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."

Read more: http://reason.com/archives/2018/05/09/the-lethal-success-of-pain-pill-restrict

Prohibition the real cause of the 'opioid crisis'

Stop Calling It an Opioid Crisis - Foundation for Economic Education - Working for a free and prosperous world - Jeffrey A. Singer, Cato Institute:

January 18, 2018 - "For nearly a decade, policymakers have bought into the misguided narrative that the opioid overdose crisis is a result of careless doctors and greedy pharmaceutical companies getting patients hooked on prescription opioids and condemning them to the nightmarish world of drug addiction. As a result, the Drug Enforcement Administration has ordered decreases in prescription opioid production. There was a 25 percent reduction in 2017 and a 20 percent reduction is ordered for 2018.

"States have set up monitoring programs that put doctors and patients under surveillance leading to a dramatic reduction in the prescription of opioids since 2010. In fact, high-dose prescribing fell 41 percent since 2010.... This focus on the supply and prescription of opioids makes many patients needlessly suffer in pain. Some, in desperation, turn to the illicit market to get relief, where they find heroin and heroin-laced fentanyl often cheaper and easier to get. Some others resort to suicide.

"Policymakers mistakenly focus on doctors treating their patients in pain. By intruding on the patient-doctor relationship, they impede physician judgment and increase patient suffering. But another unintended consequence is that, by reducing the amount of prescription opioids that can be diverted to the illicit market, they have driven nonmedical users to heroin and fentanyl, which are cheaper and easier to obtain on the street than prescription opioids, and much more dangerous....

"The overdose rate is not a product of doctors and patients abusing prescription opioids. It is a product of nonmedical users accessing the illicit market.

"The problem will not get better — it will probably only get worse — as long as we continue to call this an 'opioid crisis.' The title is too nonspecific. This is a crisis caused by drug prohibition, an unintended consequence of nonmedical drug users accessing the black market in drugs.

"Policymakers should stop harassing doctors and their patients and shift their focus to reforming overall drug policy. A good place to start would be to implement harm reduction measures, such as safe syringe programs, making Medication Assisted Treatments like methadone and suboxone more readily available, and making the opioid antidote naloxone available over-the-counter, so it can be easier for opioid users to obtain. Even better would be a sober reassessment of America’s longest war, the 'War on Drugs.'"

Read more: https://fee.org/articles/stop-calling-it-an-opioid-crisis/
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