CDC Over-Counted Opioid Overdoses
http://www.painnewsnetwork.org/stories/2016/1/23/cdc-over-counted-opioid-overdose-deaths#commenting
The conclusion of the report was the same message the CDC has been promoting (as it has been tasked with by the White House) — to reduce the prescribing of opioids.
Do you think that this administration/White House/President Obama… is encouraging all Federal agencies to violate the Americans with Disabilities Act by reducing access to opiates… regardless of a pt’s medical necessity ?
By Alison Knopf, Editor of Alcoholism & Drug Abuse Weekly
Drug overdose deaths have increased 137 percent — 200 percent for opioids — since 2000, the federal Centers for Disease Control and Prevention (CDC) announced in its January 1 Morbidity and Mortality Weekly Report (MMWR). The analysis looked at overall increases in overdose deaths from 2000 to 2014, and focused specifically on increases from 2013 to 2014. The majority (61 percent) of the drug overdoses in 2014 involved some type of opioid, according to the report.
Some overdose deaths were counted more than once. “Some deaths involve more than one type of opioid; these deaths were included in the rates for each category (e.g., a death involving both a synthetic opioid and heroin would be included in the rates for synthetic opioid deaths and in the rates for heroin deaths),” the report stated.
We asked Rose A. Rudd, CDC health scientist and lead author of the report, about the over-counting of overdose deaths.
“Some deaths do include more than one type of drug,” responded Rudd in an email to ADAW. “In 2014, there were 12,159 deaths involving a natural or semi-synthetic opioid; 3,400 deaths involving methadone; 5,544 deaths involving a synthetic opioid (exclusive of methadone); and 10,574 deaths involving heroin. There were 28,647 deaths that involved any opioid: this number of deaths does not the sum to the other categories, as deaths do include more than one type of drug.”
That is not to discount the severity of the opioid epidemic, and the increase in heroin and illicit fentanyl use and overdose deaths. Heroin and illicit fentanyl (not the prescribed medication) were responsible for most of the increase, the report stated. There was a particularly sharp increase in deaths involving synthetic opioids (other than methadone), which, the report said, was in line with law enforcement reports of an increase in illicit fentanyl on the streets. However, pharmaceutical fentanyl cannot be distinguished from illicit fentanyl in death certificates.
Between 2013 and 2014, overdose rates involving methadone were unchanged, but deaths involving opioid pain relievers increased 9 percent, deaths involving heroin increased 26 percent and deaths involving synthetic opioids (other than methadone) increased 80 percent.
“These findings indicate that the opioid overdose epidemic is worsening,” the report stated. “There is a need for continued action to prevent opioid abuse, dependence, and death, improve treatment capacity for opioid use disorders, and reduce the supply of illicit opioids, particularly heroin and illicit fentanyl.”
The greatest increases were in 25–44-year-olds and people 55 and over; in whites and blacks; and in the Northeastern, Midwestern and Southern regions of the United States.
Hardest-hit states
The report singled out the five states with the highest rates of drug overdose deaths in 2014: West Virginia (35.5 deaths per 100,000), New Mexico (27.3), New Hampshire (26.2), Kentucky (24.7) and Ohio (24.6). In addition, states with statistically significant increases in the rate of overdose deaths from 2013 to 2014 included Alabama, Georgia, Illinois, Indiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Mexico, North Dakota, Ohio, Pennsylvania and Virginia.
Specific codes
The CDC relied on the National Vital Statistics System multiplecause-of-death mortality files, which classify drug overdose deaths based on International Classification of Diseases, Tenth Revision underlying cause-of-death codes. The basic codes are X40–44 (unintentional), X60–64 (suicide), X85 (homicide) or Y10–Y14 (undetermined intent). Then the type of opioid involved is indicated by a T code (T40.0, T40.1, T40.2, T40.3, T40.4 or T40.6); natural and semisynthetic opioids (including morphine, oxycodone and hydrocodone) are T40.2; methadone is T40.3; synthetic opioids (including fentanyl and tramadol, as well as illicit fentanyl) other than methadone are T40.4; and heroin is T40.1. If more than one opioid was found, both were listed, accounting for the fact that some deaths were reported more than once.
The increase in heroin overdoses mirrors large increases in heroin use across the country, the report stated, and it adds that heroin use is “closely tied to pain reliever misuse and dependence.”
The increased availability of heroin and its low price compared with prescription opioids, as well as high purity, are “major drivers of the upward trend in heroin use and overdose,” the report stated.
Limitations
In addition to counting deaths more than once, there were other limitations to the study. The authors admit that toxicology laboratory tests performed at autopsy vary based on jurisdiction; in addition, in 2013, 22 percent of drug overdose deaths did not include any information on the death certificates about the specific drugs, and 19 percent in 2014 did not include such information. Finally, some heroin deaths might have been misclassified as morphine, because the drugs are metabolized similarly and testing might not have been done that can distinguish between them.
Message still prescription opioids
The conclusion of the report was the same message the CDC has been promoting (as it has been tasked with by the White House) — to reduce the prescribing of opioids. As the CDC’s Leonard J. Paulozzi, M.D., told us last year, people who are initiating the use of heroin started with the use of prescription opioids, and “if we can stop feeding that pool now, it will help,” while at
the same time saying, “If you have a large cohort of people who are already physiologically dependent on heroin or prescription opioids, those people aren’t going to go away. They’re going to seek drugs, and they will need to get into treatment”
However, the fact is that opioid prescribing has been reduced substantially, and at the same time, heroin use is going up, and the CDC’s main focus is still on reducing prescribing of opioids.
The MMWR was posted online as an early release December 18, shortly after the CDC announced it would issue draft guidelines on opioid analgesic prescribing for primary care providers.
Filed under: General Problems
While the spin this time around is definitely running at a higher rate of rotation, it seems like it the same basic pattern that I’ve noticed in the last 25-30 years is occurring. It has been during this time that I started paying attention to this amusing (not) song and dance routine. During this time I was studying pharmacy, obtaining my license and then practicing the profession. What is this song and dance routine that I’m referring to? It’s everyone’s favorite party game, “Whack-a-Mole”. Here is how it works, in case anyone has forgotten. these are the simplified rules.
The DEA cracks down on the diversion of Big Pharma Drug X, so the folks, for whatever reason or motive known to them, turn to an equivalent street drug, Drug Y. Then the DEA cracks down on Drug Y and the diversion of Drug X becomes an issue again…wash, rinse repeat. The difference this time is the a change in the background music the enlargement of the net that the DEA is casting and the participation of some more letters in the State’s Alphabet Soup of bureaucracies.
The lie has to be made to appear to be bigger and repeated more often than usual to keep We, the Sheeple, compliant and fearful to speak up; even as we see loved ones, who have legitimate medical need, affected in the worst way, the Will of the State Almighty must be accomplished.
“However, the fact is that opioid prescribing has been reduced substantially, and at the same time, heroin use is going up, and the CDC’s main focus is still on reducing prescribing of opioids.”
Are these people dying from overdoses twice? Once from heroin and then another from synthetic / prescription opiates.
It’s almost like the CDC is looking for synthetic opiates in heroin overdose deaths just to prove their point and drive people to heroin.
Kinda makes me wonder if the CDC is one of the alphabet agencies profiting from the importing illegal drugs like heroin? Maybe the people should demand a congressional investigation of the finance and spending of the CDC.
I beg to differ, there ARE large scores of pain patients seeking the relief that they aren’t getting by prescription, from the streets. This includes heroin. There are also folks right at this very moment that are considering suicide because they don’t want to or can’t turn to the streets. With no other options, what do you think happens? People aren’t going to just stay home and cry because they hurt. Some will, but I think most will look for a different means to end suffering. That includes turning to alcohol. Many folks get relief from marijuana and I think that is fantastic, but marijuana isn’t going to kill you. We have a responsibility to stop the discrimination going on against legitimate pain patients BEFORE they feel they have to turn to illegal drugs as a means to end suffering. BEFORE they decide upon suicide. This situation is killing people. Literally. Its time to get real and get honest. Its time to make sure the legitimate pain patients get their voices heard, before these things happen and they are bound to, given that there is no recourse.
This is part of a comment I posted on Facebook yesterday. Obviously, it’s only my opinion, but if you have proof that “scores” of pain patients are turning to heroin, I’d sure like to see it. I can only go by what I read in the news, but most stories of heroin use and overdose are reported in those who suffer from addiction, not chronic pain.
“I’m not sure we’ll see a substantial increase in heroin use within the pain patient population, as I think the majority of patients will not risk using that drug. Nor do I think that a majority of pain patients will commit suicide, although I do believe that most will definitely think about it.
No, I think the effects will be more subtle, like an increase in alcohol use, gun sales and deaths, PTSD, depression, kidney and liver damage from OTC meds, bankruptcies, filings for disability, homlessness, and even domestic violence. Actually, we’ve already seen increases like these in the general population, but it’s hard to prove causation instead of just correlation. But it’s obvious to me that the steady increase in suicide rates (and overdoses) is proof that the opioid war is causing more harm than benefit…”
Under comments:
“Leslee 6 hours ago
The reason heroin use is rising is because people who legitimately need pain medication are being cut off from receiving it. Therefore some people have no choice but to turn to street drugs to combat their pain.”
No, that’s not the reason, although it makes sense and is often repeated in the media. It’s not pain patients who are turning to heroin when they’re cut off from their medications — it’s those who are suffering from drug addiction. Drug addicts are frequently shamed and forced into procuring their medications in the underground market, regardless of which drug they’re looking for. And now pain patients are also being forced into the underground drug market, but I believe it’s only a very small percentage of pain patients who actually turn to heroin.
Wow…the truth begins.