From the CDC:
Deaths from prescription painkillers* have reached epidemic levels in the past decade. The number of overdose deaths is now greater than those of deaths from heroin and cocaine combined. A big part of the problem is nonmedical use of prescription painkillers—using drugs without a prescription, or using drugs just for the “high” they cause. In 2010, about 12 million Americans (age 12 or older) reported nonmedical use of prescription painkillers in the past year.
Enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for a month.
Time’s Healthland blog takes issue with the the CDC’s concern about prescribing habits:
Let’s start with the facts: the vast majority of people who misuse prescription painkillers — 7 out of 10, according to drug czar Gil Kerlikowske — get them from family or friends, not directly from doctors. Secondly, most people addicted to these medications have used illegal drugs previously; they do not become addicted while being treated for pain.
A 2007 study of nearly 1,400 people addicted to OxyContin, who were treated at rehabs across the country, found that 78% had never been prescribed the drug themselves; the same percentage had been in rehab for a previous drug problem. Earlier data found that 80% of those addicted to OxyContin had previously used cocaine, a rate many times that seen in the general population.
This is a bit of a straw man. Does concern about prescribing patterns equate to saying doctors are turning pain patients into addicts?
Isn’t it of concern that friends and families have extra opiates laying around to give to friends? Doesn’t this suggest that they may have been overprescribed?
It seems like the more important data point might be the following: What percentage of misused opiates originated from a prescription?
I don’t know the answer, but it wold be helpful.
The Time post trots out more straw men:
…most people who use illegal drugs don’t subsequently go looking for dealers or rob their grandmothers to get money to buy more.
Addiction doesn’t just “happen”…they are not automatons with no free will. Their ability to choose not to take drugs may be reduced as they get hooked, but it’s not eliminated: after all, no one shoots up in front of the cops.
Even among soldiers who served in Vietnam — 45% of whom tried opium or heroin while serving — just 1% developed ongoing heroin addictions that persisted after they came home.
I agree that while adult exposure to opiates might lead to dependence, it does not create addiction. However, the CDC report uses the word addiction one time, in a sidebar, and dependence does not appear at all. It uses the words death/kill/die eleven times. The report is focused on concerns about deaths from opiates AND demonstrates a relationship between prescribing patterns, misuse and deaths. Isn’t this cause for concern?
Further, the post foreshadows a resurrection of Reagan era drug war:
The fact that addiction is not just about access to drugs is why talk of drug “epidemics” rarely changes their course. Supply-side efforts have had little effect on addiction rates. The exponential growth on such spending since Ronald Reagan declared war on drugs in the 1980s has no correlation whatsoever with rates of drug problems. The recent crackdown on prescription opioids began in the mid-2000s, with intense concern over OxyContin misuse — and yet overdose deaths continue to rise.
The post ignores that supply practices appear to have had significant influence on overdose rates over the last 10 years. Why the doubt that different supply practices might influence overdose rates? Now, I know that these things can snowball into something that bears little resemblance to what was initiated, but the CDC’s draconian governmental suggestions are:
The US government is
- Tracking prescription drug overdose trends to better understand the epidemic.
- Educating health care providers and the public about prescription drug abuse and overdose.
- Developing, evaluating and promoting programs and policies shown to prevent and treat prescription drug abuse and overdose, while making sure patients have access to safe, effective pain treatment.
- Start or improve prescription drug monitoring programs (PDMPs), which are electronic databases that track all prescriptions for painkillers in the state.
- Use PDMP, Medicaid, and workers’ compensation data to identify improper prescribing of painkillers.
- Set up programs for Medicaid, workers’ compensation programs, and state-run health plans that identify and address improper patient use of painkillers.
- Pass, enforce and evaluate pill mill, doctor shopping and other laws to reduce prescription painkiller abuse.
- Encourage professional licensing boards to take action against inappropriate prescribing.
- Increase access to substance abuse treatment.