When is this country going to wake up — really wake up — to the catastrophe that prescription opioid painkillers have caused since they came into widespread use in the early 1990s?
Before then, deaths related to prescription opioid overdose were practically unknown. In 2013, though, opioids killed 16,235 people; that’s approximately half as many as died in traffic accidents that year, and about 2,000 more than were murdered. Both traffic accidents and murder have been declining for years, however, while painkiller-related deaths quadrupled between 1999 and 2013, according to the Centers for Disease Control and Prevention.
The total toll from prescription opioid overdoses in that time exceeds 175,000, three times the U.S. body count in the Vietnam War.
In short, the United States’ massive investment in reducing avoidable deaths from other causes has been undone to a large extent by avoidable deaths stemming from the abuse of opioids, whose trade names include OxyContin, Vicodin and Percocet.
The latest evidence of these drugs’ destructive impact comes from the Urban Institute, where researchers investigated the odd fact that death rates from various causes for non-Hispanic white women ages 15 to 54 — a usually healthier-than-average cohort — appear to have spiked between 1999 and 2011. Indeed, this was the only group to have experienced a marked rise in death rates during that period.
It turns out that prescription opioid overdoses explain half of the phenomenon, according to the Urban Institute study, which was released last week.
This epidemic was brought to you not by Colombian drug cartels or some other nefarious outlaw force but by the American establishment — corporate, governmental and medical — which blessed the wider use of modern opioids in the belief that pain was vastly undertreated and that new, extended-release opioid formulations would not be addictive.
To question that judgment — to suggest that pain is inherently subjective and that encouraging doctors to pass out these powerful pills not just to patients with cancer but also to those with routine lower back problems, was a huge, deadly mistake, driven in significant part by the profit motive — is to risk being accused of insensitivity to suffering people.
As Stanford University psychiatrist Anna Lembke explained in a New England Journal of Medicine article (candidly titled “Why Doctors Prescribe Opioids to Known Opioid Abusers”), many doctors give drug-seeking patients what they want to avoid bad reviews on patient surveys and in social media.
Policies and attitudes toward opioids have become more realistic since Lembke’s article appeared in October 2012. Yet even after a recent federal-state “crackdown” on opioid over-prescription, the Food and Drug Administration last year approved a new compound, Zohydro, despite a recommendation from an advisory committee that feared it would be too easily abused.
Most U.S. doctors concede that opioids are overprescribed, and they have become more cautious about prescribing. But most also say they personally are not to blame for the problem, according to a Johns Hopkins Bloomberg School of Public Health study published last year. Pharmacies still filled 207 million prescriptions for opioids in 2013, the most recent year for which data exist, according to the National Institutes of Drug Abuse.
That’s nearly triple the number in 1991 — nancand a far, far higher rate of opioid prescription than any other country. The United States accounts for almost 100 percent of world consumption of hydrocodone and 81 percent of oxycodone, NIDA reports. Does this mean doctors in Europe and Asia are indifferent to their patients’ suffering?
The slight recent reduction in opioid prescription has contributed to a rise in heroin abuse, and heroin overdose deaths, as opioid addicts seek a chemical equivalent on the street. Some argue the heroin boom discredits attempts to rein in opioid over-prescription.
This is exactly backward. The real point is how hard it is to wean thousands and thousands of people off these powerfully addictive substances, and, therefore, how terribly mistaken it was to distribute them so extensively in the first place. The sad fact is that many of those dying from heroin overdoses now might have died of prescription opioid overdoses without the “crackdown.”
The United States is in the midst of a national debate about alleged excesses in the war on illegal drugs. It’s a vigorous and necessary discussion. It’s also ironic, given that the worst havoc in recent years was wrought not by illegal substances but by perfectly legal ones. Indeed, they were produced in factories, vetted by the FDA and distributed by licensed physicians.
It appears that reducing the country’s most troubling drug-related public-health problem depends on more, and more intelligent, regulation, not less.
Whatever we do, we should remember that, like so many tragedies in the past, America’s deadly prescription opioid epidemic stemmed from a combination of greed, hubris and the best of intentions.
Charles Lane is a member of The Washington Post’s editorial board.
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