Dear Jeff Brumley
I was recently referred to your article, “Chronic Pain Sufferers Feel Forgotten In Anti-Opioid Efforts.”
In that article, you write as follows:
“Many opioid medications are household names like codeine, Vicodin, Percocet, Dilaudid and morphin (sic.) They are so common, and so potentially addictive, that some prescription users are clueless about the potency of the medications they are taking. Consequently, many have ended up addicted — and ultimately users of heroin, the king of opioids. The nation is now faced with an epidemic killing 33,000 annually.”
In an otherwise thoughtful piece, this quote stands out as highly destructive and factually wrong. I strongly suggest that you retract or edit this piece to correct the false impression you have created in your readership.
Opioid medications are indeed “household names.” And it is accurate to say that some patients (and not a few doctors) are ill informed concerning their risks. But, unfortunately for your premise, it is uncommon for chronic pain patients under active medical supervision to become addicts, even if they become physically dependent on medications for pain relief. Addiction and dependence are separate medical entities. And it is almost unheard of for pain patients to transition to heroin unless they have been denied other alternatives or have been grossly under-treated for agony (an increasingly common condition among US Veterans.) The CDC and NIH statistics on addiction reveal that up to 90% of addicts first begin abusing drugs and intoxicants while they are in their teens — long before the great majority have seen a doctor for pain strong enough to warrant prescription of an opioid pain reliever.
I believe you have attributed a false cause to a real public health problem.
Addiction to opioids which are used in medical prescriptions is not the same thing as addiction to prescribed drugs. Addiction is for the most part an issue of diversion by theft or family connection, not of drug exposure. The surge in pain prescriptions that occurred in the 1990s placed millions of pills in circulation, lost or stolen from pain patients who no longer needed them after a pain condition resolved — or sometimes stolen from people still in pain. Moreover, the so-called “opioid epidemic” is no longer dominated by opioids given to these patients under prescription, if it ever was.
The CDC has acknowledged that drug-related overdose deaths are now dominated by heroin, imported fentanyl, morphine stolen from hospitals and methadone diverted from treatment programs — with drug prescriptions in the distinct minority as a fifth category. When US States have done retrospective studies of opioid related deaths versus prescriptions, they have found that generally fewer than 25% of people who die with an opioid in their blood actually have a current prescription. Likewise alcohol and anti-anxiety drugs are a contributing factor in many of these deaths.
Much of the epidemic of death and destruction that we now see in US public life has been an unintended consequence of FDA forcing the reformulation of Oxycontin in 2010, in “abuse resistant” form. Since that action, deaths due to heroin have more than doubled, while prescriptions of Oxycontin in its new form have dropped by two-thirds. What has actually happened is that addicts who abused a safe, regulated opioid from a doctor whom they had shammed, found that it no longer gave them a high and were forced into unregulated and dangerous street drugs.
Finally, I would suggest that there are more deaths every year from liver toxicity and cardiac arrest due to over-prescription of TYLENOL, than there are from medically supervised opioid prescriptions of all types. This statistic is also confirmed from CDC mortality statistics, but few public health authorities are paying attention to the obvious issue.
I offer a deeply researched paper for your consideration, which elaborates on several of the points above. This paper has been published by the National Pain Report. I am available for telephone interview if you choose to publish further articles in this subject area. If you’re going to speak out publicly on such issues, you need to get your facts straight. This article is among several peer-reviewed papers that I have published, including two in the Journal of Medicine of the US National College of Physicians. See my publications link below. I can also refer you to medical professionals in this field.
Regards and well wishes,
Richard A. “Red” Lawhern, Ph.D.
Personal Homepage — “Giving Something Back“