Government Data Refute the Notion That Overprescribing Caused the ‘Opioid Crisis’
The Federal Trade Commission, which thinks “lack of competition and contracting practices…may be contributing to drug shortages,” is soliciting public comments on that subject. But when it comes to opioid pain relievers, the problem is not a lack of competition between manufacturers, wholesalers, or distributors. Shortages of these safe and effective analgesics are instead a result of tightened production quotas imposed by the Drug Enforcement Administration (DEA), along with a recently revealed injunction against pharmacies that was part of the National Opioids Settlement.
That $26 billion settlement resolved myriad government-backed lawsuits alleging that reckless distribution of these medications produced the ongoing “opioid crisis” of escalating drug-related deaths. The DEA’s steadily stricter production limits are based on the same premise. But that premise is fundamentally mistaken.
It may not be going too far to suggest that much of U.S. public health policy regarding medical treatment of people in pain is fraudulent. The authors of the opioid prescribing guidelines that the Centers for Disease Control and Prevention (CDC) published in 2016 and 2022, for example, knew quite well that their recommendations, which resulted in widespread undertreatment and patient abandonment, did not have a sound scientific basis.
Contrary to what Tom Frieden, then the CDC’s director, said in a press release introducing the 2016 opioid guidelines, prescription practices did not create the opioid crisis and are not sustaining it now. That much is clear from data published by the CDC itself.
In 2018, a group of highly reputable data analysts examined about 600,000 accidental death reports spanning nearly four decades, from 1978 through 2016. They published their results in the prestigious journal Science. These charts are extracted from that study:
Although these charts might seem complicated, the most important features stand out strongly. Accidental deaths involving drugs of all kinds rose steadily and exponentially for 38 years. That period began long before the increase in opioid prescribing that is widely blamed for this trend, and it includes the seven years from 2010 through 2016, when opioid prescriptions fell by 55 percent.
The breakdown of drug-related deaths varies from year to year. But deaths involving prescription opioids—the blue line in the chart on the left, one of eight overlapping categories—have never accounted for more than 22 percent of the total.
The rise in accidental deaths since 2010 is dominated by street drugs—in particular, illegally produced fentanyl, which shows up in counterfeit pain pills as well as heroin, cocaine, and methamphetamine. Legal prescriptions are lost in the noise of illicit drugs, which are often combined with alcohol. While most drug-related deaths involve multiple substances, deaths among patients who take opioids by prescription for pain relief almost never do.
The DEA has known about these data at least as far back as 2019. The agency published these charts that year as part of a course for doctors renewing their licenses to prescribe controlled substances. But this knowledge has not st
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