We have a drug overdose crisis, not a prescription opioid crisis

We have a drug overdose crisis, not a prescription opioid crisis
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The media and policymakers are mistaken when they decry an opioid crisis rather than a drug crisis. Unfortunately, the mislabeling of the drug crisis leads lawmakers to chase one suspect while the mastermind is making a clean getaway.  

Here are some examples of the way the media and others mistakenly labeled a drug crisis as an opioid crisis.

A recent New York Times op-ed by Nicolas Kristof, "Drug Dealers in Lab Coats," begins by citing “63,000” drug overdose deaths in 2016. In the next sentence, Kristof implies that these were exclusively opioid-related deaths. But they weren't. The 63,000 drug-related deaths involved all drugs including cocaine, benzodiazepines, and methamphetamines.

 

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In a recent story, CNN also misreported the data. To quote the original story, "The Centers for Disease Control and Prevention expects opioid overdose deaths to top 64,000 in 2016 when the numbers are finalized.” To its credit, CNN corrected the error and modified the statement to say the number reflected “drug overdoses.” CNN also added the sentence, “Most of these overdoses involved an opioid." But this was after the inaccurate information had been posted online and was widely read.

The Los Angeles Times unabashedly claimed that the opioid crisis "killed more than 64,000 Americans" last year. That is also untrue.

Governor Chris Christie explained his belief recently on National Public Radio (NPR) that opioids kill 175 Americans each day. If true, that would mean there would be a total of 63,875 opioid-related deaths in one year. The Washington Post cites the 175 deaths per day as well. Again, the data does not support these statements.

We've grown so used to hearing about the opioid crisis that, when we hear about drug overdoses, it's easy to reach the conclusion that the words "opioids" and "drugs" mean the same thing. However, they do not. Many media reports — and the ones I cited above are just a sampling —obfuscate that fact. Intelligent media consumers, as well as policymakers, can become confused.

There is additional confusion associated with opioid painkillers and illicit opioids. Though both are opioids, the first group is used for a legitimate medical purpose while the second group is not.

So let's be clear about this. When we read that there have been 63,000 or 64,000 drug overdose deaths, that does not mean they are deaths from prescription opioids.

Although most drug overdoses involve an opioid, that includes opioids without a medical purpose such as heroin and synthetic fentanyl products that found their way to America from China and Mexico.

Prescription painkillers certainly contribute to the crisis, but it is impossible to determine the extent to which they are involved for at least two reasons. First, heroin is metabolized into morphine which is often mis-categorized as a prescription opioid at autopsy.

To further complicate matters, fentanyl can be either prescribed for pain or smuggled from foreign countries. So, while a fentanyl-related death may be appropriately counted as a prescription opioid death, most of the increase in overdoses is from illegal fentanyl analogues.

Researching this article and ensuring its accuracy was difficult, because the available information is incomplete and, in some cases, conflicting. That said, the preliminary 2016 reports of drug overdoses indicate that about 3 out of 4, or 75 percent, of drug-related deaths appear to involve a substance other than a prescribed opioid. Therefore, of the estimated 63,000 overdose deaths, only 1 out of 4 (or 25 percent) — that is, 16,000 — are associated with prescription opioids.

We need to recognize that the opioid epidemic has shifted away from prescription opioids. The number of recent overdoses of non-prescription drugs have eclipsed the original problem of prescribed painkillers.

Yet, most reports, including the President’s Commission on Combating Drug Addiction and the Opioid Crisis, conflate the overdose data into one alarming figure that misleads policymakers into proposing interventions that don’t address the primary source of the problem.

The approach we are taking is dangerous, because attempting to curb the number of drug deaths by hyper-focusing on prescription opioids is like calling the fire department to extinguish one house fire while the surrounding three houses next door burn to the ground.

Preventing every overdose death is important, whether or not it involves prescribed opioids.

President Trump has missed an opportunity to redirect his commission to address the larger drug crisis. We know he pays attention to the media.

Let's hope the media will be more discerning with its reporting and ask policymakers what they are doing about the tragic overdose problem from drugs that are not prescription opioids.

Lynn R. Webster, M.D. is a past president of American Academy of Pain Medicine, author of The Painful Truth and co-producer of the Public Television documentary, "The Painful Truth." Dr. Webster consults and advises opioid manufacturers. You can find him on Twitter: @LynnRWebsterMD.