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The Opiate and Heroin Epidemic in America


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  • 1 year later...
  • 6 months later...

The search function on this site is awful. Searching for 'opioid' provided no results. Had to resort to Google.

Anyway, more evidence that this "opioid epidemic" is not driven by prescription opioids, from Prescription Opioid Use at 20-Year Lows:

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Prescription opioid use in the United States is expected to decline for the ninth consecutive year in 2020, with per capita consumption of opioid medication falling to its lowest level in two decades, according to a new report by the IQVIA Institute, a data analytics firm. 

...

Despite the historic decline in prescription opioid use, U.S. overdose deaths hit a record high last spring, according to a new report from the CDC.  For the 12 months ending in May 2020, over 81,000 people died of a drug overdose.

"This represents a worsening of the drug overdose epidemic in the United States and is the largest number of drug overdoses for a 12-month period ever recorded," the CDC said in a health advisory, adding that the deaths were largely driven by illicit fentanyl, heroin, cocaine and psychostimulants such as methamphetamine. Opioid pain medication is not even mentioned in the CDC report.

Despite this data, the Government continues to press its opioid hysteria agenda against opioid manufacturers and doctors who prescribe pain medication, despite the fact that this does significant harm to chronic pain patients. It has been absurd all along, but grows even moreso as time passes, and we see that the misguided Government crusade is having zero positive effect.

Edited by Just Win Baby
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  • 1 month later...

CDC Focused on Rx Opioids While Fentanyl Deaths Soared 1,040%

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The study looked at fatal overdoses from 2013 to 2019, a period when U.S. drug deaths rose by over 56 percent, culminating with 70,630 Americans dying from overdoses in 2019.  

Deaths involving prescription opioids remained relatively flat during that period, while overdoses involving other substances rose, led by an astounding 1,040% increase in deaths linked to illicit fentanyl and other synthetic, mostly black market opioids. Overdoses involving heroin, cocaine and stimulants such as methamphetamine also rose...

The new CDC study adds to a growing body of evidence suggesting that the agency’s controversial opioid guideline has been ineffective and misdirected. While the guideline helped reduce the already shrinking supply of opioid medication – prescription opioid use is now at 20-year lows – drug deaths linked to illicit fentanyl and other substances kept rising. Overdoses hit a record high last spring.

"This represents a worsening of the drug overdose epidemic in the United States and is the largest number of drug overdoses for a 12-month period ever recorded," the CDC said in a recent health advisory.

More evidence the Government opioid hysteria is misguided and harmful. At this point, I have to view it as knowing and willful, though I don't understand the motivation. The evidence is there for anyone to understand if they care to and devote even 15 minutes to it.

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  • 1 month later...

Opioids and Injury Deaths: A population-based analysis of the United States from 2006 to 2017

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Conclusion: In every state examined, there was no consistent relationship between the amount of prescription opioids delivered and total injury-related mortality or any subgroups, suggesting that there is not a direct association between prescription opioids and injury-related mortality. This is the first study to combine national mortality and opioid data to investigate the relationship between legally obtained opioids and injury-related mortality.

If anyone is surprised by this, you haven't been paying attention. That includes our politicians. :thumbdown: 

Edited by Just Win Baby
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I have totally agreed with you since this started. Just so happens that someone I once knew and was in close contact with, a former lecturer at Yale Medical School, wrote an article about how misguided the war on opioids has been. It's in the magazine National Affairs. I'll try and hook up a link. I think you should be able to read the article.

https://www.nationalaffairs.com/publications/detail/the-truth-about-painkillers

@Just Win Baby

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1 hour ago, Dinsy Ejotuz said:

Aren't people who become addicted to prescription opioids many times more likely to turn to heroin and fentanyl?

Yep.

While there certainly are people with legitimate acute and chronic pain who’ve unfairly been denied opioids, it’s hard to say we’ve gone too far in limiting prescriptions. Even after pretty profound reductions in the amount prescribed, we still lead the rest of the world by quite a bit WHO report And there are states/counties with markedly disparate prescribing practices as well. 

Does anyone have a good explanation why Americans require so much more analgesia than their international peers? Do we experience that much more pain?

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5 hours ago, Terminalxylem said:

Does anyone have a good explanation why Americans require so much more analgesia than their international peers? Do we experience that much more pain?

Recoil. Yanks project so much more of themselves onto others and upon what they do, If one invests a greater level of identity into endeavor, one will find themselves judged more frequently and harshly. This incites a cycle of defense mechanisms which bounces sound & fury throughout the psyche until noise drowns out any real chance at the introspection by which to resolve reaction and devise response, until yadayadayada, more'n'more'n'more............til the host seeks naught but quiet. I need a drink...

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50 minutes ago, wikkidpissah said:

Recoil. Yanks project so much more of themselves onto others and upon what they do, If one invests a greater level of identity into endeavor, one will find themselves judged more frequently and harshly. This incites a cycle of defense mechanisms which bounces sound & fury throughout the psyche until noise drowns out any real chance at the introspection by which to resolve reaction and devise response, until yadayadayada, more'n'more'n'more............til the host seeks naught but quiet. I need a drink...

I like the way you put words together, but I’ll be damned if I can extract any meaning from your posts. 

But it appears you’re invoking a psychosomatic component to our collective pain, and by extension, opioid use. If so, I agree, but the solution to that problem ain’t more OxyContin.

 

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10 hours ago, Terminalxylem said:

Yep.

While there certainly are people with legitimate acute and chronic pain who’ve unfairly been denied opioids, it’s hard to say we’ve gone too far in limiting prescriptions. Even after pretty profound reductions in the amount prescribed, we still lead the rest of the world by quite a bit WHO report And there are states/counties with markedly disparate prescribing practices as well. 

Does anyone have a good explanation why Americans require so much more analgesia than their international peers? Do we experience that much more pain?

Curiously, my dentist would not prescribe me pain meds for an infection. The oral surgeon who removed the tooth a few days later (which generally leaves no pain when the local wears off) practically encouraged me to get the vicodin that was coming to me. Had no pain whatsoever.

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14 hours ago, Dinsy Ejotuz said:

Aren't people who become addicted to prescription opioids many times more likely to turn to heroin and fentanyl?

First off, there is a difference between dependency and addiction, as discussed in this article: Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies. From the article, which was co-authored by Dr. Nora Volkow, the Director of the National Institute on Drug Abuse:

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There is lingering misunderstanding among some physicians about the important differences between physical dependence and addiction. The repeated administration of any opioid almost inevitably results in the development of tolerance and physical dependence... In contrast, addiction will occur in only a small percentage of patients exposed to opioids.

Addiction rates for those who take opioids long term are generally low -- different studies and sources linked in this thread report an addiction/opioid use disorder rate between less than 1% and 8-12%. I suspect the truth lies in the middle, but IMO it is on the lower end -- less than 5%.

The National Institute for Drug Abuse says:

  • Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them
  • Between 8 and 12 percent of people using an opioid for chronic pain develop an opioid use disorder
  • An estimated 4-6 percent who misuse prescription opioids transition to heroin

It isn't clear to me if that last item correlates to the first or second item. But, even assuming the larger number in the first item, doing the math suggests that up to 6% of the 29% of patients who misuse their prescription opioids transition to heroin shows that up to 1.7% of patients prescribed opioids may transition to heroin. But that is the worst case based on these numbers; I suspect the real percentage is lower.

I also think there are significant contributing factors outside of just one's susceptibility to addiction to prescription opioids, as described in this study: Socioeconomic marginalization and opioid-related overdose: A systematic review.

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A total of 37 studies met inclusion criteria and were included in the review, with 34 of 37 finding a significant association between at least one socioeconomic factor and overdose. The included studies contained variables related to eight socioeconomic factors: criminal justice system involvement, income, employment, social support, health insurance, housing/homelessness, education, and composite measures of socio-economic status. Most studies found associations in the hypothesized direction, whereby increased SEM was associated with a higher rate or increased likelihood of the overdose outcome measured.

This implies that those who are not subject to negative socioeconomic factors such as those identified here are less likely to become addicted to prescription opioids and ultimately transition to other illegal drugs.

Edited by Just Win Baby
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15 hours ago, rockaction said:

I have totally agreed with you since this started. Just so happens that someone I once knew and was in close contact with, a former lecturer at Yale Medical School, wrote an article about how misguided the war on opioids has been. It's in the magazine National Affairs. I'll try and hook up a link. I think you should be able to read the article.

https://www.nationalaffairs.com/publications/detail/the-truth-about-painkillers

@Just Win Baby

Excellent article. Thanks for posting. :thumbup: 

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13 hours ago, Terminalxylem said:

Does anyone have a good explanation why Americans require so much more analgesia than their international peers? Do we experience that much more pain?

We already discussed this earlier in the thread. As mentioned there, part of the answer is inadequate access to most of the world's population.

From A First Comparison Between the Consumption of and the Need for Opioid Analgesics at Country, Regional, and Global Levels (2011):

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Good access to pain management is rather the exception than the rule: 5.5 billion people (83% of the world's population) live in countries with low to nonexistent access, 250 million (4%) have moderate access, and only 460 million people (7%) have adequate access. Insufficient data are available for 430 million (7%). The consumption of opioid analgesics is inadequate to provide sufficient pain relief around the world. Only the populations of some industrialized countries have good access.

From Quantifying the Adequacy of Opioid Analgesic Consumption Globally: An Updated Method and Early Findings (2019):

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With our study, we have shown that the adequacy of opioid analgesic consumption continues to be problematic around the world. Also in 2015, the large majority of people (almost 6 billion) live in countries where access is inadequate, meaning that they will not have their pain managed when falling ill. This number increased over the years, despite an increase in the number having moderate or adequate access. It shows that improvement of adequacy is limited to a number of countries and that policy efforts do not manage to keep pace with the increasing world population.

 

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4 hours ago, Just Win Baby said:

I know we discussed it, but your answer doesn’t apply for most of the developed world. I’m talking about OECD countries, not Sub-Saharan Africa. Look at countries whose health care/resources are comparable.

Better yet, look at the estimated MME per capita needed for each country in your paper. For most developed countries, it’s 10 or less. The US uses 350, down from a peak of 782. Granted, the distribution is not uniform, but proving underprescribing is a major problem is a tough sell.

I realize it’s possible both under- and overprescribing occur, but I believe the latter remains the bigger issue.

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Isn't one of the issues with a proliferation of prescription opioids not that the original patient becomes an addict, but rather others around that patient stealing and abusing those drugs?

Maybe that's an urban myth about kids stealing pain pills from granny and crushing and snorting them. That leads them to illegal opiods and overdose. 

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Other possible reasons US prescribing is higher than other countries:

  • Culture:
    • Pain perception and the attitudes of healthcare providers towards pain varies widely between cultures.
    • Americans are more likely than their European or Asian counterparts to view pain as a malady rather than a natural consequence of aging or injury.
  • Differences in regulatory controls and healthcare provider oversight:
    • In the U.S. much of the regulation and oversight is performed at the state rather than the Federal level, which may afford more variation and less tight control.
  • Differences in how healthcare is delivered and reimbursed:
    • This can lead to differences in how patients are treated when they present with pain, a multifactorial symptom which can relieve many underlying ailments.
  • Large older population:
    • While the US is 36th in percentage of population age 65+, they have 53M citizens in that age group. Japan is second, with 36M, and the Russian Federation is third, with 21M. Everything isn't uniform as populations scale, and the US has 150% the number of citizens in this age group as the third highest country.
  • Surgeries:

Opioid prescribing in the US has been drastically reduced: Prescription Opioid Use at 20-Year Lows. Yet US opioid overdose deaths hit a record high for the 12 months ending in May 2020, as noted in the article.

That's because opioid overdose deaths are not correlated to opioid prescribing. See The Opioid Crisis in Three Charts.

Meanwhile, that reduction in opioid prescribing and associated, misguided opioid hysteria has absolutely done harm to chronic pain patients. That really isn't disputable.

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Article published last week: Few Patients on Long-Term Opioids Engage in Risky Behavior

Quote

Only a small percentage of pain patients on long-term opioid therapy ask for higher doses, renew their prescriptions early or divert their medication to another person, according to a new study that challenges many common assumptions about prescription opioids.

For five years, Australian researchers followed over 1,500 patients taking opioid pain medication, with annual interviews asking them about their opioid use and behavior. The study is believed to be the first of its kind to follow patients on opioid therapy for such a long period... 

Researchers found that “problematic opioid use” was infrequent and steadily declined over time, with less than 10% of patients asking for higher doses or for a prescription to be renewed early. Less than 5% of patients tampered with their medications or diverted them to another person...

By the end of the study, patients were more likely to have stopped taking opioids (20%) than they were to be diagnosed with opioid dependence (8%), suggesting that long-term opioid use does not always lead to dependence or addiction. Even when they were diagnosed as opioid dependent, most patients did not meet the criteria for dependence the following year, suggesting the original diagnosis was faulty...

Webster noted that most people in the study were stable and few demonstrated any abuse or harm from opioids, including those on high doses who were less likely to ask for more medication.

“I think the overriding message of this study is that the one-size-fits all approach to using opioids for CNCP is flawed. The idea that everyone should be at a low level doesn't address individual needs,” Webster said.

 

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1 hour ago, The Z Machine said:

Isn't one of the issues with a proliferation of prescription opioids not that the original patient becomes an addict, but rather others around that patient stealing and abusing those drugs?

Maybe that's an urban myth about kids stealing pain pills from granny and crushing and snorting them. That leads them to illegal opiods and overdose. 

Yes, diversion is a huge problem. And more liberal prescribing practices certainly won’t help that either.

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25 minutes ago, Terminalxylem said:

Yes, diversion is a huge problem. And more liberal prescribing practices certainly won’t help that either.

Well, I haven't seen any data showing that it is a 'huge' problem today. I just posted an article about a long term study in which less than 5% of patients tampered with their medications or diverted them. Any diversion is a problem, but I believe the 'huge' problem has been largely mitigated over the past several years of constrained prescribing.

Also, other steps could be taken aside from simply limiting prescribing. For example:

  • Pass a law that those who receive opioid prescriptions are required to keep them locked away, like gun owners for handguns.
  • Pass a law that a person faces potentially serious penalties if their prescribed opioids are found in the possession of someone else.

These things wouldn't completely solve the problems, but could only help. And there might be other improvements.

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