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The New York Times Suggests Opioids Should Be Reserved for Terminal Patients

An editorial calling for further restrictions on pain pills grossly exaggerates their dangers.

Wkimedia CommonsWkimedia CommonsThe New York Times agrees that "people with cancer and other terminal conditions who experience excruciating pain" should have access to opioid analgesics, albeit as "a last resort." But the paper's editorial board seems to think that other patients—people with gunshot wounds or broken bones, people recovering from surgery, people who are not on the verge of death but have chronic conditions that cause severe pain—should take Attorney General Jeff Sessions' advice to "take some aspirin" and "tough it out."

According to the Times, opioids "pose a great risk when used to treat the kinds of pain for which there are numerous nonaddictive therapies available." Apparently it does not matter whether those "nonaddictive therapies" are equally effective, as long as they are "available." This cruel prescription is based on an analysis of the "opioid crisis" that ignores important distinctions and grossly exaggerates the dangers to people who use narcotics for pain relief.

The Times is wrong when it asserts that opioids prescribed for pain "pose a great risk" to patients. The research indicates that the risk of addiction in people who take opioids for acute pain is quite low, something like 1 percent. Addiction rates are higher but still modest, according to most studies, among people who take opioids for chronic pain. The risk of a fatal overdose among patients with opioid prescriptions is even smaller—on the order of 0.02 percent a year, judging from a 2015 study of opioid-related deaths in North Carolina.

The Times conflates deaths involving all opioids with deaths involving pain pills. It says "opioid overdoses killed more than 45,000 people in the 12 months that ended in September," citing a provisional count by the U.S. Centers for Disease Control and Prevention. In the context of an editorial about the dangers of opioid analgesics, the implication is that those deaths were caused by careless prescribing. Yet a large majority of them involved heroin and illicitly produced fentanyl.

The Times says "about 2.6 million people suffer from opioid use disorder" in the United States, citing an unspecified "government survey." The 2016 National Survey on Drug Use and Health put that number at 2.1 million, 1.8 million of whom were using prescription pain relievers. The Times does not mention the total number of Americans who use prescription pain relievers, which according to NSDUH was 92 million in 2016.

In other words, NSDUH found that 2 percent of the people who used prescription opioids, whether legally or illegally, experienced a substance use disorder (SUD). By comparison, the same survey indicates that 9 percent of drinkers experienced an alcohol use disorder in 2016. Maybe whiskey should be reserved for dying cancer patients.

The Times erroneously equates SUD with addiction, a narrower category. SUD subsumes what used to be known as "substance abuse" and the more severe "substance dependence," which corresponds with what most people have in mind when they talk about addiction. Someone who is not addicted can qualify for a diagnosis of opioid use disorder by meeting two out of 11 criteria, which include a "strong desire" for opioids, using more of them than intended, and using them in physically hazardous situations.

The Times describes people with opioid use disorder as "pain patients who are addicted to their prescription pills." The implication is that medical treatment is the usual route to opioid addiction. But according to NSDUH, just 37 percent of people who used pain pills for nonmedical purposes in 2016 obtained them through prescriptions written for them, and that does not necessarily mean they began as bona fide patients. Opioid-related deaths usually involve polydrug users with histories of substance abuse and psychological problems, as opposed to drug-naive patients who accidentally get hooked while being treated for pain.

Because the Times overestimates the risks that opioids pose for the average pain patient, it ends up endorsing restrictions that are bound to cause needless suffering. "To stem the number of new opioid users," it says, "lawmakers and regulators need to stop pharmaceutical companies from marketing drugs like OxyContin and establish stronger guidelines about how and when doctors can prescribe them."

Attempts to prevent addiction by reducing access to prescription analgesics already have made it difficult or impossible for many people who suffer from severe chronic pain to obtain the medication they need to make life bearable. As the Times itself noted last week, the crackdown on pain pills has raised "questions about whether some pain patients are now being undertreated, and whether tightened prescribing over the last few years has contributed to the surge in overdose deaths from heroin and especially fentanyl."

Although opioid prescriptions have fallen substantially since 2011, opioid-related deaths continue to rise. That is mainly because of dramatic increases in deaths related to heroin and illicit fentanyl, which are more dangerous than legally produced opioids because their potency is unpredictable. To the extent that restrictions on prescription pain relievers are driving nonmedical users into the black market, they are contributing to those trends. But even deaths involving pain pills have risen since 2011.

The problem, according to the Times, is that this seemingly counterproductive strategy has not been pursued aggressively enough. "Doctors have been writing fewer opioid prescriptions in recent years," it says, "but even the new level is too high." How does the Times (or the Drug Enforcement Administration) know what level of opioid prescriptions is just right? It doesn't, and therein lies the problem for patients who suffer from severe pain but are not lucky enough to be dying from cancer.

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  • chemjeff radical individualist||

    One of those rare times when the New York Times and Jeff Sessions agree.
    Ugh.

  • BestUsedCarSales||

    I bet they agree more often then either is willing to admit.

    Also, I wonder how long until Nardz comes to this thread.

  • Chipper Morning Baculum||

    Yep, they probably agree more than they disagree.

    Christ, what a bunch of assholes.

    Also, this sounds like a recipe for more prison rape.

  • colorblindkid||

    A reminder that the Drug War was launched entirely with good intentions with largely bipartisan support, including from Democrats and leaders of the Black community. The dishonest rewriting of the origins of the Drug War to absolve Democrats and liberals of all blame, and making it appear to be entirely a racist white supremacist plot from the beginning only makes us more likely to make the same mistakes in the future.

    There are absolutely people with racist intentions when fighting the Drug War, but they were not the main drivers.

    Likewise with gun control and the Democrats' and media's refusal to acknowledge that it is largely a black man problem. Who do you think will wind up being hurt if the government cracks down on illegal guns? It's not the white gun nut rednecks. Same mistakes all over again. All for the greater good.

  • Tony||

    How do you parse all of this what with being colorblind?

  • shawn_dude||

    Any evidence that this is "largely a black man problem?"

    Let's count all of the mass shootings this year and see how many of them were perpetrated by black men.

  • UnrepentantCurmudgeon||

    If "mass shootings" were the only indicia of gun violence in this country you would have a point. Since they are not, you are just blowing smoke.

  • Michael Ejercito||

    I too have noticed the particular focus was on mass shootings.

    I am old enough to remember when gang violence was the problem.

    Both the media and politicians focused on gang violence. Gang violence was considered the greater threat than mass shootings.

    Time magazine even put a picture of Yummy Sandifer on the front page.

    A columnist for the Long beach Press-Telegram ran a series of columns titled "Javier's Legacy", which was about gang violence.

    And yet, somewhere along the way, gang violence ceased to be a problem. None of the politicians nor network pundits mention the problem of gang violence anymore.

    Apparently, to these people, only mass shootings counts.

    Apparently, to these people, Shevon Dean, Stephanie Kuhen, Joseph Swift, and Jamiel Shaw are not as dead because they were not killed in mass shootings.

  • marshaul||

    Who gives a fuck about the blame game. This is just more BS team apologia. Jesus Fucking Christ himself could have instituted the drug war and it would still be idiotic & wrong.

  • MichaelL||

    If WWJD was asked, back then, the "War on Drugs" would not have happened! Cannabis was determined as sinful, by a 12th century Pope! Although the past Popes might think they are the last word, in Christianity, I do not agree! Again, I go back to the person who was the reason for the season! Drug laws have no Christian basis!

  • DWC||

    "...the Drug War was launched entirely with good intentions..." Are you serious?

  • cravinbob||

    How many weeks back in time do you go for your "Drug War"?
    The term "War on Drugs" emerged I believe with Richard Nixon but the illegality began in the late 1800s. It is a fact that drug laws are all based 100% in racism. A 'war" over 100 years long. It is also a fact that government has never issued a single fact about drugs and the worst drugs can do to a person is cause prison time. As with anything moderation is important and the most dangerous drug out there is alcohol. Death caused by alcohol use is far and away worse than heroin in spite of the fact that you have heard about heroin O.D. often in the media but death by heroin is rare. Contraindications are the culprit, mixing drugs is ill-advised and a heroin death always involves another substance such as alcohol from which government taxes to the tune of 7 billion dollars a year. Benzodiazpems are another.

  • Microaggressor||

    This is one of those situations where reflexively opposing the "Trump Agenda" would have been a good call. But the NYT is too ideologically committed to control freakery to consider any possible upside to leaving people alone.

  • SusanM||

    Are we Americans really this fucking bored with existence that there needs to be a new apocalypse every week? And, yes, boredom. Desperately trying to fill the void left by having overcome disease, wild animals and Disco will be more our undoing than any medication.

  • BestUsedCarSales||

    As long as people are doing things others disagree with, then the apocalypse is nigh.

    Also, you play Yakuza 6 yet?

  • SusanM||

    Not yet. I'm actually alternating between Bloodbourne and the Mass Effect trilogy right now. I missed out on ME the first time around so I thought I'd see if it was as good (and as bad) as everyone says it is. People should look up to dorks to learn how to occupy one's time without being an asshole to other people.

  • sarcasmic||

    People should look up to dorks to learn how to occupy one's time without being an asshole to other people.

    Telling people about your dorky exploits isn't assholerry?

  • SusanM||

    Absolutely not. I am justly proud that while some weirdos are going around making friends and doing squishy things with other people I am filling my time properly. Someday, I hope to be as smug about it as a Prius owner or - dare I dream? - an ex-smoker!

  • BestUsedCarSales||

    I really enjoyed ME1, but it's the only one I played. Particularly the soundtrack. Bloodborne I liked as well, though not as much as DS. I think it was hyped up too much to me.

    People should look up to dorks to learn how to occupy one's time without being an asshole to other people.

    Let's not get carried away. Eltingville Club is basically a documentary.

  • SusanM||

    True, but someone spending their time arguing about the canonicity of The Killing Joke is still spending it better than someone arguing about what to ban next.

    I'm liking the MS series so far. Haven't finished 3 yet, so I'm about to see how bad the ending really is. I'm liking Bloodbourne a little less than Ni-Oh, which has a tighter level structure.

  • sarcasmic||

  • SusanM||

    My universe has expanded just a little more :) The second clip reminded me of New Years in 1979 for some reason.

  • sarcasmic||

    Metric is a great band.

    This is one of my favorites.

    This is one of my daughter's favorites.

  • silver.||

    One of my favorite bands. I missed out on seeing them open for Muse, and I've always regretted it.

  • sarcasmic||

    Do you like CSS?

  • No Longer Amused||

    To which I respond, "perhaps someone should kneecap the entire editorial staff of the times, and then tell them they can only have aspirin."

  • Unicorn Abattoir||

    When they say no opioids, they mean for the common peons. The NYT editors are totes ok with opioids for themselves.

  • Cynical Asshole||

    Most of them probably have "a guy" who can get them whatever they want. Heroin, coke, high class hookers, you name it.

    And a "fixer" who can make problems like dead hookers who got into their stash and OD'd go away.

  • sarcasmic||

    You don't?

  • Unicorn Abattoir||

    And if one of them sprains an ankle, the first thing they'll be demanding is codeine.

  • Hugh Akston||

    Never let inconvenient facts get in the way of a good prohibition.

  • Diane Reynolds (Paul.)||

    People need to be nudged into making good choices. So what if the nudging is done at the end of a bayonet.

  • Cynical Asshole||

    So long as that bayonet is attached to an "assault rifle" being wielded by a government agent, who are the ones allowed to have them, then there's no problem at all. = NYT editorial staff

  • $park¥ leftist poser||

    This has nothing to do with any "epidemic" or even with people dying from overdoses. This is what happens when you force everyone in the country to pay for the medication for everyone else in the country. Eventually you start feeling entitled to make medical decisions for people who aren't you and you're obviously going to want to save money.

  • Unicorn Abattoir||

    I'm betting the NYT editorial staff were control freaks long before healthcare was socialized. They feel entitled to make decisions for everyone else because they're the NYT editorial staff.

  • Citizen X - #6||

    Yeah. That's the fun thing about secular Puritanism - getting all up in other people's choices is its own justification.

  • Cynical Asshole||

    What's the point of having this big, bloated, all-powerful leviathan of a government if you can't use it to force your preferences on others?

  • Unicorn Abattoir||

    Well, we could use it to protect people's freedoms and let them live their lives as they please...

    Just kidding. Let's keep trying to create a communist autocracy with us installed at the top.

    /NYT Progs

  • Diane Reynolds (Paul.)||

    I'm glad to see the New York Times, ever skeptical of state power and the damaging effects of the drug war, have taken a stand on this issue.

  • Brett Bellmore||

    I don't know. I have to say that I've had opiates prescribed for me for recovery from surgery, when I had cancer, (The chemo worked, thankfully!) and while I was waiting for the swelling to go down enough for a broken ankle to be operated on.

    And they never did me any more good than good old naproxen.

    But I may be atypical, (In fact, I know I am; Opiates cause me insomnia!) and I generally don't think newspaper editors and legislators are the best people to get your medical advice from.

  • Pain sucks||

    NSAIDs are powerful pain relievers and probably work just as well as opiates
    For a it's pain relief...problem is with chronic pain they can start to and can destroy your digestive system which can kill you when organs start failing...worst side effects with opiates is they can stop you from breathing but easily remedied by taking them as prescribed like most chronic pain patients do when they're lucky enough to be prescribed them in this opiate hysteria climate. Most of my life NSAIDs were enough ...until they started damaging my digestive system and causing pain where there had been none before. Now I'm lucky enough to be prescribed the smallest dose of tramadol a very weak synthetic opiate and I'm grateful to be in bed but not writhing in pain...I used to have an active life outside of my bed, but sadly the government has decided that a medical treatment that was working for me is no longer allowed for no good reason...I'm just hoping this changes in my lifetime as my condition gets worse as I age and I'm only 47 spending the majority of my life in bed.

  • Pain sucks||

    Oh and opiates also cause me insomnia too...and a desire to talk to people

  • Eddie1975||

    Do I get to be involved in their healthcare decisions?

  • shawn_dude||

    Yes. If you vote based on "Obamacare" and such, you already have been.

    The larger question is, are you also paying for the externalities caused by over-prescription of addictive drugs? And the answer to that is, if you're paying for insurance, then yes, yes you are.

    Even the OP author grudgingly admits, at the very end of his rant, that maybe some of the non-prescription opioid addicts got their start on a legal prescription and graduated to heroin and other drugs when their prescriptions dried up.

    Libertarians are all gung ho for liberty, which is great as far as it goes, but they don't seem to ever consider the external costs. Heroin addicts mugging people and breaking into homes to steal whatever they can hock for drugs is just one set of costs everyone pays for the addict's habit.

  • Citizen X - #6||

    Libertarians are all gung ho for liberty... but they don't seem to ever consider the external costs.

    Drink!

  • marshaul||

    Heroin addicts mugging people and breaking into homes

    Hah hah! Good one.

    https://tinyurl.com/y8ybqu5z

  • Eddie1975||

    "Yes. If you vote based on "Obamacare" and such, you already have been"

    Not really.

  • Tony||

    How about I get the drugs and then "tough it out" during the withdrawal.

  • shawn_dude||

    If your healthcare covers addiction services, then yes, this a reasonable solution.

  • marshaul||

    "Addiction services" is a euphemism for drug dealing, right?

    Seriously, though. Having lived with an addict, from what I've seen watching South Park is a much better rehab program than whatever you have in mind.

  • John||

    As with all things at the New York Times, there is a huge element of class snobbery going on here. Rich people go to rehab when they get hooked on pain pills. Poor people go to jail. The Times knows this and is happy to send more poor people to jail for their own good. If rich people went to jail over this, the Times would view it differently.

  • shawn_dude||

    An interesting hypothesis which is easily debunked by simply considering what the Times is recommending: that poor people are also denied access to these drugs if they aren't terminally ill. If the poor are denied access, they won't get addicted and they won't have illegal drugs or commit crimes to get more supply. That means the poor would be less likely to go to jail over post-prescription addictions.

    More to the point, if you can only be prescribed opioids when your insurance covers addiction therapy, then that would be classist because only the rich could afford the better insurance that would give them the more effective drugs. But that's the basic Libertarian approach to healthcare anyway so I'm not getting your source of outrage (other than just an extreme dislike for a Left-leaning newspaper.)

  • Unicorn Abattoir||

    So if they're not terminally ill but are in severe pain (read the article), they shouldn't have access to legal opiates so they don't get addicted.

    Of course, without those legal opiates (with their low addiction rates) poor people should have to seek out street drugs instead or just suffer at the behest of their betters. You're a real humanitarian.

  • sarcasmic||

    because only the rich could afford the better insurance that would give them the more effective drugs

    public assistance covers more than private insurance

  • marshaul||

    Shawn, you reprehensible shitheel, the only method government has for "denying access" to anything is to jail those who access it anyway.

    Stop pretending you have a high horse, or a moral bone in your body. You're a vindictive, selfish fuck.

  • MichaelL||

    Ignorance about the "addiction problem" is why we get attitudes such as yours. People who get treated for pain, rarely become addicted. It is the people who choose to abuse opiods, and those with other mental conditions, that are becoming the addicts. some reports have the addiction rate at 0.05% of pain patients, who received pain prescriptions. That is less than the alleged 1.5% of the general population that become addicted! The media is the biggest problem with the present "opiod epidemic", with all of its ignorant propaganda! It should, more properly, be called the "heroin/Fentanyl epidemic", from clandestinely produced "opiods". But, lets let the politicians decide who gets what! And, let the other doctors, ignorant of all of these facts, run the real pain management doctors out of business! As if, they understand the plight of the poor. I am one physician who could relate to the poor, while I practiced, and now that I am surviving on retirement from Uncle Sam! You see, it is not as common that physicians come from families that lived with poverty level income, which I did before, and during, my schooling.

  • JuanQPublic||

    The NYT and the lions share of publications have done an incredible disservice to law-abiding patients who experience real chronic pain, first and foremost, and everyone else.

    The problems are the huge implications of the articles, without outright lying. The implications usually suggest that addiction rates are high among the general public who uses the medications, with no context whatsoever. They are likely making the problem worse.

  • Juice||

    I'll bet a month's salary that none of the people that say shit like this live with severe chronic pain.

  • Mindscape||

    They fail to take into account the number of lives SAVED by opioids. I had debilitating pain for months and I would absolutely be dead if not for pain meds. I got addicted and quit cold-turkey once a long-term solution was identified (in my case, epidurals). The first 3 days after I stopped taking the meds were hell. The next 10 days sucked. After that, I was fine. I would gladly take those few weeks of self-supervised rehab in exchange for relief of excruciating pain over the course of months. I tried physical therapy, massage, acupuncture, healthy diets, etc. Until you have experienced prolonged chronic pain, you have no idea what it can do to you mentally.

  • Pain sucks||

    I think you were physically dependent and not "addicted" ...most powerful drugs must be titrated off...like steroids, ssris, etc.

  • silver.||

    So, the "opioid crisis" is way overblown, but how big of a problem are the "deaths of despair" as a whole? Those without degrees are getting left behind, but hasn't worker obsolescence been a problem since the beginning of the industrial revolution? Some people are going to lose their place in any free market and have to either adapt and overcome or fail.

    Is this a simple market correction or the start of the breakdown of society? Some folks are pointing at Brexit and Trump as symptoms of the same restlessness, but I just have no perspective on the magnitude of normal social tumult. It still isn't anything like the 60s/70s, right?

  • JuanQPublic||

    A Bachelors degree is essentially what a high school diploma was 30-40 years ago. But college isn't for everyone. Plenty of bright people could benefit from the shortage of skilled labor by going to a technical or trade school.

  • sarcasmic||

    A Bachelors degree is essentially what a high school diploma was 30-40 years ago.

    That's what they were telling me twenty years ago.

    I think it's because they don't focus on the three R's as much because we use keyboards instead of pens, internet searches instead of libraries, calculators instead of arithmetic, and so on and so forth.

    There is so much more accessible information out there than there ever was before.

    In my mind the problem is trying to teach everyone a bit of everything. That's like giving a man a fish. Teach kids how to learn, how to think, and how to look up information. That showing them how to fish. Facts are useless by themselves. But the ability to look them up is more valuable than the ability to remember them.

  • MichaelL||

    That was the attitude at my medical school at Southern Illinois University, from where I graduated in 1979! There is no way to memorize everything! It is more important to be able to research things for yourself. Sadly, medicine, in general is still catching up! Sadly, the education caused trouble with the good old boys, with whom which I had to practice! That was medicine in the '80-s...(;-P

  • Echospinner||

    Then came patient satisfaction surveys, RVUs, fifth vital sign, what is a doc to do?

  • jjsaz||

    I have to seriously consider cancelling my subscription to the Prohibition Times. What a cluster!

  • ||

    Opiates saved my life. I no longer have to use them but there was a point (for 10 months) my pain was so great my options were Assisted End of Life in Switzerland or Opiates.
    FUCK OFF STATISTS!

  • RonBPalmer||

    I personally wish those editors experience decades of chronic pain so that they can experience first hand the pure evil that they embrace.

  • JFree||

    Addiction rates are higher but still modest, according to most studies, among people who take opioids for chronic pain.

    Well that study you cited is hardly evidence of 'modest addiction rates'. They cite 8% as some strict definition (whatever that is) of addiction - and ranges of 15-26% (and I've seen studies that go up to 35%) for slightly 'less strict' definitions that include actual behavioral examples of abuse/misuse/etc that are strong indicators that the prescription is no longer mainly for medical purposes. With 4% transitioning to heroin. This is not 'modest' at all considering the marketing of the drugs to a mass market on TV.

    It is doctors - not gummint - that began to realize they were being played for suckers re opioids. No surprise however that Sullum thinks opioids are the best thing since sliced bread.

  • MichaelL||

    Addictionologists (who get paid to treat addictions) are the ones who came up weth these numbers! Other studies, by real pain specialists, do not agree with those numbers!

  • JFree||

    How much do pain specialists get paid for refusing to prescribe opioids to a patient who's lying to them?

  • Eric L||

    "...the kinds of pain for which there are numerous nonaddictive therapies available."

    Ah, yes. I can just see hospital staff coming into your room, lighting a black candle and leading you, the patient, in saying the following:

    God and Goddess

    Hear my plea

    Take this pain away from me

    Leave me feeling good instead

    Strong of body, clear of head

    So Mote It Be

  • Eric L||

    or you could just put the lime in the coconut and drink it all up.

  • WillPaine||

    We have mercy for the dying; why can we not have mercy upon the living. Serious medicine that, in its misuse, is maligned; used well, opioids will give you time in life without having to be practically be immobile. Medicine is not something I want my government to practice. Let my doctor practice medicine, not politicians, for social control.
    Pain began with your first bicycle crash at about 8 yoa. May you live well and prosper, long enough to know; then, you will know why God put this plant on earth

  • gjdagis||

    Only people who are in pain should be allowed to determine opiod use policies.

  • MichaelL||

    Certainly not journalists and politicians!

  • LEAPGuyAZ||

    As pain management physicians reduce or cut off patients who suffer chronic pain who will be responsible for the increase in suicides?

    Patients can only live in pain being treated like a drug addict by physicians and pharmacists before the fight becomes too much and they give up and end the pain.

  • Duelles||

    I am terminally ill. Not to make light of those with horrible afflictions who are short term, but we are just deteriorating slowly. I drink every day and on occasion get some opioid prescription which rarely gets completely used since I don't need them forever. What I want more than ever (not) is to have my healthcare, pain management approved of by the NYTimes. Holy crap!

  • Mat||

    In my professional opinion your rebuttal misses the real concern. Exposure of exogenous opioids to systemic cell receptors alters the underlying neurophysiological processes of nociception and ultimately the pain experience by also acting on HPA axis and emotional/affective processing and stress physiology, effectively increasing potential for central sensitization and moving into a maladaptive state of chronic pain. On a related note, this sensitization process at a chemical level can occur with even one dose in some cases. The issue is not primarily about addiction. Next, virtually anyone taking these medications longer than a few weeks will develop dependence -a distinct physiological construct from addiction, which is why the side effect profile from removal is great in attempting to discontinue their use, independent of the presence of addiction. Additionally, the risk for depression and other serious effects with exposure represents a public health concern. I agree with the Times, but not because of the focus on abuse/overdosing. These other facets represent the real concern - poorly treated pain, poor understanding of pain and complexity of factors informing predisposition to chronic pain (ACEs, chronic stress, psychophysiology and more). We have a systemic and cultural problem in the US, not seen in other countries. Your argument about unnecessary suffering is correct, but your use of that construct is philosophically flawed.

  • Echospinner||

    You make some good points.

    Philosophy has nothing to do with it.

    That is where libertarians, I am one, often miss the issue. There is science backed by long experience in this class of drugs.

    This is not weed.

  • drisco304||

    NYT is practicing medicine without a license.

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