MENU

Reason.com

Free Minds & Free Markets

Opioid-Related Deaths Keep Rising As Pain Pill Prescriptions Fall

The crackdown on analgesics continues to push nonmedical users toward deadlier alternatives.

New Hamphire State Drug LaboratoryNew Hamphire State Drug LaboratoryThe official numbers for opioid-related deaths in 2017, released by the U.S. Centers for Disease Control and Prevention today, demonstrate once again the folly of trying to tackle this problem by reducing access to prescription pain pills. The volume of opioids prescribed for American patients has been falling since 2010, while the upward trend in deaths involving opioids has accelerated, reaching a record number last year.

Of the 47,600 opioid-related deaths the CDC counted in 2017 (the black line on the chart below), 60 percent involved the drug category that consists mainly of illicitly manufactured fentanyl and its analogs (the red line). Just 30 percent involved the category that includes the most commonly prescribed pain medications (the blue line), and some of those deaths also involved fentanyl or heroin (the yellow line), which was implicated in one-third of the opioid fatalities. Last year's 13 percent increase in opioid deaths was due almost entirely to a 47 percent increase in deaths involving fentanyl and its analogs, since deaths involving heroin and pain pills stayed about the same, while deaths involving methadone fell.

Allowing for deaths involving multiple opioids, the CDC's numbers indicate that pain pills account for less than 30 percent of these deaths, and the actual number is probably considerably lower. A 2017 analysis of opioid-related fatalities in Massachusetts found that heroin or fentanyl was the deadliest drug in 85 percent of the cases.

The Trump administration nevertheless wants to reduce opioid prescriptions by a third during the next three years. But opioid prescriptions, measured by total morphine milligram equivalents (MME) sold, have already fallen by a third since 2010, as indicated by the green area in the chart (with units, in billions of MME, on the right axis). During that period, opioid-related deaths more than doubled. Does this seem like a winning strategy? CDC & FDACDC & FDAFar from reducing deaths involving opioids, the crackdown on pain pills has pushed nonmedical users into the black market, where the drugs are much more dangerous because their potency is highly variable and unpredictable. "Synthetic drugs tend to be more deadly than prescription pills and heroin for two main reasons," The New York Times notes. "They are usually more potent, meaning small errors in measurement can lead to an overdose. The blends of synthetic drugs also tend to change frequently, making it easy for drug users to underestimate the strength of the drug they are injecting. In some parts of the country, drugs sold as heroin are exclusively fentanyls now."

Meanwhile, patients suffering from severe pain are finding it increasingly difficult to obtain the medication they need to make their lives bearable. Many people with severe chronic pain who have functioned well on opioids for years have seen their doses dramatically and arbitrarily cut as a result of government pressure, including the CDC's own supposedly voluntary but increasingly mandatory prescribing guidelines.

Even people with agonizing terminal illnesses are not immune from the imperative to reduce opioid prescriptions. Barbara McAneny, the president of the American Medical Association, recently described a patient with metastatic prostate cancer who tried to kill himself after he could not get the medication he was prescribed for his bone pain because a suspicious pharmacist called his insurer, which denied coverage. While "I share the nation's concern that more than 100 people a day die of an overdose," she said, "my patient nearly died of an underdose."

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  • DiegoF||

    Is that supposed to be a representation of how much of each drug gets you equally fucked up?

  • Zeb||

    More likely equally dead in those quantities.

  • DiegoF||

    You get dead from taking one carfentanil? Why do they even make the pills in that dose? What a weird product decision. Mr. Gottlieb, I suggest you divert some agency resources away from almond milk and vape juice toward this matter for a day or two.

  • Echospinner||

    Looks like lethal doses

    Fentanyl is given in microgram amounts. Mostly used IV for sedation and anesthesia. Given by people trained in that. There is a patch used mostly in palliative care.

    Carfentanyl is only used in large animals like if you need to sedate a hippopotamus or something, so far as I know.

  • Homple||

    Want to not die from a drug overdose?

    (1) Don't take street drugs or unprescribed legit ones.
    (2) Take your prescription drugs in recommended doses only.
    (3) Don't expect libertarians bitching about the government to save you from your own stupidity.

  • Bubba Jones||

    The point is that the government makes it very difficult to get "prescription drugs in recommended doses."

  • BestUsedCarSales||

    And that policy in place by the government has led to less predictable and thus more dangerous versions of these drugs to hit the streets. There is always some inherent risk, arguably there is inherent risk in every single thing we do. The least the government can do is not further increase the risk.

  • SQRLSY One||

    Government Almighty policies are NOT data-driven; they are stupid-ideology and self-righteousness driven. Expecting data-driven policy out of Government Almighty is futile! It's like asking a fish to give up living in water!

  • Homple||

    Don't worry about government policies, data driven or otherwise. Want to not die from a drug overdose? Leave that shit alone.

  • Zeb||

    What if you care about other people, even stupid people making bad choices, not dying from an overdose?

    You aren't required to give a fuck, and I don't care if you do or not, but a lot of people do anyway.

  • BestUsedCarSales||

    This is such an odd argument I see here a lot. That is, if something has some danger to it, such as drugs, then who cares if the government enacts policy that makes it more dangerous? I've seen some form of it here quite often.

  • Overt||

    It is basically a domain of premises. While many people favor government intervention because they "care" about the individual, too many people just mentally accept that this means ALL people who "care" must therefore ride in the pro-government band wagon. Thus if you don't like the government, you obviously don't care about people making dangerous choices, and therefore shouldn't care about the level of risk.

    This is unfortunate, because it perpetuates the myth that libertarians care about themselves only. I am libertarian not only because I believe in individual rights, but ALSO because I believe that its practices are better for my community.

  • Homple||

    I care enough about people to tell them not to make bad choices in the first place. I tell them, contrary to libertarian thought that misuse of drugs is not kewl. I tell them to leave that shit alone. Then they don't have to worry about somebody improving government policy in time to keep them alive.

  • BestUsedCarSales||

    Sure, but you're also arguing that it's okay for the government to make it worse. Not even counting the attack on human freedom it causes. This makes a somewhat dangerous thing, considerably more dangerous by forcing further uncertainty into the equation.

    So, is your argument that if one does something dangerous in some capacity, then who are they to complain if the law is making it more dangerous?

  • Homple||

    No. People can avoid overdosing irrespective of what the government does by simply leaving that shit alone.

  • Yellow Tony||

    This is hilariously naive.

  • Homple||

    Not dying from not taking illegal drugs might be naive. I admit to being the original naif..

  • SQRLSY One||

    The writings of James Bovard ("Freedom in Chains" etc.) about 2 decades ago, informs me that fed anti-booze agents were known to chortle with glee when people died (or "merely" went blind) of methanol poisoning, from drinking badly-brewed booze. In those days, would you merely have told people not to drink booze? Would you NOT have been pissed off that self-righteous bastards had passed such bad policies, and empowered such assholes to ride us to death, merely for copping a buzz now and then?

    MeThinks you might have some NAZI-like tendencies run at least a wee tad amuck, and might consider some serious self-examination...

  • BestUsedCarSales||

    I can generalize this to anything. People can avoid dying in car accidents by not riding in cars (something with a pretty significant risk rate, btw). People can avoid dying by X by not doing X. That's just a tautology you're saying.

    The question is, if people are going to do it, should the government use force that actively makes the activity more dangerous. Your logic would say that if the government started taking shots at people rock-climbing, that it's then all on them if they die while rock climbing. There are many such absurd conclusions, all of which are consistent with your statement. All of it seems based in an idea that, once government makes something you disagree with illegal, then the government has no moral culpability for the results of their actions.

  • Overt||

    All of it seems based in an idea that, once government makes something you disagree with illegal, then the government has no moral culpability for the results of their actions.

    I would add that perhaps "moral culpability" is debatable. However, it is not at all inconsistent to say "People should be free to take risks" and also say "They should be free to take those risks without the government making them even riskier". Nor is it wrong to point out the obvious- "If you try to 'save' people by outlawing 'risky' stuff, you actually create more tragedies."

  • Overt||

    I care enough about people to tell them not to make bad choices in the first place.

    This is a simplistic statement. If you are injured on the job and the doctor prescribes you pain pills, are you making a bad choice? Probably not. But your doctor pretty much has his hands tied, and can only prescribe a certain number of pain pills because of some one-size-fits-all prohibitionist "recommendation". If he feels you need more, he runs the risk of paperwork and enforcement problems. So is it a "good" choice if he thus chooses to under medicate you?

    As noted in one of the links, the government has made all sorts of pain treatment nearly impossible. If your doctor prescribes OxyCotin for chronic pain, you have to follow draconian rules, including accounting for every pill. Have you made a "bad" choice if you lose a week's worth of pills, and are now permanently banned from having any pain pills? Maybe you made a bad choice and got hooked, but now you want to make the "good" choice. Prohibition makes it harder for you to get effective treatment without legal trouble.

    While there are certainly people with bad priorities, government policy is increasingly forcing people to either make a "bad" choice, or get ineffective or no treatment for their pain. Many of these people would have chosen the "good" choice if it was available to them.

  • Homple||

    I agree, the government is wrong for messing with necessary prescriptions. The government has overreacted to the people killing themselves with overdoses by making pain killers needlessly hard to get for those who need them.

    Just because I think people should avoid illegal drugs and be careful with legally prescribed ones does not mean I agree with the feds' stupidity.

  • BestUsedCarSales||

    You keep using illegal drugs like it's some inherent category and not an aspect of policy just like all laws. During prohibition, if someone drank (alcohol, an illegal drug at the time) and got sick from drinking due to government policy preventing safe consumption, were they also guilty? Was the government guiltless?

  • SQRLSY One||

    There's also the problem of disaster prep (approaching hurricane, etc.). Prepare (and take with you if you must depart) your stash of critical meds!

    But Government Almighty says I can only get 5 pain pills at a time, and then I have to see a doctor of doctorology again!

    What the hell am I supposed to do, if I really do need pain meds, when preparing my boogey-outta-town bag?!?! Pack my personal prescribing doctor of doctorology into my bag?!!?

  • BestUsedCarSales||

    a patient with metastatic prostate cancer who tried to kill himself after he could not get the medication he was prescribed for his bone pain because a suspicious pharmacist called his insurer, which denied coverage.

    Sheesh, what a drama queen. Someone tell him to harden the fuck up.

  • Overt||

    I went to get my wife some pain pills after she broke a bone a couple weeks back. I ended up waiting at the pharmacy for over 2 hours in the middle of the night. It turns out that they are required to have a time-delay safe for opioids. So when I drop off the prescription, even if there is no one ahead of me, they enter the order and have to wait for the safe to output the drugs.

    This is so insane. We have basically made it so that people with an addiction have to turn to unscrupulous doctors who don't care about well being and the black market for their drugs. Is it any surprise that opioid deaths are shooting up? And on top of this, it has created such a demand for black market drugs that people who really need the drugs have to sit like idiots at the local CVS for hours, or go to the pharmacy several times to fill tiny orders, or whatever.

    But I'm sure we just need a little more prohibition and that will take care of everything.

  • Homple||

    "We have basically made it so that people with an addiction have to turn to unscrupulous doctors who don't care about well being and the black market for their drugs."

    One of the things Reason seems to insist on is that people have a right to take the stuff that gets them addicted in the first place. Then it's odd for an outfit that whoops for personal ownership and responsibility to blame the government for what people do to themselves voluntarily.

  • Overt||

    Ugh. We get it. Taking drugs is risky. You would *never* take any risks.

    Reason fights for the freedom to take risks, but also the freedom to *manage* those risks. There is nothing logically inconsistent here. Maybe you don't see a need to taking a risk with opioids. Some people with chronic pain might make a different decision. Again, part of the libertarian ethos is that we should give those people the maximum freedom to manage risk individually.

    The government has made it very difficult for real patients to manage chronic pain. It has made it very difficult for people to manage addiction. Your answer seems to be "Fuck those people- they should have chosen to live with the pain from crushed nerve endings for the rest of their lives. It isn't my fault that the only choice left to those people due to the government is to go underground."

  • Homple||

    Take all the risks you want, just don't bawl about dealing with the consequences yourself.

  • BestUsedCarSales||

    If I take drugs, and the government comes in and kills me, puts a bullet in my head, is this just a consequence of my actions? The government owns no blame?

  • Yellow Tony||

    Nearly every governor and congressman in my state was running on throwing a fuckton of money at solving this unfortunate and salient problem. They were also running on shooting more resources from their money dicks into "revitalizing" rural shitholes. Both are dark pits, and they would be best solved by letting local communities, independent human agency, and the Free Market™ do their thing. Because from what I've seen, keeping fucks in these small depressing and nearly-derelict areas is influencing them to find refuge in deleterious and outright harmful "solutions."

  • Bronze Khopesh||

    If only the "hugs not drugs" thing had caught on.

  • Yellow Tony||

    I'm fairly sure it was a thing for a brief period before it was shown that it led to unprotected sex and AIDS.

  • DajjaI||

    Reducing prescriptions means that fewer people will get addicted to the drugs in the first place. Deaths would be a lot higher if not for that. We just need to expand access to treatment. Yes there are very effective treatments but many states refuse to fund them.

  • Homple||

    If the government does anything, the feds should loosen their grip on valid prescriptions. States and private organizations should support addiction treatment.

  • Echospinner||

    ^ that

    It is not just the feds. A lot of those regulations come from state medical boards.

  • Echospinner||

    I had a related experience today.

    Took our older dog to the vet with my son. The dog is having some age related problems.

    The vet prescribed her something and my son told her that he had found online the CBD oil can help. CBD oil is legal here.

    Turns out the state is blocking the veterinarians from dispensing or directly recommending it. Once we brought it up she was very enthusiastic about it and gave us a recommendation of what to buy.

    She had just had a lecture on the subject. One interesting thing is dogs have more receptors for canabis than humans so it may work better for them. THC is toxic for dogs so you need a pure product

GET REASON MAGAZINE

Get Reason's print or digital edition before it’s posted online