From time to time. I post repeats of past papers I have offered to email distribution lists, in mainstream medical journals or in popular media.  Thus, I’m passing along what I call “The Opioid Crisis in Three Charts”. These charts were published last year in a paper on Dr Lynn Webster’s blog, and I’ve used them repeatedly in other published work, including a June 2019 editorial in the respected STAT News within the Boston Globe Group.

Taken together, these charts demonstrate that over-prescribing did not cause and is not sustaining our so-called “opioid epidemic”. The original data were published by the US CDC Wonder Database and the National Multiple Cause of Death database.  But CDC has actively refused ever to publish these data together in one place to allow an assessment of the implications for policy.  I regard this refusal as gross malfeasance.

From data published by CDC, we know that opioids are prescribed three to six times more often among seniors over age 62 than they are to youth under age 19. But overdose-related mortality in youth is three to six times higher than in seniors. Mortality has been stable for the past 17 years in seniors while it has skyrocketed in youth.   More basically, there is simply no cause-and-effect relationship between State-by-State prescribing rates versus overdose mortality.  Although mortality overall has risen sharply since 2010, it remains below national average in States with the highest medical prescribing rates.

In short, the basic premises of the 2016 CDC guidelines on prescription of opioid analgesics to adults with chronic non-cancer pain are wrong.  And CDC KNOWS they are wrong!

Higher overdose mortality from 2010-2020 is a direct outgrowth of socioeconomic factors and the invasion of illegal Fentanyl into US street markets. We also know from State-level analysis of Prescription Drug Monitoring Programs data that when a prescription-type opioid is found in postmortem toxicity screens, it is likely to be only one substance among several, including illegal or diverted drugs and alcohol. Our “drug crisis” is driven by illegal drugs, not prescriptions.

Doctors who treat pain are NOT at fault in the opioid crisis. They never were. CDC policy seeking to force restrictions on opioid prescribing — at a huge and growing cost to patients — must change NOW, not a year from now. 

See charts below:

Outlook-tfdzuasl.png