Pubdate: Sun, 22 Mar 2015
Source: Albuquerque Journal (NM)
Copyright: 2015 Albuquerque Journal
Contact:  http://www.abqjournal.com/
Details: http://www.mapinc.org/media/10
Author: Charles Lane, the Washington Post

THE PRESCRIPTION OPIOID CATASTROPHE

When is this country going to wake up - really wake up - to the 
catastrophe that prescription opioid painkillers have caused since 
they came into widespread use in the early 1990s?

Before then, deaths related to prescription opioid overdose were 
practically unknown. In 2013, though, opioids killed 16,235 people; 
that's approximately half as many as died in traffic accidents that 
year, and about 2,000 more than were murdered. Both traffic accidents 
and murder have been declining for years, however, while 
painkiller-related deaths quadrupled between 1999 and 2013, according 
to the Centers for Disease Control and Prevention.

The toll from prescription opioid overdoses in that time exceeds 
175,000, three times the U.S. body count in the Vietnam War.

In short, the United States' massive investment in reducing avoidable 
deaths from other causes has been undone to a large extent by 
avoidable deaths stemming from the abuse of opioids, whose trade 
names include OxyContin, Vicodin and Percocet.

The latest evidence of these drugs' destructive impact comes from the 
Urban Institute, where researchers investigated the odd fact that 
death rates from various causes for non-Hispanic white women ages 15 
to 54 - a usually healthier-than-average cohort - appear to have 
spiked between 1999 and 2011.

It turns out that prescription opioid overdoses explain half of the 
phenomenon, according to a recent Urban Institute study.

This epidemic was brought to you not by Colombian drug cartels or 
some other nefarious outlaw force but by the American establishment - 
corporate, governmental and medical - which blessed the wider use of 
modern opioids in the belief that pain was vastly undertreated and 
that new, extended-release opioid formulations would not be addictive.

To question that judgment - to suggest that pain is inherently 
subjective and that encouraging doctors to pass out these powerful 
pills not just to patients with cancer but also to those with routine 
lower back problems, was a huge, deadly mistake, driven in 
significant part by the profit motive - is to risk being accused of 
insensitivity to suffering people.

As Stanford University psychiatrist Anna Lembke explained in a New 
England Journal of Medicine article (candidly titled "Why Doctors 
Prescribe Opioids to Known Opioid Abusers"), many doctors give 
drug-seeking patients what they want to avoid bad reviews on patient 
surveys and in social media.

Policies and attitudes toward opioids have become more realistic 
since Lembke's article appeared in October 2012. Yet even after a 
recent federal-state "crackdown" on opioid over-prescription, the 
Food and Drug Administration last year approved a new compound, 
Zohydro, despite a recommendation from an advisory committee that 
feared it would be easily abused.

Most U.S. doctors concede that opioids are overprescribed, and they 
have become more cautious about prescribing. But most also say they 
personally are not to blame for the problem, according to a Johns 
Hopkins Bloomberg School of Public Health study published last year. 
Pharmacies still filled 207 million prescriptions for opioids in 
2013, according to the National Institutes of Drug Abuse.

That's nearly triple the number in 1991 - a far higher rate of opioid 
prescription than any other country. The United States accounts for 
almost 100 percent of world consumption of hydrocodone and 81 percent 
of oxycodone, NIDA reports. Does this mean doctors in Europe and Asia 
are indifferent to their patients' suffering?

The slight recent reduction in opioid prescription has contributed to 
a rise in heroin abuse, and heroin overdose deaths, as opioid addicts 
seek a chemical equivalent on the street. Some argue the heroin boom 
discredits attempts to rein in opioid over-prescription.

This is exactly backward. The real point is how hard it is to wean 
thousands and thousands of people off these powerfully addictive 
substances, and, therefore, how terribly mistaken it was to 
distribute them so extensively in the first place. The sad fact is 
that many of those dying from heroin overdoses now might have died of 
prescription opioid overdoses without the "crackdown."

The United States is in the midst of a national debate about alleged 
excesses in the war on illegal drugs. It's a vigorous and necessary 
discussion. It's also ironic, given that the worst havoc in recent 
years was wrought by perfectly legal substances.

It appears that reducing the country's most troubling drug-related 
public health problem depends on more, and more intelligent, 
regulation, not less.

Whatever we do, we should remember that, like so many past tragedies, 
America's deadly prescription opioid epidemic stemmed from a 
combination of greed, hubris and the best of intentions.
- ---
MAP posted-by: Jay Bergstrom