Pubdate: Sun, 16 Jul 2017
Source: Lexington Herald-Leader (KY)
Copyright: 2017 Lexington Herald-Leader
Author: Josh Bloom


As the death toll from opioid overdoses in Kentucky and the rest of
the Midwest continues to soar, it's truly disconcerting to see that
policymakers are taking steps that are not only devoid of medical and
common sense, but virtually guaranteed to make matters worse.

The recent passage of the ill-conceived House Bill 333, which imposes
a three-day limit (with certain exceptions) on opioid prescribing,
reflects a fundamental misunderstanding of the reasons behind the
addiction epidemic.

All this new law will accomplish is to make matters worse for both
pain patients and addicts. The former will suffer needlessly; the
latter will die in even greater numbers.

The absence of common sense in Kentucky's approach to this problem is
mind-boggling. Lawmakers, who believe that further tightening of the
already-stringent legal prescription practices of opioid painkillers
will stop the wave of deaths that has hit the region so hard, have it
dead wrong.

It is crystal clear in multiple states across the country that the
overwhelming majority of opioid overdose deaths are not a result of
pills. Death from opioid pills (in the absence of other drugs) is uncommon.

Perversely, the increase in deaths we are seeing now is a direct
result of the difficulty in obtaining pills. Within the past decade,
opioid pills became difficult to get and prohibitively expensive,
which caused addicts to switch in droves to heroin. This is the root
cause of soaring overdose deaths, not pills from pharmacies.

Second, and far worse, heroin is no longer the "safe" drug that it
once was. Over the past three years, it has been increasingly mixed
with, or replaced entirely by, fentanyl and its far more potent
chemical cousins. It is this progression from pills to heroin to
fentanyl that is responsible for the skyrocketing overdose deaths we
are now seeing.

Although it is convenient and plausible to blame today's crisis on
prior over-prescription of pain medications, this is simply a false
narrative. This is seen in multiple literature analyses, including a
review of 30 studies in the journal Pain and a comprehensive Cochrane
review, which examined 26 more.

Patients who are being treated responsibly for moderate-to-severe pain
rarely become addicted. The Cochrane review found that only 0.46
percent of pain patients became addicted. The vast majority of today's
addicts became so by using opioid pills recreationally and later
progressing to injectable opioids once the supply of pills dried up.

But the real victims here are pain patients.

Many of them, who have been treated for very painful chronic injuries
or medical conditions for decades, are terrified of being cut off from
the medicines that are essential for their survival. That's because
states are already beginning to impose arbitrary limits of maximum
daily doses of the drugs.

That is both cruel and scientifically flawed, especially since it's
known there is a very wide range in how people metabolize opioids --
as much as a 15-fold difference between individuals, which drastically
affects blood levels of the drugs.

This ensures a "one-size-fits-all" approach is doomed to fail.
Although anecdotal, stories involving suicides of pain patients who
have been unable to obtain the drugs that they need just to exist are
easy to find.

When states and government agencies crack down on a legally
prescribed, essential medicine, they are not only addressing the wrong
problem but also are making matters worse for both addicts and
patients. Laws such as Kentucky's may seem to make sense on the
surface, but even a little digging reveals how flawed they really are.
Everyone gets hurt.

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Josh Bloom is director of chemical and pharmaceutical sciences at the
American Council on Science and Health.
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