Checking the Accuracy of a Story

In a recent Washington Post story, “Are restrictions on opioids a threat to human rights?,” Charles Lane states that the wave of prescription opioid overdoses has crested thanks to public policy changes including the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.

Actually, opioid prescribing and overdoses essentially peaked four years before the CDC guidelines were introduced. According to a recent report from the CDC, the rate of opioids prescribed is lower than at any time in the past 10 years. The peak occurred in 2010.

The CDC Guidelines’ Unintended Negative Consequences

From another perspective, the CDC guidelines have had unintended negative consequences. In fact, on the one-year anniversary of the publication of the CDC’s guidelines, Pain News Network published a survey suggesting changes in policy have harmed patients by reducing their access to compassionate care. Tragically, it has been reported that some of them have committed suicide as a result.

Lane quotes Keith Humphreys, Jonathan P. Caulkins, and Vanda Felbab-Brown who wrote, in the May/June issue of Foreign Affairs, “…legal drugs pushed by corporations can bring death on a scale vastly surpassing the effects of illegal ones.”

While Lane doesn’t argue with that statement, it is untrue. According to the American Journal of Managed Care, synthetic opioids have overtaken prescription opioids as the major cause of overdoses. The musician Prince is one of those who died from illegally manufactured and distributed fentanyl, but his death is classified as an unintentional opioid overdose. His death may have been unintentional, but it wasn’t from a prescription opioid.

Diverted Opioids Play a Role in Overdoses

Approximately 16,000 overdoses were blamed on prescription opioids in 2016. However, we don’t know how many of the decedents were people who were prescribed opioids or who used diverted opioids. Since two-thirds of abused prescription opioids are diverted, it is reasonable to assume that most of the people harmed from prescription opioids were not prescribed the drugs.

The heartbreaking death of Eric Chase Bolling, son of former Fox News host Eric Bolling, is an example. According to Bolling, his son “bought Xanax from someone. It was a street Xanax. Turns out it was laced with Fentanyl.” This undoubtedly was an unintentional overdose.

But What About the Intentional Overdoses?

President of the American Psychiatric Association, Dr. Maria Oquendo, and the Director of the National Institute of Drug Abuse, Dr. Nora Volkow, reported in the April 28^th 2018 issue of the NEJM that as many as 30% of the overdose deaths reported as unintentional may be due to suicide. This may be, in part, because of pain patients’ lack of access to compassionate care.

Earlier this year, a research team in which I participated and which was led by Ian R. H. Rockett reported in PLOS ǀ One that suicides counted as drug intoxication deaths in the U.S. are “likely profoundly under-reported.” It is extremely important that we understand the reasons for the deaths if we are to implement appropriate interventions to mitigate the potential harm from drugs.

Opioids have been overprescribed, but pain continues to be undertreated. The Human Rights Watch (HRW) correctly asserts that depriving chronic pain patients of appropriate healthcare treatment might be a human rights violation. As a pain and addiction specialist and researcher, I would welcome a plan that could reduce the overprescribing of opioids without endangering people in pain.

But the tsunami of patients being abandoned by their doctors, largely due to the CDC guidelines, demonstrates it is a human rights issue. This seems inarguable to me, and I’m disappointed in the fact that the Washington Post disagrees.