Monday, May 14, 2018

US opioid deaths rise as gov'ts cut prescriptions

The Lethal Success of Pain Pill Restrictions - Jacob Sullum, Reason Hit and Run:

May 9, 2016 - "In a speech on Monday, Attorney General Jeff Sessions said the Justice Department is striving to 'bring down' both 'opioid prescriptions' and 'overdose deaths.' A study published the following day suggests those two goals may be at odds with each other, highlighting the potentially perverse consequences of trying to stop people from getting the drugs they want.

"Columbia University epidemiologist David Fink and his colleagues systematically reviewed research on the impact of prescription drug monitoring programs (PDMPs), which all 50 states have established.... Fink et al. say the evidence that PDMPs reduce deaths involving prescription opioids is 'largely insufficient,' adding that 'implementation of PDMPs may have unintended negative outcomes — namely, increased rates of heroin-related overdose'....

"The picture looks worse when you take into account deaths involving illegally produced drugs, which now account for a large majority of opioid-related fatalities.... To the extent that PDMPs succeed in making pain pills harder to obtain, they encourage nonmedical users to seek black-market substitutes. 'Changes to either the supply or cost of prescription opioids after a PDMP is instituted,' Fink et al. observe, 'might reasonably drive opioid-dependent persons to substitute their preferred prescription opioid with heroin or nonpharmaceutical fentanyl'....

"If the aim is preventing drug-related deaths, this shift is counterproductive, to say the least. Because their purity and potency are inconsistent and unpredictable, illegally produced opioids are much more dangerous than pain pills.

"A report published last month by the health care consulting firm IQVIA shows that the total volume of opioids prescribed in the United States fell by 29 percent between 2011 and 2017, from 240 billion to 171 billion morphine milligram equivalents. According to data from the U.S. Centers for Disease Control and Prevention (CDC), deaths involving pain pills nevertheless rose by 24 percent from 2011 to 2016, while total deaths involving opioids rose by 85 percent.

"That trend includes a 252 percent increase in heroin-related deaths and an astonishing 628 percent increase in deaths involving the opioid category that consists mainly of fentanyl and its analogues. Final CDC figures for 2017 are not available yet, but the provisional numbers indicate there will be more increases....

"Since the current strategy is manifestly not working, drug warriors are, as usual, redoubling their efforts. The Drug Enforcement Administration, which sets annual quotas for opioid production, reduced the limit by 25 percent in 2017 and 20 percent this year."

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