CDC Admits Counting Rx Opioid Deaths Wrong

Whoops. All of the U.S. Government data about prescription opioids causing overdose fatalities has been reported incorrectly – by a lot. This inaccuracy has lead the common and consistent narrative of “prescriptions and doctors caused the opioid crisis” to be drilled into everyone from policy makers and legislators to your neighbor and your grandma. Everyone in America is certain that prescriptions have been the cause of all of the overdose fatalities.

Only, they weren’t. In the April 2018 American Journal of Public Health, four researchers at the Centers for Disease Control and Prevention’s Division of Unintentional Injury Prevention report that the CDC’s methods for tracking opioid overdose deaths have over-estimated the number of those deaths due to prescription opioid as opposed to heroin, illicitly manufactured fentanyl, and other illicit variants of fentanyl. They called the prescription overdose rate ‘significantly inflated’.

How did this happen? It’s admittedly complicated. Often the exact drugs involved in overdose deaths are never identified. The number of deaths due to diverted prescription opioids (those stolen, smuggled, or sold on the street) is unknown. And here’s the key thing: They also note that multiple drugs are involved in over half of their reported cases of prescription opioid overdoses – although other centers report a rate of polypharma overdose in over 90% of overdoses.

So the big number which the CDC had disclosed – 64,000 people died of drug overdoses in 2016! – wait, that accounts for ALL drugs including over the counter medications like Tylenol and other NSAIDs. Whoops. Okay! The CDC had estimated that 32,445 Americans had died from overdoses of pain medications in 2016. Now they admit the number is more like half of that number, or 17,087. Or maybe that number is still wrong, they can’t be sure.

A couple of things spring to mind about this disclosure:

  1. Why was this disclosed in an editorial of a little-known journal and not on CDC’s website, or with any amount of fanfare?
  2. Why was this disclosed by four individual researchers, and not with the full weight of the CDC?
  3. Why did it take the CDC so long to realize that their data was vastly mis-represented? An opinion piece in The Hill by Dr. Lynn Webster broke down the numbers a full five months earlier back in November 2017. His estimates put the number at closer to 16,000 total for 2016 – and he shows his work.
  4. How did the media coverage completely escape this significant correction? The 64,000 number shot around the world so quickly and pervasively that you can still find it in reputable news sites everywhere. But that number was never accurate.

Policymakers seem intent on seeing doctors treating patients in pain as the source of the opioid overdose crisis. And their focus has been on getting doctors to curtail prescribing opioids, while ordering a reduction in the manufacture of opioids (25 percent in 2017 and 20 percent this year) by pharmaceutical companies. This has made a lot of patients, in and out of the hospital, suffer from under-treatment of pain. Yet, the government’s own numbers have shown for years that the overdose crisis is primarily the result of nonmedical users seeking drugs in the black market created by drug prohibition. This article from the CDC researchers provides yet another reason why policymakers should rethink their approach.

Where is the public outcry that all of the current policies to curb the addiction/overdose crisis are based on incorrect data? Where is the massive course correction to ensure those efforts – and the massive amounts of government spending – are aimed at solving the actual cause of the problem: illicit street drugs, and towards evidence-based treatments?

Where is the concern over what well-intended people have done to chronic pain patients and their providers? Now that the CDC has admitted that their data has been wrong all along, surely they will amend their guidelines? Surely?