Federal policy is unquestionably making the nation’s opioid problem worse — while also inflicting collateral damage on Americans in genuine need of pain medication.
And this disaster is being further driven by a myth that has gained additional credence from the Centers for Disease Control and Prevention’s latest guidelines for prescribing opioids.
The myth: that lax prescription of opioid drugs, such as oxycodone, is a primary driver of addiction. This notion has triggered a nationwide crackdown on these prescriptions in the name of preventing addiction and saving lives, an action that has been a catastrophe by almost any measure.
Dissenting opinions do exist. Physicians for Responsible Opioid Prescribing, a group that promotes strict control of prescriptions, admits that chronic pain patients have a “very legitimate fear” of restrictions. Yet the group, which was involved in formulating the CDC guidelines, nonetheless recommends a one-size-fits-all daily cap on the permissible opioid dose, regardless of the patient.
Reviewers have rightly criticized PROP for using shoddy evidence in support of its findings. In the past decade, more than a dozen professional papers — including a systematic analysis known as a “Cochrane Review” of 26 other studies, and a 38-study review in the journal Pain — have debunked the idea that addiction routinely starts with legal use. In most cases, it doesn’t; people who use prescription opioids properly and legally rarely become addicts.
Overwhelmingly, the ones who become addicted are those who start off using opioids for recreational purposes. The next stop is street drugs.
Paradoxically, the CDC guidelines managed to harm both addicts and patients with legitimate needs in one fell swoop. Consider OxyContin — a major drug of choice for addicts that in 2010 was reformulated to make it far harder to abuse.
Illegal OxyContin use did indeed plummet immediately — but abusers then switched in droves to heroin, which is far more dangerous, and deaths from heroin overdose soared from 3,000 in 2009 to 13,000 in 2015.
Worse still, black-marketeers are now blending fentanyl — a highly potent, synthetic version of heroin — with heroin itself, or substituting it outright for the “natural” drug. That’s responsible for much of the soaring ODs.
The Department of Health in Ohio — which has the highest number of opioid deaths in the nation — reported in 2015 that more than 80 percent of opioid deaths arose from heroin or fentanyl, up from 20 percent in 2010. Health agencies in Florida and Massachusetts report similar trends. It’s now indisputable that most recent opioid deaths result from heroin/fentanyl, not pain pills.
Another side of the equation is the cruel and needless suffering inflicted on blameless Americans who can no longer easily get pain medications. Just as addicts will do almost anything to feed their addiction, people in severe pain will do what is needed to escape it — even suicide.
Indeed, escaping pain is becoming increasingly difficult. People who have been treated appropriately and responsibly for years are now finding it difficult to obtain the relief they need, even from the same doctors. And you can’t blame the doctors.
Physicians rightly view the CDC “advice” as anything but voluntary. With the DEA looking over their shoulders, they fear losing their licenses for overprescribing. This creates just another wall between doctors and patients, many of whom are now forced to cope with their pain by using non-opioid, over-the-counter drugs such as Advil and Tylenol. These drugs are less effective and also carry their own risks, chiefly liver, kidney, stomach and heart toxicity.
But perhaps nothing illustrates the folly of government policies better than the rising number of pain sufferers who turn to street heroin because they can no longer get legal medication. What a travesty.
As a nation, we now find ourselves in a worse place than before this simple-minded crackdown began. While the most vulnerable suffer, rivers of the real killer drugs pour into our country illegally unabated.
“First, do no harm” is the essence of the Hippocratic Oath. Federal policymakers should honor that principle — and abandon their cruel and unconscionable war on pain medication.
Josh Bloom is director of Chemical and Pharmaceutical Sciences at the American Council on Science and Health.
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