Willem Scholten, PharmD MPA, Consultant – Medicines and Controlled Substances, Willem Scholten Consultancy, Lopik, the Netherlands
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.
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).
Keep up to date with global advocacy and policy issues . . .
You can view previous posts from Willem Scholten and others in the Opioid Access category of the EAPC Blog.