Willem Scholten, PharmD MPA, Consultant – Medicines and Controlled Substances, Willem Scholten Consultancy, Lopik, the Netherlands
Willem Scholten
Recently, I published an article with Jack E. Henningfield on the ‘opioid overdose death epidemic’ in which we challenged the usual view of an epidemic for which pain patients are to blame.
There is a disturbing tendency among doctors, politicians and the media in the US to be preoccupied by certain aspects of opioids: their benefits are questioned and their risks sensationalised. Furthermore, they tend to export an imaginary problem to Europe, where non-medical use of prescription opioids is very limited.
We found that facts are often distorted. For instance, President Obama said: “Sales of powerful painkillers have skyrocketed. In 2012, enough prescriptions were written to give every American adult a bottle of pills.” This may be true, but he should have added that this bottle would contain no more than seven to ten pills!
There is not a sudden epidemic of prescription opioid use: it is generally known that opioids have been used non-medically for decades. It was in the last decade that users shifted from heroin to prescription opioids. From a public health perspective, this is improvement. A preparation having pharmaceutical quality is much safer than illicit heroin, usually adulterated with substances varying from lactose to glass powder or fentanyl, and of uncertain purity ranging from 10% and 90%. Heroin overdose mortality in the US rose sharply after prescription opioids use did not further increase after 2013. Apparently, US policies had the effect of shifting from non-medical use of prescription opioids to street heroin.
We analysed the origin of the prescription opioids used by those who died from an overdose in the US. Most originated from crime: opioids were never prescribed to the majority of them. Yet, (and this is an essential distinction) the debate is mostly about ‘prescribed opioids’ instead of ‘prescription opioids’.
Patient access became restricted in the US in recent years. However, this will not resolve the real problems from harmful use of prescription opioids. We agree with policies minimizing the harm from opioids, but in the right context and in a rational way.
We advocate that any new policies should be based to the greatest extent possible on accurate evaluation of the science and epidemiology, including a root-cause analysis. Only then, measures should be developed that impact on these cause-effect relations. Blocking access to prescription opioids should not have a negative impact on pain treatment or worsen overall harmful substance use.
Globally, the burden of pain is at least as important as the burden from non-medical substance use. In 2013, opioid use disorders caused a loss of 8,136,200 Disability-adjusted Life Years (DALYs). Low back pain, neck pain and neoplasms cost 37 times as many: 303,759,000 DALYs. This should be acknowledged by all policies addressing this issue.
Reference
Willem Scholten and Jack E. Henningfield. Negative outcomes of unbalanced opioid policy supported by clinicians, politicians and the media. J Pain and Palliative Care Pharmacother. Published online: 18 Feb 2016. 10.3109/15360288.2015.1136368. (Abstract only. To download the PDF you will need to subscribe to the journal or purchase a copy of the article).
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You can view previous posts from Willem Scholten and others in the Opioid Access category of the EAPC Blog.
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Hello, we are glad you found Willem’s article interesting – we are very fortunate to have such great contributors to the blog. And thank you for sharing our posts in Pallium newsletter, which is always a great read. Regards from the team.
The president of the United States, Barack Obama and other politicians are not on touch with the American people. There’s a hell of a Lot of suffering happening over here because of misguided information and addiction lobbyist. They have it ALL wrong! Thank you for writing this blog to explain. Now, only if the politicians of the US would get in touch with reality. The citizens have tried for the past 5 years to get them to listen but they’ve got their own agenda. We can only hope that our new next president will listen and professionals who wrote blog can help us make them understand.
While less than 0.016% of people in chronic pain die from unintentional overdose of opioids, it is the rationalization used by doctors and the CDC for denying access to pain medication for over 100 million Americans.
That is violates our human rights is currently ignored by the medical community.
http://apps.who.int/medicinedocs/en/d/Js18774en/
There is no actual “opioid epidemic” — The term “epidemic” has a specific meaning:
Merriam-Webster, Definition of epidemic:
1: Affecting or tending to affect a disproportionately large number of individuals within a population, community, or region at the same time.
The anti-opioid hysteria which is the excuse touted by politicians for leaving 100 million Americans in endless chronic pain is not an “epidemic” of any sort — there is no “disproportionately large number of individuals within a population” dying from opioids according to the CDC’s own numbers.
The CDC states that in 2014 there were 28,647 people that died from ALL opioid related drugs, of which over 10,500 are due to street drugs (heroin, etc.)…with me so far?
….In 2014, 61% (28,647) of drug overdose deaths involved some type of opioid including heroin.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm
…. From 2013 to 2014, heroin overdose death rates increased by 26%, with more than 10,500 people dying in 2014.
http://www.cdc.gov/drugoverdose/data/heroin.html
Now, of the remaining 18,167 deaths due to prescription opioids, between 12%-18% (2220-3330 people) were suicides — people who seriously wanted to die and used the least painful way to go about ending their lives.
….Of the drug-poisoning deaths in 2013, 81% were unintentional, 12% were suicides, 6% were of undetermined intent
http://www.cdc.gov/nchs/data/databriefs/db190.htm
Which leaves roughly between 14837-15937 people that die from prescription opioid overdoses “accidentally” <– this is your actual number of people unintentionally dying from prescription opioids.
Hardly an "epidemic", let alone sufficient justification for leaving 100 million Americans in "untreated or under-treated chronic pain" (according to the 2011 Institute of Medicine Report "Relieving Pain in America")
http://www.ncbi.nlm.nih.gov/pubmed/22553896
Let me say this more clearly…(using the higher estimates of death from opioids) less than 0.016% of the 100 million people in endless chronic pain are dying from prescription opioid overdose, yet this is their rationalization for forcing over 100 million Americans to live in endless pain.
If the CDC actually wanted to prevent unintentional deaths from opioid overdoses (of all sorts) they would insist upon Naxolone (a drug that counteracts opioid overdoses) being provided to everyone with an opioid prescription.
Instead, our mothers, fathers, sisters, brothers, children, friends, etc. are being left in endless pain to feed this false "War on Drugs" pathology that has been integrated in your "medical industry". This iatrogenic pathology will destroy us and our children, and our family — and for everyone not currently in chronic pain, your turn is coming.
This blatantly hypocritical and harmful framing is used to violate the human rights over 100 million Americans as stated in this report by the World Health Organization on how people have a fundamental human right to relief from pain.
http://apps.who.int/medicinedocs/en/d/Js18774en/