menu ☰
menu ˟

Scapegoating Opioid Makers Lets True Offender Get Away

24 Apr 2019

Jeffrey A. Singer

April 24 (UPI) — John Oliver is a brilliant comedian with
a large platform, and he has been using it of late to
demonize
the pharmaceutical companies that produce opioids.
Major targets of his attack are Purdue Pharma and its Sackler
family principals, developers of OxyContin, which, until around
2010 was a drug of choice for non-medical users.

Like the tobacco companies in the 1990s, it is understandable to
focus indignation at companies, driven by the profit motive, that
purvey products that can cause harm and even death. It is
reasonable to question and criticize their marketing ethics and
aggressiveness.

But at the end of the day, extracting a pound of flesh from the
Sacklers won’t stop the overdose rate from climbing. That’s because
the standard narrative that overprescribing of opioids caused the
overdose crisis is based upon misinformation — as is the
belief that opioids have a high overdose and addiction
potential.

Data from the National Survey on Drug Use and Health, as well as
the Centers for Disease Control and Prevention, clearly show

no correlation
between the number of opioid prescriptions
dispensed and “past month non-medical use” or “pain reliever use
disorder” among adults over age 12. As high-dose opioid
prescriptions dropped 58 percent from 2008 to 2017 and overall
prescriptions dropped 29 percent in that time period, the overdose
rate continued to climb. Decreasing the availability of
prescription pain relievers for diversion into the black market
only drives non-medical users to more dangerous heroin and
fentanyl.

The real villain is the
war on drugs. Yet it’s getting off scot-free.

In 2017, heroin and fentanyl
comprised
75 percent of opioid-related overdose deaths. Deaths
from prescription pain pills also involved drugs like cocaine,
heroin, fentanyl, alcohol and benzodiazepines 68 percent of the
time. Less than 10 percent of overdoses from prescription pain
pills in 2017 did not involve other drugs.

Opioids prescribed in the medical setting have been repeatedly
shown to be safe. Researchers following over 2 million North
Carolina patients prescribed opioids noted an overdose rate of

0.022 percent
, and nearly two-thirds of those deaths had
multiple other drugs in their system. A 2011 study of chronic pain
patients treated in the Veterans Affairs system found an overdose
rate of
0.04 percent
. A larger population
study
found an overdose rate of 0.01 percent.

Researchers at Harvard and Johns Hopkins universities recently
found
a total misuse rate of 0.6 percent in over 560,000
patients prescribed opioids for acute and post-op pain between 2008
and 2016.
Cochrane

studies
, highly regarded for their rigor, found addiction rates
in chronic pain patients on opioids of roughly 1 percent.

People often mistakenly equate physical dependency with
addiction. Physical dependency is seen with a variety of drugs,
including antidepressants, anti-epileptics, and beta blockers. A
person can be slowly weaned off these drugs. But addiction is a
compulsive behavioral disorder with a genetic component featuring
repeated use despite self-destructive consequences. The director of
the National Institute on Drug Abuse points out in a 2016
paper
that true opioid addiction “occurs in only a small
percentage of persons who are exposed to opioids — even in
those with pre-existing vulnerabilities.”

As researchers at the University of Pittsburgh recently
demonstrated
, non-medical use has been on a steady exponential
increase at least since the mid-1970s and shows no signs of slowing
down. The only things that have changed over the years are the
drugs in vogue for non-medical use. It seems sociocultural factors
are at play. In fact, young people seem more willing to engage in
risky drug use than their predecessors. A 2017 study showed

33.3 percent
of heroin users initiated with heroin.

At the end of the day, the drug overdose problem is the result
of sociocultural dynamics intersecting with
drug prohibition
— and all the dangers that a black
market in drugs present. Prohibition also presents
powerful incentives
to corrupt doctors, pharmacists and
pharmaceutical representatives who seek the profits offered by the
underground trade.

When Portugal
decriminalized
all drugs in 2001, it saw a 75 percent drop in
its population of heroin addicts by 2015, and now has the lowest
overdose rate in Europe, at 6 per million population (compared to
312 per million in the United States). Along with Portugal, most of
the developed world has put an emphasis on
harm reduction
strategies over restrictionist, prohibitionist
approaches, one reason they have lower death rates than the United
States. These strategies include medication-assisted treatment with
drugs like methadone and buprenorphine; safe injection facilities;
needle-exchange programs; and making the overdose antidote naloxone
more available.

None of this is meant to defend the conduct of a few
pharmaceutical companies or those who work for them. It is meant to
refocus energy and anger where it belongs.

The real villain is the war on drugs. Yet it’s getting off
scot-free.

Dr. Jeffrey A.
Singer
is a general surgeon in Phoenix and a senior fellow at
the Cato Institute.

Click here to view the full article which appeared in CATO Journal