March, 2016: The Centers for Disease Control officially release their ‘opioid prescribing guidelines’ despite months of controversy, complaints by medical groups and pain advocacy groups, threats of lawsuits, and a congressional inquiry into their process.
CDC has never answered the question: Why them, and not the Food and Drug Administration? Why focus on prescription opioids when their own data – and just about all data – clearly shows the drugs of choice which cause addiction and overdose is heroin, illicit fentanyl, and the deadly polypharma combination of several non-medically used substances (alcohol, methamphetamine, cocaine, illicit fentanyl, heroin, benzodiazepines, etc.)
Regardless: The guidelines became final. The result, predictably, was catastrophic. With the CDC declaring officially that prescription opioids were the continuing cause of the ‘opioid/overdose epidemic’ in the United States and declaring that primary care medical providers should adhere to strict prescribing limits, several short-sighted and terrible things came to pass:
- The DEA orders repeated production limits on opioid analgesic medications. If prescription opioids are the problem, then limit them, right? Only what if prescription opioid medications were never the problem, and you still limit them? Here’s what:
- Hospices and palliative care facilities don’t have medications for their patients, where misuse is almost never the case. People routinely dying in pain becomes a real possibility in our country.
- Hospitals are forced to delay elective surgeries and ration medications. Shortages are forcing physicians and pharmacists to ration legitimately prescribed opioid medications.
- Hospital Shortages lead to Patient Pain, Medical Errors
- Pets and animals start needlessly suffering – Opioid Shortages are Harming Veterinary Patients, too.
- States across the nation pass legislation limiting prescriptions to opioid analgesics, either in dosage, duration, or both.
What has been the net result? As previously stated: a dramatic decrease in the number of opioid prescriptions in the United States – regardless of who or why they were written (the American Medical Association reports a 22.2% decrease from 2013 to 2017). People with legitimate injuries or illnesses are now routinely denied access to pain relief. The number of people suffering from untreated pain in this country is horrific. But hey, it’s all worth it if we are ultimately saving the lives of people who are struggling with addiction or opioid use disorder, right?
We are not saving lives. We’re losing more people than ever before. As long as the efforts to tackle the ‘opioid crisis’ are aimed squarely at pharmaceutical opioid analgesics and not at the illicit street drugs we will continue to lose ground. Note: While prescription opioids make an appearance on the list of causes of opioid deaths, it can be misleading. Multiple studies have shown that when people seek illicit street drugs like heroin, illicit fentanyl, etc. they often also seek whatever else they can find; sometimes as many as 10 other drugs in their system.
A study out of New Hampshire found that nearly all fentanyl-involved overdose deaths in the state also involved another drug—and that 20% of people who died of an overdose involving fentanyl had 10 or more drugs in their system.https://www.thefix.com/what-percentage-fentanyl-related-deaths-involve-other-drugs
In other words: people seeking illicit street drugs are routinely also seeking illicitly-sourced prescription medications as well. The presence of a prescription medication in one’s system does not mean that person had a legitimate prescription – it means that they obtained a pharmaceutical opioid medication somewhere.
The ramifications of the CDC Opioid Prescribing Guidelines will become a dark chapter in American medical history. But in 2016 many people – and the common media narrative – celebrated the guidelines as a positive step in the ‘war on opioids’. Later even the CDC would come to regret those guidelines and would publicly recognize how they were ‘misinterpreted’ and ‘mis-implemented’. Stay tuned.