Pubdate: Wed, 25 May 2016
Source: Odessa American (TX)
Copyright: 2016 Odessa American
Contact:  http://www.oaoa.com/
Details: http://www.mapinc.org/media/708
Author: Jacob Sullum

'OPIOID EPIDEMIC' MYTHS

Last week, the House of Representatives approved what The New York 
Times described as "a mountain of bills addressing the nation's 
opioid abuse crisis." The 18 bills passed "by huge bipartisan margins."

A flurry of legislative activity like this usually materializes when 
the drug problem it targets is already receding. That seems to be the 
case with the so-called opioid epidemic, notwithstanding the fresh 
attention attracted by the recent death of Prince, which may have 
involved prescription painkillers.

According to the National Survey on Drug Use and Health (NSDUH), 
nonmedical use of opioid analgesics such as oxycodone and hydrocodone 
peaked in 2012 and has since dropped below the rate in 2002. Although 
the recent decline in prescription painkiller use was accompanied by 
an increase in heroin use, total opioid use was still lower in 2014 
than in 2012.

Despite the decline in use, opioid-related deaths reported by the 
U.S. Centers for Disease Control and Prevention continued to rise 
through 2014, when there were 29,467, a record number.

An overwhelming majority of such deaths - more than nine out of 10, 
according to data from New York City - involve mixtures of opioids 
with other drugs rather than straightforward overdoses.

That pattern, illustrated by the untimely ends of celebrities ranging 
from Janis Joplin to Philip Seymour Hoffman, suggests that the most 
effective way to prevent opioid-related deaths is to discourage 
people from combining painkillers or heroin with other drugs, 
especially depressants such as alcohol and benzodiazepines. It also 
suggests that the inherent deadliness of opioids has been greatly exaggerated.

The CDC says "health care providers wrote 259 million prescriptions 
for painkillers in 2012, enough for every American adult to have a 
bottle of pills." That year the CDC counted about 16,000 deaths 
involving opioid analgesics, or one for every 16,000 or so prescriptions.

Opioid-related deaths are rare even for patients who take narcotics 
every day for years. 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.

The risk of addiction also has been exaggerated. According to NSDUH, 
those 259 million painkiller prescriptions in 2012 resulted in about 
2 million cases of "dependence or abuse," or one for every 130 prescriptions.

A recent study by Castlight Health estimated that 4.5 percent of 
people who have received opioid prescriptions qualify as "abusers," 
and its definition, based on the amount prescribed and the number of 
prescribers, probably captures some legitimate patients as well.

According to NSDUH, only a quarter of people who take opioids for 
nonmedical reasons get them by obtaining a doctor's prescription.

Hence the sequence that many people imagine - a patient takes 
narcotics for pain, gets hooked, and eventually dies of an overdose - 
is far from typical of opioid-related deaths.

The rarity of addiction to opioids should come as no surprise to the 
vast majority of Americans who have taken Vicodin or Percocet for 
pain. Maybe they enjoyed the buzz, but they did not continue taking 
opioids every day once their pain was gone.

The truth is that using such drugs regularly for their psychoactive 
effects appeals to only a small minority of people, which is one 
reason heroin has never been very popular even among illegal drug 
users. "We lose sight of the fact that the prescription opioids are 
just as addictive as heroin," says CDC Director Thomas Frieden. In 
other words, not very.

Some of the legislative responses to the increase in opioid-related 
deaths, such as shielding people who report overdoses from criminal 
charges and making the opioid antagonist naloxone more widely 
available, are sensible. But the crackdown on painkiller 
prescriptions is bound to hurt bona fide patients while driving 
opioid users to black-market heroin, which is more dangerous because 
its potency is unpredictable - a hazard created by an earlier round 
of antidrug legislation.
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MAP posted-by: Jay Bergstrom