8% of Opiate OD’s: were from pharma grade opiates – about 10 OD’s/day

Prescriptions Are Down, but Overdoses Are Up — Is That Progress?

https://www.cato.org/publications/commentary/prescriptions-are-down-overdoses-are-progress

President Trump recently spoke at the annual Prescription Drug Abuse and Heroin Summit in Atlanta, touting “pretty amazing” progress in combating the overdose crisis afflicting the country and expressing pride in government efforts to reduce the total number of opioids prescribed, claiming a 34 percent drop in total opioid prescriptions during his time in office.

The number of opioid prescriptions might be coming down, but overdose deaths continue to mount, with the Centers for Disease Control and Prevention provisional report showing over 46,000 opioid‐​related deaths in the 12 months ending April 7, 2019, 60 percent of which involved illicit fentanyl. Thirty‐​two percent involved heroin.

If this rates as “pretty amazing” progress then the president is grading on a steep curve. If he wants to really see progress, the focus of drug policy must move away from the number of pain killers prescribed and over to harm reduction.

Patients in pain grow desperate as doctors are terrorized into under‐​prescribing pain medication, fearing arrest and prosecution. State regulators, licensing boards and even pharmacies and insurers have misinterpreted and misapplied the already controversial 2016 CDC opioid prescribing guidelines which were meant to be “voluntary [guidelines] rather than prescriptive standards.”

This misapplication has resulted in chronic pain patients being abruptly tapered off of their medication, leading some in desperation to turn to the black market or resort to suicide. It has gotten so bad that during the same week of the drug summit the CDC issued a “clarification,” stating their guidelines were never intended to encourage abrupt tapering.

The government’s own data show no correlation between the prescription rate and non‐​medical opioid use or opioid use disorder. That’s why we need harm reduction, which seeks to reduce the physical dangers that come from nonmedical drug use in a dangerous black market fueled by drug prohibition.

In the states where we have seen improvements in mortality rates, it is because those states have begun to employ harm reduction. Ohio and Massachusetts, for instance, have greatly proliferated needle exchange programs and widely distribute the overdose antidote naloxone. They have also expanded the number of licensed methadone treatment clinics. Needle exchange programs are endorsed by the CDC and the Surgeon General and have been proven to reduce the spread of HIV and hepatitis; now many of them hand out naloxone to people along with clean needles. Unfortunately, unlike Ohio and Massachusetts, many states still have anti‐​paraphernalia laws that prohibit needle exchange programs.

Harm reduction strategies are beginning to reap rewards. Ohio’s Cuyahoga County, for instance, reported 560 overdose deaths in 2018 compared with 727 in 2017. Overdose deaths dropped by four percent during the same year in Massachusetts. But much of harm reduction requires action on the federal level.

President Trump should push reform of regulations on methadone clinics, buprenorphine prescribing and other forms of what is called Medication Assisted Treatment, so that more primary care providers can treat more patients. In the UK, Canada and Australia, primary care physicians are permitted to treat addicts with methadone in their offices, but in the U.S., addicts must seek treatment at heavily regulated clinics approved by the Drug Enforcement Administration and this restricts their availability. And providers are still limited by quotas on how many addicts they can treat at any given time with buprenorphine.

The president should seek a repeal of the federal “Crack House Statute” that doesn’t allow our major cities to establish safe consumption/​overdose prevention sites, which have saved so many lives in more than 120 cities in Europe, Canada and Australia. He should have the FDA make naloxone available off‐​the‐​shelf to increase its availability and legalize cannabis so it can be used to treat pain and can undergo trials as a Medication Assisted Treatment

Drug overdoses and abuse are not confined to the U.S. The problem exists in much of Europe, in Canada and in Australia. But death rates in those countries are dwarfed by those in the U.S. and that’s largely because harm reduction strategies have been widely adopted in most of the rest of the developed world since the 1980s.

President Trump can set a new precedent — and make historic progress — by being the president who shifts the strategy from a war on drugs to a war on drug‐​related deaths.

10 deaths/day… but while they claim that these deaths are from pharma opiates..  there seems to be no further facts… how many of those 10 OD’s were from legally obtained pharma opiates ?  Pharma opiates are only “legal” if they are in the possession of pharma, wholesaler, pharmacy, pts to whom they were prescribed..  If they are in the possession of anyone else… they AUTOMATICALLY BECOME AN ILLEGAL OPIATE.

Prescription bottles/labels will have the following statement: Federal law  prohibits the transfer of this med to any person other than the patient to which it was prescribed.

So what percent of those 10 OD’d per day where illegal obtained , whatever that number is… the remaining OD’s may have been a death of despair (suicide). Self harm (suicide) from legally prescribed opiates would suggest that the pt was not getting adequate pain management .. for many reason.. like the prescriber was limiting their daily MME’s to some arbitrary limit.  You have a CRPS pts who is a ultra fast metabolizer… there is no way that a arbitrary MME/day are going to properly manage their pain… and this disease is referred to as the “suicide disease”.  Under/untreated pain could lead to anxiety and depression and cause suicidal idealization.  Suicide tends to be a rather impulsive act… the result of a “final straw” to a person that is already dealing with suicidal idealization.  In reality, those deaths labeled as OD’s could not be from a on going abuse of those meds by the person that has a legal prescription. If there is no suicide note or if there was and SOME HOW the note disappears…  their death and their death certificate cannot be properly defined ?

3 Responses

  1. Well many families will cover up the suicide and try to blame on the drug as a intended OD. This is especially true for devote Catholics who limit suicide patients from having proper funeral in the church. They will do memorials but not a mass and will not allow the person to be buried in a Catholic cemetery. For many families they see suicide as a failure of the family and is shameful.
    But the biggest problem is we are not seeing the biggest problem is with teens getting into drugs and because there brains are still forming they have a much harder time with it. Also the age they start using is basically where they are mentally and emotionally so they start at 13 and quit at 30 it is still like they are 13 years olds in the maturity and ability to go out on there own. So addicts just do not need rehab many need education and a lot of other help. Addiction is not about the drug as much as the mental illness that cause the person to make the choice to abuse the drugs to begin with. Meanwhile the majority of people who get scripts are over the age of 50 years old, have no history of abuse and have chronic pain or just had surgery. The numbers are of death in that age group is very low. The other problem is the fact people do not follow the prescription and self medicate. To me that is not a doctors fault and should not be blamed by crummy patients who cannot do the right thing for themselves. I think doctors get very frustrated because more of the health problem people get are preventable and yet they want pills instead of doing what they need to help the issue. Meanwhile the DEA shoul just be defunded since they are overpriced thugs that should go.

  2. The real problem lies within the CDC which never should have been the alpha to address what they have caused: The National Pain Crisis.

    How absurd and unbelievable that any Agency is privy to invite to the Roundtable of Pain Mgt. and not ONE single Bd Certified Pain Clinician was invited for input. Not ONE.Further, an Agency who could not even get the real hard data science based facts re PAIN PTS. No, they couldnt even determine the proper algorithm…and even when this egg on their faces was discovered, they still continued to report bogus data
    If that wasnt enough, the now former FDA Dir announced to the public they too had used the wrong algorithm…but hey, ” It wasnt OUR fault. We hired a 3rd party outside Contractor and they used the wrong.
    algorithm!

    Never mind the CDC held their mtgs behind closed doors in 2015 in order to roll out the 4/2016 so called GUIDELINES FOR GP’S for Opiate Prescribing.” Never mind that the top ring contributor re these so called guidelines was a psychiatrist who has never treated PAIN pts., his experience with addicts only. So…here we have a bigot, a zealot, die hard anti opiate telling the world opiates have 0 place in society. Everybody who takes an opiate is an instant addict and will keep over from legal opiates…What a pile of trash and utter nonsense…
    Of course, he was only promoting the ” miracle” drug for MAT which has made his a multi millionaire…

    And, look who was appointed to lead the Task Force to address the so called ” Opiate Crisis,” fmr Gov Chris Christy…and 6 more, NOT 1 single person on the Task Force was a health pro, let alone a pain expert or strong pain pt advocate…a bunch of politicians were on Christy’s ” Task Force,” at least 1 with a very public, longstanding history of addiction…

    Looks to me like plumbers were called in as this pathetic Task Force. Unfortunately, the electricians were needed to do the job…Metaphorically. They all failed. Miserably. So, wrong Agency, wrong ppl all along. Any wonder why 20 mil ppl are left as intractable pain pts now either UNDERtreated and countless numbers left to suffer even worse as the abandoned and INtreated. Then, there has been the DOJ/DEA, then individual states who have become the biggest clown ship car M of all…

  3. President Trump is part of the problem, he will never be part of the solution. What he “should do” and what he “will do” are two different things. I remember, at one time, when he was giving a public address. He stated (to paraphrase), “You break your arm and go into the hospital where they give you pain pills for your discomfort. You leave the hospital 3 days later and you are a drug addict.” TOTAL IGNORANCE!

    We, the CPP community will find no help for our “untreated pain crisis” from Donald Trump. Petitioning a person this ignorant (as to how addiction happens) to stop mistreating chronic pain patients, or to stop the War on Drugs, or to implement Harm Reduction programs is a total waste of time.

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