A new Brown University study of nearly 3,400 veterans over ten years found that when participants began to misuse opioid painkillers, they had a very high likelihood of also beginning to use heroin. This shouldn’t come as a surprise. Last year, Time magazine reported that 4 of 5 heroin addicts say they came to the drug from prescription painkillers.
It’s Raining Scripts
An ASIPP Fact Sheet states: “Americans, constituting only 4.6% of the world’s population, have been consuming 80% of the global opioid supply.” According to the CDC, health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills. And according to Time, 9.4 million Americans take opioids for long-term pain.
Evidence-Based Medicine, right?
Anyone who has had surgery or suffered severe acute pain can attest to how helpful these drugs can be, but what does the evidence say about the outcomes of long-term opioid treatments? One published study found:
“Opioid usage was significantly associated with reporting of moderate/severe or very severe pain, poor self-rated health, not being engaged in employment, higher use of the health care system, and a negative influence on quality of life. […] opioid treatment of long-term/chronic non-cancer pain does not seem to fulfil any of the key outcome opioid treatment goals: pain relief, improved quality of life and improved functional capacity.”
The American Pain Society conducted a review of the evidence for chronic opioid therapy and here are some of their findings:
- “Up to 50% of opioid‑naïve patients placed on potent opioids report no change or worsening of their chronic pain.
- “About half of patients randomized to opioids in randomized trials report adverse events, and nearly one‑quarter withdraw from the trials due to adverse events.”
A CDC Opioid Prescribing Guideline states:
“It has become increasingly clear that opioids carry substantial risks and uncertain benefits, especially as compared with other treatments for chronic pain.”
Substantial Risks
The CDC reports that 78 Americans die every day from an opioid overdose. And their prescribing guideline states:
“Deaths from prescription-opioid overdose have increased dramatically in the United States, quadrupling in the past 15 years.”
The Candy Man
If the evidence for positive outcomes (with long-term use) is scant, and the evidence for risk is strong, how are so many of these drugs making it onto the street? Who is writing all the scripts? To be clear, there is no doubt there are well meaning doctors who want to offer a solution to patients who are desperate for relief from chronic pain. But, that isn’t the whole story.
One MD at a Tomah, WI VA Clinic earned the name “Candy Man” when he prescribed, on average, the equivalent of 25,000 milligrams of morphine to each of the 128 patients he saw in 2012. An investigation by Sharyl Attkisson revealed the American Federation of Government Employees raised concerns about this doctor in 2009, and they referred to an instance where he wrote a prescription for 1,000-plus narcotic tablets for a 30-day supply.
The Candy Man has said, “You don’t hear a lot of veterans complaining about me.”
An Issue of National Security?
Perhaps the one of the greatest danger lies in the financial cost. A report from US Department of Health and Human Services Office of Inspector General states almost 12 million Medicare Part D beneficiaries (nearly 1 in 3) received opioids in 2015, and Part D spending for these drugs exceeded $4 billion.
Statesman reported in 2012 that the military spent $1.6 billion on opioid painkillers over the previous decade. They also found:
“Department of Defense drug spending has ballooned by more than 123 percent since 2002, from $3 billion to $6.8 billion in 2011, according to Tricare officials. That outpaces by nearly double the overall pharmaceutical sales in the United States, which grew about 67 percent over that time.”
“If we don’t address it soon, it may harm our national security in the long run,” the centrist think tank Third Way wrote in a [2012] report about ballooning defense health budgets. “It will also impact operational effectiveness and threaten health care benefits for active duty troops and their families.”
The VA reported a $2.6 billion budget shortfall last year.
Featured Image Credit: GraphicStock
