Menu
Back to Journals » Journal of Pain Research » Volume 12
Today’s nonmedical opioid users are not yesterday’s patients; implications of data indicating stable rates of nonmedical use and pain reliever use disorder
Authors Singer JA , Sullum JZ , Schatman ME
Received 28 December 2018
Accepted for publication 23 January 2019
Published 7 February 2019 Volume 2019:12 Pages 617—620
DOI https://doi.org/10.2147/JPR.S199750
Checked for plagiarism Yes
Editor who approved publication: Dr Katherine Hanlon
Jeffrey A Singer,1–3 Jacob Z Sullum,4,5 Michael E Schatman6,7
1Valley Surgical Clinics, Ltd., Phoenix, AZ, USA; 2Department of Health Policy Studies and Center for the Study of Science, Cato Institute, Washington, DC, USA; 3Goldwater Institute, Phoenix, AZ, USA; 4Reason Magazine, Los Angeles, CA, USA; 5Creators Syndicate, Hermosa Beach, CA, USA; 6Research and Network Development, Boston PainCare, Waltham, MA, USA; 7Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
According to the narrative underlying current policies aimed at reducing opioid-related deaths, the problem can be traced to a dramatic increase in opioid prescribing that began in the late 1990s. This trend supposedly was fueled by unscrupulous pharmaceutical company representatives who convinced practitioners that opioids posed a low risk of misuse and overdose (although a recent analysis1 suggests there were probably 30 or more root causes of the crisis). To illustrate this narrative, politicians and journalists have cited examples of patients who accidentally became “hooked” on opioids while taking them for pain, such as teenagers with orthopedic injuries who found the analgesics prescribed for them so alluring that they progressed to lives of drug abuse and addiction.2 This narrative drives policies targeting the prescription of opioids to patients in pain, with the goal of reducing the risk of addiction as well as the diversion of prescription opioids to the underground market. These policies include state prescription drug monitoring programs (PDMPs), abuse-deterrent formulations of prescription opioids, prescribing guidelines, and legal restrictions on prescribing for both acute and chronic pain.
Conclusion
The current overdose crisis is rooted in the intersection of long-term psychosocial and cultural trends with the lucrative opportunities offered by drug prohibition. Ending drug prohibition will not curb the growing tendency to use drugs nonmedically. However, it will potentially reduce the resulting harm. Short of decriminalization, policymakers should abandon one-size-fits-all intrusions into the clinician–patient relationship. As an alternative, they should consider prioritizing harm reduction measures such as expanded access to medication-assisted treatment, needle exchange, and supervised injection facilities, and rescheduling naloxone to make it available as a truly over-the-counter drug.26
Health care in general, and pain and addiction management in particular, are nuanced undertakings. Current public policies aimed at reducing opioid-related deaths ignore such nuance in favor of ham-handed, empirically dubious, and demonstrably harmful dictates. Americans suffering from chronic pain, and those from whom they receive their treatment, deserve medical care managed through better-informed and more even-handed policy.
Disclosure
Dr Singer serves as a consultant to Reed Smith, LLC. Dr Schatman serves as a consultant to Kaleo Pharma. The authors report no other conflicts of interest in this work.
References
Madras BK. The President’s Commission on combating drug addiction and the opioid crisis: origins and recommendations. Clin Pharmacol Ther. 2018;103(6):943–945. | ||
Christie C, Baker C, Cooper R. Final Report of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Washington, DC: White House; 2017. Available from: https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-1-2017.pdf. Accessed December 26, 2018. | ||
Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999-2017. National center for health statistics, data brief No. 329; 2018; 1–7. Available from: https://www.cdc.gov/nchs/data/databriefs/db329-h.pdf. Accessed December 26, 2018. | ||
Hoots BE, Xu L, Kariisa M, et al. Annual surveillance report of drug-related risks and outcomes. U.S. Centers for Disease Control and Prevention; 2018. Available from: https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf. Accessed December 26, 2018. | ||
United States Food and Drug Administration. FDA analysis of long-term trends in prescription opioid analgesic products: quantity, sales, and price trends. Available from: https://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Reports/UCM598899.pdf. Accessed December 26, 2018. | ||
IQVIA. U.S. prescription opioid volume declined 12 percent in 2017–largest drop in 25 years. IQVIA; 2018. Available from: https://www.iqvia.com/newsroom/2018/04/iqvia-institute-for-human-data-science-study-us-prescription-opioid-volume-declined-12-percent-in-20. Accessed December 26, 2018. | ||
Deprez EE, Hui L, Wills K. Deadly Chinese fentanyl is creating a new era of drug kingpins. Bloomberg; 2018. Available from: https://www.bloomberg.com/news/features/2018-05-22/deadly-chinese-fentanyl-is-creating-a-new-era-of-drug-kingpins. Accessed December 26, 2018. | ||
Schatman ME, Ziegler SJ. Pain management, prescription opioid mortality, and the CDC: is the devil in the data? J Pain Res. 2017;10:2489–2495. | ||
United States Centers for Disease Control and Prevention. About multiple cause of death, 1999–2017. Available from: http://wonder.cdc.gov/mcd-icd10.html. Accessed December 27, 2018. | ||
Singer JA. Abuse-deterrent opioids and the law of unintended consequences. Cato Institute Policy Analysis; 2018. Available from: https://object.cato.org/sites/cato.org/files/pubs/pdf/pa832.pdf. Accessed December 26, 2018. | ||
Fink DS, Schleimer JP, Sarvet A, et al. Association between prescription drug monitoring programs and nonfatal and fatal drug overdoses: a systematic review. Ann Intern Med. 2018;168(11):783–790. | ||
Bergen-Cico D, Scholl S, Ivanashvili N, et al. Opioid prescription drug abuse and its relation to heroin trends. In: Preedy VR, editor. Neuropathology of Drug Addictions and Substance Misuse. Volume 1: Foundations of Understanding, Tobacco, Alcohol, Cannabinoids and Opioids. London, UK: Academic Press; 2016:878–887. | ||
Center for Behavioral Health Statistics and Quality, United States Substance Abuse and Mental Health Services Administration, United States Department of Health and Human Services, Research Triangle Institute. Results from the 2014 National Survey on Drug Use and Health: Detailed Tables; 2015. Available from: https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs2014/NSDUH-DetTabs2014.htm#tab6-47a. Accessed December 26, 2018. | ||
Carise D, Dugosh, KL, McLellan AT, et al. Prescription OxyContin abuse among patients entering addiction treatment. Am J Psychiatry. 2007;164(11):1750–1756. | ||
Jalal H, Buchanich JM, Roberts MS, et al. Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016. Science. 2018;361(6408):1218. | ||
Fox M. Opioid crisis started 40 years ago, report argues. NBC news; 2018. Available from: https://www.nbcnews.com/storyline/americas-heroin-epidemic/opioid-crisis-started-40-years-ago-report-argues-n911456. Accessed December 26, 2018. | ||
Cicero TJ, Ellis MS, Kasper ZA. Increased use of heroin as an initiating opioid of abuse. Addict Behav. 2017;74:63–66. | ||
Sullum J. America’s war on pain pills is killing addicts and leaving patients in agony. Reason. 2018;49(11):18–29. | ||
Mencken HL. Prejudices: Second Series. London: Jonathan Cape; 1921. | ||
Singer JA. The war on opioids has become a war on patients. Cato at Liberty; 2018. Available from: https://www.cato.org/blog/war-opioids-has-become-war-patients. Accessed December 26, 2018. | ||
Kertesz SG, Gordon AJ. A crisis of opioids and the limits of prescription control: United States. Addiction. 2018;14:169–180. | ||
Mundkur ML, Gordon AJ, Kertesz SG. Will strict limits on opioid prescription duration prevent addiction? Advocating for evidence-based policymaking. Subst Abus. 2017;39(2):125–128. | ||
Singer JA. The AMA gets it right by defending evidence-based medicine and patient, physician autonomy. Cato Institute; 2018. Available from: https://www.cato.org/blog/unfairly-accused-ama-actually-shows-backbone-defense-evidence-based-medicine-patient-physician. Accessed December 26, 2018. | ||
Darnall BD, Juurlink D, Kerns RD, et al. International stakeholder community of pain Experts and leaders call for an urgent action on forced opioid tapering. Pain Med. 2018;19(11):2099–2100. | ||
Singer JA. New FDA initiative implies CDC opioid guidelines are not evidence-based. Cato at liberty; 2018. Available from: https://www.cato.org/blog/new-fda-initiative-implies-cdc-opioid-guidelines-are-not-evidence-based. Accessed December 26, 2018. | ||
Singer JA. Harm reduction: shifting from a war on drugs to a war on drug-related deaths. Cato Institute Policy Analysis; 2018. Available from: https://object.cato.org/sites/cato.org/files/pubs/pdf/pa-858.pdf. Accessed December 26, 2018. | ||
Dove Medical Press encourages responsible, free and frank academic debate. The content of the Journal of Pain Research ‘Editorial’ section does not necessarily represent the views of Dove Medical Press, its officers, agents, employees, related entities or the Journal of Pain Research editors. While all reasonable steps have been taken to confirm the content of each Editorial, Dove Medical Press accepts no liability in respect of the content of any Editorial, nor is it responsible for the content and accuracy of any Editorial. |
© 2019 The Author(s). This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License.
By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.