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Law & the Courts

Junk Science, a Presidential Commission and Opioid Myths

Over at Reason, Jacob Sullum does the work that the political class is either too idle, or  too nervous or too blinkered to do—and takes a look at what lies behind some of data surrounding today’s opioid crisis:

Sullum reports that the President’s Commission on Combating Drug Addiction and the Opioid Crisis (motto: “We’re from the government and we’re here to help”) headed by Chris Christie has endorsed the idea that the current wave of opioid abuse began with “a growing compulsion to detect and treat pain.”

As ‘compulsions’ go, that strikes me as being on the benign side, but there we are.

Sullum (my emphasis added):

[T] he narrative endorsed by the commission is wrong in several crucial ways. Doctors did not mistakenly believe that the dangers posed by opioids had been greatly exaggerated. They correctly believed that the dangers posed by opioids had been greatly exaggerated, and they were right to think that excessive fear of opioids had led to inadequate pain treatment. Contrary to the impression left by a lot of the press coverage, opioid addiction and opioid-related deaths rarely involve drug-naive patients who accidentally get hooked while being treated for pain. They typically involve polydrug users with histories of substance abuse and psychological problems. Attempts to prevent overdoses by closing off access to legally produced narcotics make matters worse for both groups, depriving pain patients of the analgesics they need to make their lives livable while driving nonmedical users into a black market where the drugs are more variable and therefore more dangerous.

That was something that would have consequences that were both predictable and catastrophic.

I wrote a bit about this here, amongst other things citing this passage from Josh Bloom of the American Council on Science and Health (again, my emphasis added):

A bit of digging around on the NIH [National Institute of Health] site tells us otherwise. In 2010, the year that OxyContin became abuse-resistant, 20,000 people died from opioid overdoses. During the ensuing five years, OxyContin abuse dropped and the strict restrictions we now see on opioid pills began to take hold. The result? Between 2010-2015 [annual] opioid overdose deaths in the US increased by 65%, roughly 13,000. And even a cursory examination of Figure 2 [You’ll have to follow the link to the whole piece to see the chart] shows that increase was entirely due to injectable drugs like heroin or fentanyl.

Heckuva job, drug warriors.

Sullum (again, my emphasis added):

According to the National Survey on Drug Use and Health (NSDUH), 98 million Americans used prescription analgesics in 2015, including both legal and illegal use. About 2 million of them qualified for a diagnosis of “substance use disorder” (SUD) at some point during the previous year. SUD is a catchall category that subsumes what used to be known as “substance abuse” and the more severe “substance dependence.” The Substance Abuse and Mental Health Services Administration, which oversees the survey, does not report the breakdown between mild, moderate, and severe SUD. But based on this survey, it looks like somewhere between 1 and 2 percent of prescription opioid users experience addiction in a given year. By comparison, NSDUH data indicate that about 5 percent of past-year drinkers had an alcohol use disorder in 2015. That group was about evenly divided between “abuse” and “dependence.”

… The risk of fatal overdose among patients is very low. The CDC cites “a recent study of patients aged 15–64 years receiving opioids for chronic noncancer pain” who were followed for up to 13 years. The researchers found that “one in 550 patients died from opioid-related overdose,” which is a risk of less than 0.2 percent. A 2015 study of opioid-related deaths in North Carolina found 478 fatalities among 2.2 million residents who were prescribed opioids in 2010. That’s an annual rate of 0.022 percent….

[W]hen you look at the characteristics of the people whose deaths were attributed to prescription opioids, you see that 61 percent had used illegal drugs, 80 percent had been hospitalized for substance abuse (including abuse of alcohol and illegal drugs as well as prescription medications), 56 percent had a history of mental illness, and 45 percent had been hospitalized for psychiatric reasons other than substance abuse…

So-called overdose deaths typically involve combinations of drugs. In the North Carolina study, for example, benzodiazepines were detected in 61 percent of the deaths attributed to prescription opioids. The numbers in New York City are similar, and that’s just for one class of depressants. Over all, more than 90 percent of opioid-related deaths in New York involve drug mixtures. For the most part, people are not dying simply by taking too many pain pills…

The prescription guidelines that the CDC issued last year, which encourage physicians to be stingy with opioids, already have had a noticeable impact on patients’ ability to get adequate treatment for their pain.

And their suffering will do nothing to reduce the death toll from an opioid crisis that in its causes and consequences is far for more complex than the politicians and a panic-of-the-day media would like you to think.

But for Chris Christie, that’s fine.

He’s from the government and he’s here to help.

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