Several states and the DEA have spent the past few years “cracking down” on doctors who prescribe opioids such as OxyContin. However, we are now experiencing a heroin epidemic and the opioid problem is far from being resolved.
Are there any arguments or studies that indicate politicians and the DEA are making the opioid problem worse by creating these new policies?
Here's an argument as to how an insufficiently cautious prescription reduction law might do harm...
Suppose loyal Perdue Pharma booster Dr. X was a true believer and prescribed 500mg a day of opioid pills to each of 100 of his patients. This continues for years, and let's say all of those 100 patients become addicted. Addicted patients can't quit cold turkey, or they go through physical withdrawal symptoms, plus psychological withdrawal symptoms that are, as of yet, still somewhat poorly understood. The only way to get those 100 addicted patients off that 500mg/day is to taper the dosage -- this works something like a 747 jet airplane landing, it needs a long runway with a certain minimum length proportional to the momentum of the plane.
Suppose a well-meaning law to reduce doctor's prescriptions underestimates the correct length of that "runway" -- for example suppose the law mandates that Dr. X needs to get them down to 100mg/day in just one year. Some of Dr. X's 100 patients may "land" safely, let's say half do -- leaving 50 patients who have tapered too quickly and must crash into severe withdrawal symptoms. Those 50 patients are now potential customers for black market opioids such as heroin.
Since black market opioids are not formally regulated as to quantity and quality, the consistency of a unit dosage can vary widely from vendor to vendor, and from week to week. If some of the patients become black market customers, then attempting to maintain their customary 500mg/day addiction may be quite frustrating -- it would be as though they were prescribed not a standard pill with a known dosage, but rather a wildcard pill with a question mark on it -- this week that pill might be 500mg, next week it might be 50mg, and if they take 10 of them to compensate, then if next week it's back to 500mg and they again take 10 of those, (i.e. 5000mg), they OD.
Multiply that by all the Dr. Xs out there and all their addicted patients...
It is not clear how the reference to
a heroin epidemic
is related to
“cracking down” on doctors who prescribe opioids
other than heroin being classified as an opioid.
Are there any arguments or studies that indicate politicians and the DEA are making the opioid problem worse by creating these new policies?
It would be nearly an impossible to make a rational argument that policies intended to lower prescription of opioids by physicians or punish physicians who prescribe opioids would have a negative impact on society, with the opioid prescription rate in 2016 being 66.5 prescriptions per 100 people, see Centers for Disease Control and Prevention U.S. Prescribing Rate Maps; in pertinent part
The overall national opioid prescribing rate declined from 2012 to 2016, and in 2016, the prescribing rate had fallen to the lowest it had been in more than 10 years at 66.5 prescriptions per 100 persons (over 214 million total opioid prescriptions).
In about a quarter of U.S. counties, enough opioid prescriptions were dispensed for every person to have one.
- While the overall opioid prescribing rate in 2016 was 66.5 prescriptions per 100 people, some counties had rates that were seven times higher than that.
What could be argued is that the lack of policies aimed at reducing production of opiods by pharmaceuticals for profit (see These Pharmaceutical Companies Are Making a Killing Off the Opioid Crisis) is worse than focusing on the distribution of opioids by physicians for profit who receive finished opioid products from pharmaceutical companies for profit, Ex-DEA agent: Opioid crisis fueled by drug industry and Congress
JOE RANNAZZISI: This is an industry that's out of control. What they wanna do, is do what they wanna do, and not worry about what the law is. And if they don't follow the law in drug supply, people die. That's just it. People die.
...
JOE RANNAZZISI: This is an industry that allowed millions and millions of drugs to go into bad pharmacies and doctors' offices, that distributed them out to people who had no legitimate need for those drugs.
BILL WHITAKER: Who are these distributors?
JOE RANNAZZISI: The three largest distributors are Cardinal Health, McKesson, and AmerisourceBergen. They control probably 85 or 90 percent of the drugs going downstream.
BILL WHITAKER: You know the implication of what you're saying, that these big companies knew that they were pumping drugs into American communities that were killing people.
JOE RANNAZZISI: That's not an implication, that's a fact. That's exactly what they did.
Drug firms shipped 20.8M pain pills to WV town with 2,900 people
Between 2006 and 2016, drug wholesalers shipped 10.2 million hydrocodone pills and 10.6 million oxycodone pills to Tug Valley Pharmacy and Hurley Drug in Williamson, according to Drug Enforcement Administration data obtained by the House Committee.
Springboro, Ohio-based Miami-Luken sold 6.4 million hydrocodone and oxycodone pills to Tug Valley Pharmacy from 2008 to 2015, the company disclosed to the panel. That’s more than half of all painkillers shipped to the pharmacy those years. In a single year (2008 to 2009), Miami-Luken’s shipments increased three-fold to the Mingo County town.
Miami-Luken also was a major supplier to the now-closed Save-Rite Pharmacy in the Mingo County town of Kermit, population 400.
The drug wholesaler shipped 5.7 million hydrocodone and oxycodone pills to Save-Rite and a branch pharmacy called Sav-Rite #2 between 2005 and 2011, according records Miami-Luken gave the committee. In 2008, the company provided 5,624 prescription pain pills for every man, woman and child in Kermit.
though there is some policy movement in that direction as of late, see DEA Proposed Rule Would Limit Drug Manufacturer’s Annual Opioid Production.
Doctors in the US are now prescribing opioid painkillers like fentanyl less often, and that is cause for concern. Policies aimed at curbing abuse of the opioids have led to such drugs being less available than is needed to treat patients. While opioids have a bad reputation for causing addiction problems, they are painkillers that have far less side effects than NSAID-type painkillers. Older patients are at greater risk than younger patients of gastro-intestinal bleeding due to NSAIDs, they need to use a higher PPI dose to reduce stomach acid. But recent research has linked the use of PPIs to cardiovascular problems, dementia, and kidney problems, these side effects are likely caused by PPIs accelerating vascular aging.
