war. (However they don’t do that because many of them actually still believe in addiction despite all the evidence.)

    1. Yeah I’ve been attending AA meetings for over 25 years. I have any idea what you’re talking about. The addiction specialist doctors are not in the rooms of AA. They have no clue.

      1. Like I said, all pain patients have to do is go to meetings and listen to your drunkalogs where you brag about your sexcapades and deny it. Then they will be disgusted for suffering for your sins and they will demand an end to addiction nonsense.

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    2. Working together with whom? With the scoundrels?

      1. If you can’t figure it out yourself that’s fine. But then I have little sympathy for you, like I said.

        1. STFU, tardo

  5. That strategy already has deprived bona fide patients of the medication they need while driving nonmedical users toward black-market substitutes that are far more dangerous because their potency is highly variable and unpredictable.

    Well, yes, it’s also created a vast black market in legally produced pills that are merely sold on the secondary market.

  6. While opioid-related deaths were already rising, The New York Times notes, “the pandemic unquestionably exacerbated the trend, which grew much worse last spring: The biggest jump in overdose deaths took place in April and May, when fear and stress were rampant, job losses were multiplying and the strictest lockdown measures were in effect.”

    Lockdown measures the Times supported and cheered on.

  7. The increase in opioid-related fatalities is the latest manifestation of that long-term trend. When it comes to drug-related “deaths of despair,” the root problem is the despair, not the drugs.

    This is where things get tricky. It seems, increasingly, that if one tries to have a rational discussion about despair, you’re written off as some kind of kooky right-wing populist who refuses to accept the benefits of our liberal, technological utopia that has created benefits for all across the spectrum, and anyone who questions the downside just doesn’t understand the downstream benefits of a tech-service related economy.

    1. I’m pretty sure – nay 100% certain – that ‘right-wing populist’ solution to ‘despair’ is crap. All you are doing is politicizing a mental health issue. Vs Sullum who wants to medicalize it via drugs.

      Hell I can posit something else entirely – that Americans are generally unhappy because of a)extremely high expectations that we should be happy and b)moderate ability to realize those expectations and c)very poor ability to bridge the gap between a and b.

      May be true. May not be. But hell even my supposition can help explain reactions to 2020/lockdown/etc.

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    2. Right wing? I thought touchy-feely stuff like despair as a side effect of modern society was primarily within the province of the “left”

  8. In other words, pandemic-related isolation, psychological stress, and economic difficulty help explain last year’s surge in drug-related deaths. The pandemic magnified the problems that make drug use more attractive, but it did not create them. Reducing opioid prescriptions does nothing to address those problems; it merely encourages people who experience them to use other, more dangerous drugs.

    What in the flying fuck. You’re implying that increasing opioid prescriptions helps deal with and maybe even solve isolation, stress, or economic difficulty.

    And since ‘economic difficulty’ is one of the conditions that you think doctors should be prescribing medication for, you are really asserting that the US should have national opioid subsidies.

    1. Yes. Because I can’t get the same medication I got before the 2016 cdc guidelines on pain medication for chronic pain, I can no longer work which creates economic difficulties.

  9. Sure the “suicides” dropped, but the overdoses and murders rose. I notice libertarians ignored the rise in murder rates and waved their hands at overdoses all right.

    The covid lockdowns failed. The “peaceful” protests were violent. The government is focusing on all the wrong things. The people are unhappy. I expect there’s gonna be a great 2022 election in which many woke democrats get tossed out permanently.

    1. I expect there’s gonna be a great 2022 election in which many woke democrats get tossed out permanently.
      Why would you think that? You highlight the fact that government is doing everything badly, which it is, but largely people aren’t unhappy because the government is doing too much wrong. They are unhappy because the government is not doing enough wrong. The People want more spending on everything, more restrictions on the people they don’t like, more government control of free speech, less individual rights. The solution to government created problems is always more government. Voters only have a hammer so every problem must be a nail.

  10. Yet President Joe Biden still wants to “stop overprescribing while improving access to effective and needed pain management,” which is code for continuing to discourage and restrict opioid prescriptions.

    Is there only one control knob on this machine? Is there only one control knob possible on this machine? Is it impossible to discriminate better: to simultaneously make it easier to get narcotics to people who need them, and harder to get them to those who would be harmed by them?

    It’s fine to be in favor of individual liberty, but since it seems so hard to make progress quickly in that regard, are there any second-best solutions we can have to improve life in the meantime?

    For instance, maybe we can’t drive taxes down far, or even keep them from increasing, but can we alleviate the problem by simply getting richer, so there’s more for us all, including government? If we can’t get prostitution legalized, can we make our sex lives better, so we don’t need prostitution as much? For those who are against abortions, are there good substitutes for abortions? I think there’s a chance in all those cases — that there are ways to improve society that are orthogonal to questions of individual liberty, and that make those questions less pressing. Is narcotics prescribing just too resistant to finding such amelioration?

  11. Right now Kaiser Permanente in Washington is force tapering patients against CDC, HHS, VA, AMA, FDA and Human Rights Watch guidelines. This is a violation of the ADA which also provides that doctors cannot discriminate on patients based on the legally controlled substance they require (see Selma Medical v DOJ). I have asked in writing for accommodation and been denied.

    The province has made the practice illegal due to the damage it causes. I am one of the patients who is being even more disabled by KP policies. I am losing my ability to walk and stand. I had to get a walker and take paratransit, yet they dare to blame my pain on opiates.

    Well, the opiates are gone, and my symptoms are still there, but overwhelming at times and affecting every other one of my conditions. I am falling through the cracks of one of the number one rated health providers in the country.

    I have filed 6+ grievances and NOTHING. I am now going public w my sensitive medical history looking for an advocate somewhere. I am willing to write on my own if need be and put it all out there.

    I have recordings of me in tears asking a doctor what I should do for my pain, he yells at me in anger “GETOFFTHEDAMNOPIATES.” I am ready to try to file a class action suit.

    I have all my documentation I have sent them, and records of my decline. I have a ten page report on the guidelines. The same doctor above told me “YOUAREWRONG.” when I told him about forced tapering being against guidelines.

    I have not gotten meaningful medical care in 12 months. My doctor, in writing, invoked paternalism, telling me I was willing to accept any risk to stay on opiates, therefore I am not able to give informed consent. This is not true. I used opiates successfully for 15+ years with no adverse events. NONE. Revoking consent is highly unethical and only done in cases where patients are a danger to themselves. I am not.

    I asked him why I did so much better on higher doses, his answer, “I don’t know.” I am ready to blow it all up and publish everything if that is what it is going to take.

    PS He also refused to discuss the dangers of untreated pain. I need help badly and there is no one to be my advocate so I am going to have to do what I have to do, and if that means putting all these grievances up on a website, so be it.

    I am not going to give up on myself and the ability to live the best life I can in comfort. I AM NOT THE PROBLEM.

  12. Curious about correlation studies concerning getting a $1200 stimulus check while being a heroin addict. Do overdoses increase?

    1. It is simple methematics

  13. When those in severe pain can not get the relief that they need and even to get a paltry hay-fever pill someone sneezing their head off has to wait for a special clerk with a special code and endure a mini interrogation, we are sacrificing too many and too much to protect a very small and dumb minority of drug users from themselves and to pad some cops’ pay and pensions.

    1. Stop having medical insurance pay for all prescriptions outside the hospital setting

  14. A lot of this is Darwin at work. It sounds cruel but that is what it is. If a person becomes addicted after a medical procedure, that is one thing. If they get addicted from recreational use or they just can’t handle life, that is nature trying to thin the herd. They are the slow running gazelles of the human race.

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  16. You’re not allowed to tally the health costs of the lockdowns. Only the imagined benefits.

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