What Is the Truth About Overdose Deaths?
In its 2015 Report Overview, the Clinton Foundation calls prescription drug abuse (leading to overdose) an imminent public health threat that kills “more people than motor vehicle accidents.”
The CDC reports that, during 2014, a total of 47,055 drug overdose deaths occurred in the United States. Indeed, that is a large number of tragic deaths.
Is There More to This Problem Than Prescription Drugs?
But a closer look at that statistic reveals that these deaths were caused by all drugs, not just prescription drugs, which is what those who relay statistics to the public often imply. Furthermore, the number also includes overdoses of illicit drugs along with over-the-counter medications.
In 2014, 61% of 47,055 (28,647) drug overdose deaths involved some type of opioid, including heroin. Note that even this figure is about one third fewer than the number of motor vehicle deaths reported for the same year.
In fact, National Safety Council reports that, in 2015, “38,300 people were killed on U.S. roads, and 4.4 million were seriously injured.” That number makes the Clinton Foundation’s statement that prescription drug abuse kills more people than motor vehicle accidents alarming.
3 Reasons Why the Clinton Foundation Is Wrong
But the statement by the Clinton Foundation is inaccurate for three reasons.
First, the Clinton Foundation apparently puts all drug overdoses into the category of prescription drug overdoses. Many drugs contributing to the overdose statistic are not prescription drugs. For example, acetaminophen, ecstasy, and ibuprofen are not prescription drugs but contribute to the mortality stats.
Second, of the drug overdoses that are related to prescription drugs, many resulted from drugs other than opioids. Antidepressants, antipsychotics, and amphetamines are common examples.
Third, opioid-related drug overdoses comprise prescription opioids (including Oxycontin and Methadone) and illicit, non-prescription opioids (such as heroin and synthetic fentanyl).
All overdoses are bad, but it is important not to misrepresent the data. In order to curb the opioid epidemic, we have to understand the statistics that could drive policy.
The actual number of prescription opioid overdose deaths was closer to 14,000 in 2014 and has been on the decline since 2011, despite an increase in the number of illicit opioid deaths (mainly due to heroin and synthetic fentanyl opioids).
The Clinton Foundation is correct when it calls prescription drug abuse a serious public health threat. Unfortunately, this is interpreted and reported by many as predominately a prescription opioid problem.
This isn’t to trivialize the points that the Clinton Foundation is making. Any drug overdose is devastating to a family of a decedent. However, to suggest that all of these deaths are due to prescription opioids just muddies the water and confuses the issue. Even the CDC cannot determine from death statistics whether an opioid is responsible for a death or whether it’s only associated with the death.
When an opioid is involved, it’s rarely possible to determine from the statistics the degree to which these overdoses were caused by a prescription opioid or other factors. Most people die from polysubstance abuse rather than just one drug. Ignoring the other factors that contribute to deaths means we have only part of the information we need to develop appropriate interventions.
An example is the report that 40% of people who use opioids also use prescription benzodiazepines. An FDA review found, “the growing combined use of opioid medicines with benzodiazepines or other drugs that depress the central nervous system (CNS) has resulted in serious side effects, including slowed or difficult breathing and deaths.”
Questionable reporting and mischaracterized, unclear statistics have lead policymakers to blame prescription opioids as the main culprit in the overdose epidemic. Prescription opioids have contributed to a large number of overdoses, but they have not come close to exceeding the number of deaths from motor vehicle accidents.
So neither prescription drugs nor prescription opioids cause more deaths than motor vehicle accidents.
In an attempt to curb the opioid crisis, people in pain are being ignored or told by physicians that nothing can be done for them. This is happening partly because of the misunderstandings of the data that lead to statements such as the Clinton Foundation’s and public policy. Solving the opioid crisis is important, but efforts to reverse the problem should not be based on misinformation. Policy should be based on fact and not a catchy headline.
Purchase my book, The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon), or read a free excerpt here.
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Josh Bloom at the American Council on Science and Health also casts light on this issue with recent articles on the so-called “epidemic” of prescription opioid deaths. The epidemic is in large part hype rather than reality. However, by restricting prescriptions of effective opioids, CDC and others are doing grievous harm — literally driving people into much more dangerous drugs, both recreational abusers and many thousands of pain patients who are desperate for help to maintain any quality of life at all.
See http://acsh.org/news/2016/11/22/trumps-wall-and-opioid-crisis-10450 “Trump’s Wall and the Opioid Crisis
Thank you for your efforts to correct the miss representation of the opioid problem. The limitation of using medications that are appropriate and the pain setting is doing more harm to patients then good many times. Our clinic appreciate your effort.
Dr. Webster highlights the dilemma faced by regulators and law makers in dealing with drug control policy. A listing of “standard treatments” for chronic pain patients include an expansive list of safe and effective drugs approved by the FDA. The 12-hour opiate prescription is written preceding a second immediate release opiate prescription for “breakthrough pain” and that is added to a third prescription for the benzodiazepine to address the anxiety experienced in dealing with the chronic pain syndrome, or to help with sleep onset associated with chronic pain syndromes. Then of course, it is the prescription or purchase of stimulant laxatives to combat the opioid induced constipation, or benadryl for the treatment of pruritis associated with the opiate treatments……and so on and so on and so on. Of course all of this is legal, all of this can be supported by literature reviews, and all of this represents the “standard of care”. But when the patient dies and the tox report comes back, we are all eager to point to “polydrug” use as the cause of death. By definition, the standards of care for chronic pain represents an entourage treatment strategy – it is a polydrug methodology. Critically important in the doctor patient relationship is the maintenance of a written or verbal contract that ensures that the primary physician on the case (be it neurologist, anesthesiologist, or pain manager) has valid and reliable information as to the compendium of drugs the patient is taking, including herbal products, vitamin supplements, nutriceuticals, over-the-counter meds, etc. As the only legally competent authority to write a prescription and supply the patient with many of these core elements of the treatment protocol and who has the requisite level of knowledge required to make informed decisions on the entourage treatments it is the ultimate responsibility of that physician to address “the tough questions” and set limits of what can and cannot be taken by the patient outside the scope of the treatment center or office. If physicians adopt a “write rather than fight” attitude with the patient all is lost. Most patients feel OTC drugs are safe, “natural” means safe, “herbal product” means safe; the message has to be more effectively transmitted to patients that the only treatments/pills/drugs/health supplements that they can take are the ones the primary or lead physician has given them. The patient has to be educated that under your treatment contract, all other medications must be screened and approved by you through a dialogue with that other physician. Under the contract, no other treatments such as OTC, herbal, health food store products can be bought or consumed without your prior approval. A prescription is a contract. Another contract has to be implemented between the patient and the physician regarding the “rules of treatment compliance”. If the goal is to effectively treat chronic pain then a more “controlled” doctor-patient relationship must be imposed. You don’t give a loaded gun to child, you certainly should not feel comfortable giving a list of prescriptions to a patient without setting limits based on their pharmacology and the knowledge of their direct additive, infra-additive, or supra-additive interactions. With the privilege comes responsibility. We must always keep in mind that these are, in fact, potent synthetic compounds intentionally targeting homeostatic mechanisms regulating (ab)normal physiological functions. Pharmaocology 101 – All drugs have multiple effects !!!! Let’s not lose site of that fact.
SO HOW DO WE GET THE ACCURATE INFORMATION TO THE POWERS THAT BE.
PEOPLE IN CHRONIC PAIN ARE DYING DAILY FROM SUICIDE LACK OF SUPPORT OR UNDER TREATMENT AND MANY HAVE BEEN FORCED TO TURN TO THE STREETS. PAIN IS HARDER TO LIVE WITH THEN HUNGER.
THE CDC MUST REVERSE THE GUIDELINES AND THE SURGEON GENERAL MUST RETRACTABLE HIS LETTER TO EITHER ERYKAH DOCTOR SAYING OPOID PRESCRIPTIONS ARENT WORKING..
THERE ARE 40 MILLION OF US THAT SAY LONG TERM OPOID THERAPY WORKS. SOME TIMES WE NEED LOW DOSE AND SOME NEED VERY HIGH DOSE. THIS IS BASED ON THE PATIENTS TOLERANCE TO THE MEDICATION.
WHY WONT anybody ask us. NOT ONLY IS IT CRUEL PUNISHMENT, ITS AN INSULT TO OUR INTELLIGENCE. INSURANCE COMPANIES THAT ARE ALSO PROVIDERS ARE HOLDING THE GOLDEN TICKET TO SAY “WE DONT CARE IF IT’S BEEN WORKING FOR TEN YEARS” WE MUST FOLLOW THE GUIDELINES. I’M SURE THE PROFIT FROM THE SAVINGS FOR KAISER ALONE IS IN THE TENS OF BILLIONS OF DOLLARS. ITS GOTTA BE ILLEGAL AND A CONFLICT OF INTEREST. KAISER IS LITERALLY KILLING PEOPLE AND NOBODY CARES.