Prescription opioids continue to contribute to the rise in drug overdose deaths
PROP applauds the Biden administration for promulgating guidelines that will help expand access to evidence-based medication assisted treatment for opioid use disorder.1
Treatment, however, is only part of the solution. Prevention may be even more important, and decreasing new opioid prescriptions is key to ending this epidemic. Because most opioid-related deaths now involve illicitly synthesized opioids (fentanyl, carfentanyl), surpassing deaths due to prescription opioids, a conventional view is that the prescription opioid crisis is over. In fact, deaths due to prescription opioids have continuously increased from 1999 through 2017.(Fig)2
After the CDC released its 2016 guideline on opioid prescribing, and related state and local prescribing guidelines reduced U.S. opioid prescribing3, deaths from prescribed opioids substantially declined in 2018 and 2019 for the first time in almost two decades.4 But U.S. prescription opioid consumption and related prescription opioid overdose deaths remain at historically high levels; the United States uses more prescription opioids than any country in the world. Tragically, prescription opioids still account for about 28% of all opioid-related deaths. Prescription opioids also contribute to synthetic opioid deaths because many heroin and illicit fentanyl users developed their addiction from taking prescription opioids.5
The best evidence now shows that prescription opioids are ineffective for long-term management of common chronic pain conditions, such as osteoarthritis and low back pain.6 Reducing opioid use for acute pain (after injuries, post-op) leads to fewer persons transitioning to chronic opioids, fewer then becoming opioid-dependent, fewer persons becoming addicted, and ultimately fewer opioid overdose deaths.
In 2020, over 93,000 people died in the US from drug overdoses.4 This 29.4% jump was the highest single year increase ever recorded. This contrasts with the estimated highest peak of gun deaths of 40,000 in 2017, the highest peak of HIV deaths of 45,000 in 1995, and the highest peak of car crash deaths of 53,000 in 1972.7 Overprescribing of opioids continues to fuel this epidemic. Reducing new opioid prescriptions remains vitally important.
PROP also calls for the millions of persons who needlessly became opioid dependent to be given effective treatments for opioid dependence and opioid use disorder to prevent drug overdoses involving the dangerous illicit synthetic opioids now readily available.
- Practice guideline for the administration of buprenorphine for treating opioid use disorder. Department of Health and Human Services. 4/28/21. URL: https://www.federalregister.gov/documents/2021/04/28/2021-08961/practice-guidelines-for-the-administration-of-buprenorphine-for-treating-opioid-use-disorder. Accessed 7/20/21.
- National Institute on Drug Abuse. Overdose death rates. Jan 29, 2021. URL: https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates. Accessed July 16, 2021.
- Bohnert ASB, Guy GP, Losby JL. Opioid prescribing in the United States before and after the Centers for Disease Control and Prevention’s 2016 opioid guideline. Ann Int Med 2018; 169: 367-375.
- Ahmad FB, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2021. URL: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm. Accessed 7/16/2021.
- National Institute on Drug Abuse. Prescription opioids and heroin research report. Revised Jan 2018. URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a1.htm. Accessed 7/20/2021
- Krebs EE, Gravely A, Nugent S, Jensen AC, DeRonne B, Goldsmith ES, Kroenke K, Bair MJ; Noorbaloochi S, Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis PainThe SPACE Randomized Clinical Trial. JAMA. 2018;319(9):872-882.
- Katz J, Sanger-Katz M. “It’s huge, it’s historic, it’s unheard-of”: Drug overdose deaths spike. NYT 7/14/2021 Url: https://www.nytimes.com/interactive/2021/07/14/upshot/drug-overdose-deaths.html. Accessed 7/16/2021.
Follow us on Twitter