The Man-Made Opioid Epidemic: A 5 Part Series.

Posted on | November 18, 2015 | Comments Off on The Man-Made Opioid Epidemic: A 5 Part Series.

CDC: Connecting Dots, Opioids-Heroin.

Mike Magee

As we learned last week, the opioid epidemic that we’ve been debating for a decade, which has been largely fueled by prescription drugs, has now managed to bend the survival curve for middle aged white males in America. And there’s plenty of blame to go around.

There’s the pharmaceutical companies that marketed products as addiction proof when they were not, and funded medical professional and consumer organizations to advance the cause of a pain free society at any cost. Their mantra: “pain” is the 5th vital sign.

There’s the medical community that endorsed new societies of pain specialists, with pharmaceutical employees on their boards, and published a stream of liberalizing pain management papers in their peer reviewed journals.

There’s the 20 state medical boards and state legislatures, which in response to active lobbying by the pharma-funded medical organizations, for the first time, lifted all regulatory prohibition on the use of opioids for non-cancer chronic pain management. As one state statute made clear in 1999,“no disciplinary action will be taken against a practitioner based solely on the quantity or frequency of opioids prescribed.”

There’s the lobbyists like Rudolph Guiliani, who went over the heads of federal prosecutors in 2002 and accessed friends in the Justice Department to shut down efforts to prosecute firms the were knowingly profiting from the drug trade.

There’s the countless primary care and specialty clinicians who drank the Kool-Aid presented by pharma-supported “pain specialists” and freely prescribed without question, reassuring some, and turning a blind eye to others.

There’s the unfortunate patients who got hooked, and the bad actors that crushed, repackaged, and pushed their wares in the secondary sale street market.

And there’s the heroin dealers, who came in on the back end, with new demand for opiates already well established, to fill in the gap when it became more difficult to find prescribed pills on the street.

But for the moment, let’s not dwell on who’s to blame. How big is the problem, and what can be done now that over 100,000 people have been lost in the past 15 years? That’s the philosophy embraced by a new Johns Hopkins report on the topic titled “The Prescription Opioid Epidemic: An Evidence Based Approach.”

It begins with a blistering critical assessment of the effectiveness of “pain specialists”, their societies, and their ambitious pharma-supported advocacy. Here’s what the report states:

“These systematic reviews concluded that the overall effectiveness of chronic opioid treatment for chronic non-cancer pain is limited, the effect on improved human function is very small and the safety profile of opioids is poor. Briefly stated, the evidence on efficacy and effectiveness of these drugs for chronic non-cancer pain has demonstrated:
1. A variety of adverse events associated with opioid use, including: hypogonadism and infertility; neonatal abstinence syndrome; sleep breathing disorders; cardiac arrhythmias; opioid-induced hyperalgesia; and falls and fractures among the elderly;
2. High rates of healthcare utilization associated with these adverse events, including emergency department visits and hospitalizations from non-fatal overdoses;
3. High rates of deaths from unintentional poisonings, especially at doses at or above 100–120 morphine milligram equivalents (MME) per day, which generally occur at home during sleep;
4. Minimal improvement in pain and function associated with long-term opioid use for chronic non-cancer pain; and
5. An overall unfavorable risk/benefit balance for many current opioid users.
….. position papers of expert groups differ, as does the soundness of their recommendations, including some recommendations under investigation by the U.S. Senate at the time of this writing.”

How big is this self-made problem? Again, Hopkins reports:
“Drug overdose death rates in the U.S. increased five-fold between 1980 and 2008, making drug overdose the leading cause of injury death. In 2013, opioid analgesics were involved in 16,235 deaths — far exceeding deaths from any other drug or drug class, licit or illicit. According to the National Survey on Drug Use and Health (NSDUH), in 2012 an estimated 2.1 million Americans were addicted to opioid pain relievers and 467,000 were addicted to heroin. These estimates do not include an additional 2.5 million or more pain patients who may be suffering from an opioid use disorder because the NSDUH excludes individuals receiving legitimate opioid prescriptions.”
What’s to be done? In the next four Health Commentary reports, I’ll address four active areas that show promise:
1. Prescription Drug Monitoring Programs linked with mandatory electronic prescribing for opiates.
2. Roll-backs on liberalizing statutes and regulations governing prescribing of controlled substances.
3. Active oversight involvement of Pharmacies and Pharmacy Benefit Managers in the prescription use and abuse of opioids.
4. New technologies that should help track the movement and impact negligent or criminal distribution of prescription opiods.