Last week, the Centers for Disease Control and Prevention (CDC) released a report about “the epidemic” of overdoses involving prescription opioid pain medicines (strong pain medicines like morphine, including oxycodone, hydrocodone, and others).  The report blames rampant overprescribing by doctors and other professionals for the sharp uptick in deaths related to opioid abuse, leading the CDC to propose various solutions aimed primarily at reducing the supply of these medications.  In reality, if Americans want to know where these misused medications are coming from, they need to look in the mirror – or more accurately the medicine cabinet behind the mirror.
 
In its report, CDC states that that 14,800 people died of overdoses in which prescription opioid pain medicines were present, an increase from about 4000 such cases in 1999.  The CDC then argues that because this increase in deaths occurred while sales of these drugs increased, one caused the other.  This is an easy conclusion to leap to – and one that the CDC has focused on in the past – but it doesn’t make that conclusion right.  And what’s even more dangerous is proposing new policy based on unproven conclusions.

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This is not to say that there is no relationship - the report does not prove or disprove one - but it certainly means we must question their proposed solution.  The CDC’s almost exclusive focus on reducing the number of prescriptions for these medicines overlooks the legitimate use of these medications.  A recent Institute of Medicine report found that 116 million adults, roughly one in three people, live with chronic pain.  This is pain that persists long after an injury that caused it has healed, or that is related to another chronic condition like arthritis.  Some people I’ve treated face chronic pain that is so debilitating that they can no longer work.  This unrelenting chronic pain robs people of their lives to a point where suicide can sometimes seem like the only way out.
 
Opioid pain medications, along with a range of other treatments, allow many of these people to get out of bed in the morning and perform day-to-day tasks that we all take for granted.  Quite simply, they can give people their lives back.  Cutting back the supply of these medications and assuming that will cut back the misuse is misguided and hurts these people with chronic pain.  Considering there are 10 times as many people who suffer from chronic pain as those who misuse these medications, we have to think about whom this action would impact the most.  We need to find ways to keep these vital medicines out of the hands of those who misuse them, without preventing people they help from being able to use them properly.
 
The answer lies in another finding from government surveys, which CDC did not mention.  In five out of six cases, people misusing opioid pain medications said they obtained the medication from sources other than doctors.  In the majority of these situations, the medications were given or sold to the person misusing them by a friend or family member.  Previous research found that 60% of most people who died of overdoses involving these medications did not have prescriptions for them.
 
If we want people to stop dying from overdoses, the most effective solution is to prevent people from getting opioid pain medications from friends and relatives – not stopping doctors from using these medications for legitimate pain relief.  We already have laws on the books to stop this behavior (giving or selling opioids without a prescription is a felony, and a death as a result could be involuntary manslaughter), we’re just not enforcing them as we should.  In 2008 alone, there could have been nearly 10,000 such cases of involuntary manslaughter in the United States. How many of them were prosecuted?
 
If we want to stem the tide of prescription opioid abuse and resulting deaths, we need to focus on the real sources of these misused medicines.  They’re coming from medicine cabinets, not doctors or pharmacies.  Limiting prescriptions and withholding opioids from people who depend on these medications to alleviate their daily pain is a drastic across-the-board solution that will cheat many innocent people out of a good quality of life, while ignoring the real sources of abused medicines.  That’s just wrong.

 


 Bob Twillman, Ph.D., FAPM,2011-2012 Mayday Pain and Society Fellow and Director of Policy and Advocacy American Academy of Pain Management