Understanding Opioid Addiction

Today's article from pain-topics.org (see link below) looks at a survey of attitudes towards opioids among adults but especially among medical practitioners. The levels of ignorance are surprising and that is the important point in this post. People with severe neuropathy may well end up on opioids but realising that many doctors just aren't aware of the consequences and how to deal with possible addiction, puts the responsibility back on the patient to talk to their doctors carefully. Patients should always be monitored on opioids; even more so now when many doctors and pharmacies are finding their options limited by laws that don't take into account the nature of chronic pain and its treatment.
In his commentary, Dr. Leavitt points out that the survey was carried out by a drug company whose specialty is medicines used to treat opioid addiction and warns the reader to beware of bias. He also says that despite that, the survey provides some revealing and worrying data for chronic pain patients.

Survey Shows Opioid “Addiction” Misunderstood
Posted by SB. Leavitt, MA, PhD Wednesday, June 26, 2013


A new national survey found that both adults and primary-care physicians in the United States cling to a variety of misperceptions and stereotypes about opioid addiction that may affect the way the disease is diagnosed and those afflicted are treated. The survey conducted during January and March 2013 involved more than 1,000 adults, ages 26 to 49, and 200 physicians. A major objective was to understand current attitudes about addiction to opioids — whether prescribed or illicit —and treatment for the disease. Along with that, the survey revealed some surprising knowledge deficits among the public and healthcare providers.

As reported in a news release [here], the survey discovered that more than a third (35%) of the physicians — none of whom were certified to treat addiction via a DATA (Drug Addiction Treatment Act) 2000 waiver — admitted to not knowing much about opioid addiction; two-thirds (66%) attributed low education level as contributing to the disorder, while more than half (57%) said that low income was a likely cause. [Responses to survey questions were not mutually exclusive, so numbers may add up to more than 100%.]

Two-thirds of adult respondents (67%) indicated that they do not know much about opioid addiction. At the same time, 45% of adults and 30% of physicians believed that opioid addiction “is more of a psychological problem,” such as a poor lifestyle choice, than a chronic illness or disease. Nearly half of adults (44%) and most physicians (92%) associated prescription analgesics with opioid addiction, but inexplicably only 55% of adults and 69% of physicians associated heroin with opioid addiction.

Two-thirds of adults (68%) and a vast majority of physicians (87%) concurred that opioid addiction affects millions of Americans, and 76% of adults and 96% of physicians were aware that misuse or abuse of prescription opioid analgesics poses a significant burden on the U.S. healthcare system. The adult respondents and physicians almost unanimously agreed (≈90% in each group) that opioid addiction can happen to anyone.

In that regard, nearly half (47%) of all adults surveyed reported having a personal connection with addiction and 12% admitted to personally struggling with the disorder. The surveyors observed that this is greater than the percentages of persons with diabetes (7%) or cancer (3%) combined.

Why would those suffering from addiction refrain from seeking treatment? Stigma and fear may be major barriers, since more than 77% of adults and most physicians (93%) mentioned shame or embarrassment, fear that others will find out, and/or fear of putting life on hold as reasons people avoid treatment. Most of the survey respondents — 71% of adults and 85% of physicians — also believed that persons with addiction do not seek help because they think they can stop on their own.

The survey detected some important misperceptions and attitudes among physician respondents:
Only about a quarter of physicians (27%) were aware that any physician [who is properly licensed and certified] can prescribe medications to treat someone with opioid addiction.

Nearly a third (31%) wrongly believed that special certification (known as a Drug Addiction Treatment Act [DATA] 2000 waiver) was unnecessary for dispensing or prescribing certain FDA-approved medications for maintenance treatment of opioid addiction.

A small percentage (7%) also said that they prefer not to treat patients with addiction in any way. The most commonly cited reasons for this included: a) the patient population is too difficult to treat (78%), b) it would require too much paperwork or take up valuable office staff time (61%), and c) not wanting to be viewed as an “addiction practice” (55%).

The vast majority of adults (92%) and physicians (98%) optimistically believed that opioid addiction is treatable. Roughly two-thirds of both groups, adult respondents and physicians, believed the disease could be “cured”; yet only 35% of adults and 21% of physicians thought that a stay at a rehabilitation clinic would be effective. And, a majority of adults (56%) and physicians (69%) believed that most people in recovery from opioid addiction will experience a relapse. Most of the adults (83%) and physicians (92%) concurred that people recovering from opioid addiction need a long-term combination of medication and behavioral changes to be successful with treatment.

COMMENTARY:
This extensive and data-rich survey was conducted online by Harris Interactive on behalf of Reckitt Benckiser Pharmaceuticals, a specialty company that manufactures and markets medications for treating opioid addiction (eg, Suboxone® [buprenorphine] sublingual film). Therefore, it is predictable that the survey is slanted toward examining a need for greater awareness and implementation of office-based medication assisted treatment, or MAT, for opioid addiction.

The sponsor was no doubt pleased that 58% of adult respondents and 73% of physicians said they strongly support the use of prescribed medications to treat opioid addiction. Yet, less than half of adults (44%) were aware that such medications prescribed by physicians could be an option.

Commercially sponsored surveys like this one are not peer reviewed and are always suspect in terms of the underlying motives and accuracy of findings. It also may be questionable whether the responses of merely 1,000 adults and 200 physicians representing vastly larger populations would have external validity, no matter how carefully respondents are selected and weighted to approximate overall populations.

There are some remarkable knowledge gaps evident in the survey data, particularly among the physician respondents. Additionally, several other points are worth noting:
Throughout the survey report — and, of course, in news media stories that merely reiterated the press release — the term “dependence” was used to denote “addiction.” In fact, the survey found that for three-quarters of adult respondents (75%) dependence and addiction were considered to be synonymous, as also was the case for a sizeable portion physicians (43%). [In all instances, we replaced “dependence” with “addiction.”]

This is a problem, because physiologic dependence (ie, tolerance and adverse withdrawal effects) is NOT the same asaddiction when it comes to opioids, and confusion of the two terms and conflation of the underlying clinical concepts has led to many innocent patients with chronic pain being accused of, and erroneously treated for, an addictive disorder that does not truly exist. This was discussed extensively in an earlier Pain-Topics UPDATE article [here].

It is surprising that a third of physicians thought that they could prescribe medications for treating opioid addiction without special approval (eg, DATA 2000 waiver); although, the survey did not assess how many actually were engaged in such unlawful prescribing. At the same time, only 7% indicated that they do not want to treat patients with addiction in their practices, which is somewhat puzzling in that it seems to be a small proportion.

Office-based medication assisted treatment, or MAT, for opioid addiction can be time consuming and challenging. The medications used — eg, buprenorphine with or without naloxone, methadone, naltrexone — are not wonder drugs and, despite the beliefs of two-thirds of adults and physicians that addiction can be “cured,” common thinking is that the disease of addiction can be put into remission but not permanently resolved or cured. MAT could be but one part of a therapeutic milieu — which may include psychologic counseling, lifestyle changes, 12-step group participation, and other modalities — for achieving a state of remission.

In the survey, most of the adults (83%) and physicians (92%) appropriately believed that people in addiction recovery need a long-term combination of medical care and behavioral changes to be successful. However, this sort of ongoing care may be beyond the purview of typical primary-care practices.

Certainly, more education of the public and healthcare providers on opioid addiction is much needed, as evidenced in the survey. The term “addiction” (and, erroneously, “dependence”) is much overused; particularly when applied to patients with chronic pain who are on long-term opioid analgesic therapy. Whether or not primary-care physicians should be the ones diagnosing and treating the disease of opioid addiction, just as they would care for patients with other chronic and sometimes life-threatening illness, could be debatable.

http://updates.pain-topics.org/2013/06/survey-shows-opioid-addiction.html

Non Opioid Creams For Neuropathy

Today's post from globenewswire.com (see link below) reports on the results of a study into how efficient non-opioid creams are for chronic pain. As a significant percentage of chronic pain sufferers, neuropathy patients are used to going through the gamut of pill treatments until one (or sometimes none) eventually bring some relief. In the end, the only relief is generally provided by opioid prescriptions but that's the end of the line as far as options go. This study seems to suggest that non-opioid creams can be very effective and are absorbed through the skin instead of being released internally through pill or capsule form. If this is true then we can expect to see an increase in 'cream' development as a chronic pain treatment. On the face of it, it certainly seems to be a very useful alternative option and any viable alternative to opioids must be welcomed. Many neuropathy patients already use capsaicin (chili)based creams but they have their limitations and are difficult to use but this seems to be something else entirely. We'll wait and see.

Studies, Reporting Significant Reduction in Chronic Pain Via Non-Opioid Prescription Creams, to be Presented at American Pain Society Conference - 
ROME, Ga., April 21, 2014 (GLOBE NEWSWIRE) -- 


New study data, to be presented at this month's annual meeting of the American Pain Society in Tampa, report a sharp drop in the level of chronic pain reported by patients after using pharmacy compounded non-opioid prescription pain creams. The patients also reported a major decrease in their reliance on traditional, opioid-based oral medications like hydrocodone and oxycodone.

The patient outcome surveys are among those selected for the author-attended poster sessions at the annual meeting, representing "the best innovations and research in the study and treatment of pain," according to the American Pain Society's website.

With one of every three Americans, an estimated 100 million people, suffering from chronic pain, the total national economic cost associated with chronic pain is estimated by the Institutes of Medicine to be as high as $635 billion every year. This is ten times more the costs usually reported that involve opioid-related abuse, addiction, and accidental death, and is the result of inadequately managing chronic pain, resulting in what the IOM calls the "conundrum of opioids."

Attendees of the American Pain Society's 33rd Annual Scientific Meeting will have an opportunity to view and discuss the survey results with Tino Unlap, Ph.D., principal investigator for Patient Outcomes Analytics (POA). POA conducted the scientific studies under contract to DeTOURE, a research and development organization supporting outcomes associated with the compounding of topical non-opioid pain creams.

This will be the second major presentation for DeTOURE-sponsored research in the last 30 days. In early April, it presented the findings from a study of senior citizens suffering from chronic pain at the Academy of Managed Care Pharmacy's annual meeting. That survey also reported a significant reduction in reported pain levels among patients who used a pharmacy compounded non-opioid cream.

The three topics to be presented at the APS conference are:
The results of a survey, showing that more than four of every five patients (87%) who used a compounded prescription, non-opioid topical pain cream said their pain lessened after using the cream, reducing their pain levels by more than half over a 24-hour period. In addition, 42% indicated their use of oral pain medications had decreased. The patients surveyed suffered from chronic pain, and were covered by TRICARE, the government's healthcare plan for members of the military and their families.

The results of another survey, reporting that almost 3,600 chronic pain sufferers reported a significant reduction in their pain levels after using the compounded prescription cream. The participants said their pain levels decreased, on average, by 20 percent after four weeks' continuous use of the cream. More than 70 percent said their pain had lessened, with an average 24-hour reduction of 58 percent; 38 percent indicated their use of oral pain medication had decreased, echoing the study mentioned above.

A graphic illustrating POA's newly developed integrative model to improve pain management. The model shows how data from patients using personalized compounded transdermal pain creams is collected, analyzed by POA scientists, validated by an outcomes research company and presented on a doctors' portal site where physicians can monitor the progress of their patients' treatments.

"These studies confirm that using topical, non-opioid anti-pain creams to reduce pain as well as lead to a reduction in the use of oral pain medications is a viable solution to the growing epidemic of chronic pain in America," said Rob Gussenhoven, PharmD, Chief Scientist at DeTOURE. "Treating chronic pain is vital — not only to our patients' wellbeing, but also to the wellbeing of our society. By bringing the results of these surveys to the members of the American Pain Society, I believe they will recognize both the direct and secondary values inherent in lessening Americans' dependency on opioids, and adopt other approaches, such as the prescribing of creams which address pain at the source, rather than through a systemic approach with its negative, long-term impact."

Rob Gussenhoven

DeTOURE

Steve Friedberg

MMI Communications

http://globenewswire.com/news-release/2014/04/21/628213/10077391/en/Studies-Reporting-Significant-Reduction-in-Chronic-Pain-Via-Non-Opioid-Prescription-Creams-to-be-Presented-at-American-Pain-Society-Conference.html

Do You Take Opioid Strength Medications For Your Neuropathy

Today's post from nationalpainreport.com/ (see link below) is another very sensible article looking at the problem of what to do with patients who take their strong medications to control their pain sensibly but are now confronted by pharmacists, insurers, media and politicians who have decided in their wisdom that these people can simply do without! Yes, it's a North American problem at the moment but don't be fooled, it will spread across the world because of the international nature of the health industry.  This article asks the very pertinent question: who's thinking about these patients and what are they going to do about them? Are they going to be left to suffer pain unnecessarily because of an inflated hype? Well worth a read.

Reduce Opioids – Then What?  
Posted on May 24, 2016 in Pain Medication  By Ed Coghlan

When we read that opioid prescriptions are not only being reduced, but also Cigna, a major health plan, was committing to reduce opioid prescriptions by another 25% in the next three years, it again brought up a question that has been asked but seldom answered by government regulators (or insurers like Cigna).

“If opioids are going to be reduced, then why aren’t we talking about the alternatives to them for patients who use them responsibly?”

We turned to Beth Darnall, PhD from Stanford University. Beth is Clinical Associate Professor in the Division of Pain Medicine at Stanford University and author of Less Pain, Fewer Pills. She writes about using less medication—but also talks about alternatives.

She thinks we have to do more than simply reduce opioid prescriptions:

This is a great question. First, we need individualized pain care- one size does not fit all. Broadly speaking we need 3 things:

(1) Alternatives. It’s shortsighted to simply take something away: we have to give alternatives, ideally make them available before medications get started.

(2) Understanding that the patient experience is critical. Simply taking away opioids can engender anxiety, anger, and feelings of injustice—especially in those who believe the medications are working well. In all of the conversation about whether opioids are good or bad, there is not enough focus on how to ease the emotional distress of patients on this issue. We need to acknowledge the emotional distress and deliver treatment approaches to reduce it. Give them access to alternatives. Then, if opioids must be tapered, help patients feel more in control of the process. Tapering works best when anxiety and stress are low. I write a lot on the under appreciated importance of this topic.

(3) Recognize that most patients take opioids responsibly. The issues of whether opioids are good for chronic pain (on average) and addiction have been conflated. In my experience, the vast majority of patients taking opioids take them responsibly and exactly as prescribed. They are doing nothing wrong! Whether or not they work well, improve function, and have low side effects and low risks is a separate issue, and this is where most patients find that opioids are no panacea. The problems they experience have nothing to do with addiction or so-called “aberrant behaviors”. Patients are doing everything right, taking medications as prescribed, and they are having problems caused by the medications. In these cases – and I have seen many—tapering opioids helps reduce problems. They get better. They still have chronic pain, but they had it before on the opioids, too. Granted, when I work with patients I help connect them to those alternatives so that the focus is on managing pain differently with key lifestyle changes and use of skills. They may begin other non-opioid pain medications that may have lower risk profiles.

There’s no perfect solution here because each patient is different. Opioids do work well for some people with chronic pain, and even with the CDC guidelines in place prescribers have discretion to prescribe the medications long term. Ideally, there will be less of a focus on treating pain with opioids ONLY, as has been the case in the past.

The second question that bothered us in the wake of Cigna’s announcement was the fact that many insurers simply don’t cover alternatives.

Now, we have a new problem: insurance companies do not provide good access to the opioid alternatives so desperately needed by patients. How about providing free chronic pain self-management classes to patients? Free or low cost pain psychology classes? We need scalable solutions to meet the treatment needs of millions of Americans. In an ideal world the U.S. would have put these solutions in place before issuing edicts on prescription limits.

Here’s last week’s story on Cigna’s decision to reduce opioid prescriptions.

http://nationalpainreport.com/reduce-opioids-then-what-8830538.html

Preserving Opioid Effects For Neuropathic Pain

Sometimes a scientific article may seem to be light years away from our daily neuropathic experiences but this one from sciencedaily.com (see link below) will be of interest to those people with severe neuropathy. Especially those who have become tolerant of opioids as painkillers, thus constantly needing stronger doses. Results of a study on rats, shows that with the addition of a polyphenol called Resveratrol, the effects of opioids can be extended and preserved, thus reducing the need for more. As with all these studies, the end results may be some way off (although Resveratrol is already available as a supplement) but if you're having problems with opiates it might be worth alerting your doctor to these findings.

Resveratrol May Preserve Pain-Relieving Effects of Morphine

ScienceDaily (Sep. 25, 2012)

Resveratrol -- the same natural polyphenol found in red wine -- preserves the potent pain-relieving effect of morphine in rats that have developed morphine tolerance, suggests a study in the October issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

If the findings are confirmed in humans, resveratrol might become a useful addition to clinical pain management approaches -- especially in patients with chronic, severe pain who have become tolerant to the effects of morphine. The study was performed by Dr Chih-Shung Wong and colleagues of Cathay General Hospital, Taipei, Taiwan.

Resveratrol's Effects in Spinal Cord Affects Morphine Responses

The researchers designed experiments to evaluate whether and how resveratrol affects behavioral pain responses to morphine in morphine-tolerant rats. Morphine and related opioid drugs play an important role in the treatment of severe pain, including cancer pain and other chronic pain conditions. However, the development of tolerance -- requiring much higher doses for effective pain control -- is an important limiting factor on their use.

Resveratrol is a polyphenol compound found in many plant-based foods; its presence in the skins of grapes may contribute to the health benefits of red wine. Previous studies have shown several biological effects of resveratrol, including antioxidant and anti-inflammatory effects as well as protective effects on the nervous system.

After inducing morphine tolerance in rats, the researchers tested the animals' spinal cord responses to morphine, with or without resveratrol. The results showed significant enhancement of morphine's effects in animals receiving resveratrol. In morphine-tolerant rats, the pain-relieving response to morphine was about 20 percent of normal. In rats receiving resveratrol, morphine responses were restored to about 60 percent of normal.

In preserving the pain-relieving effects of morphine, resveratrol appeared to work in two ways. It reversed the increase in expression of a type of neurotransmitter (N-methyl D-aspartate, or NMDA) receptors associated with morphine tolerance. Resveratrol also blocked the increase of inflammation-promoting substances, called cytokines, in rats with morphine tolerance.

The results add to other recent experimental evidence suggesting that resveratrol can maintain the pain-relieving effect of morphine. It also adds new information on how that effect may occur -- specifically through resveratrol's effects on the NMDA receptors and neuroinflammatory responses.
More research will be needed to determine whether some form of resveratrol treatment could be useful in clinical pain management -- "particularly for patients who need long-term morphine administration and for morphine-tolerant patients who require better pain relief," the researchers conclude.

http://www.sciencedaily.com/releases/2012/09/120925114337.htm

Are Pain Patients The Victims Of Official Opioid Overdose Mistakes

Today's post from fee.org (see link below) may well turn out to be one of the most important posts of 2017 for neuropathy sufferers who need to take opioid medications to control their pain (and it's only January 2nd , so that's saying something!) The statistics show that many people are dying from self-inflicted overdoses of opioid medications but this article takes a closer look at the facts behind those seemingly damning statistics. It comes to the conclusion that the opioid painkillers are not the problem, but in fact, the measures taken to control and repress their use, are directly contributing to the increase in opioid suicide. It's some claim and a brave one at that but if you read the article, you can draw your own conclusions. It seems to be primarily a problem in the USA but as we all know, what happens in the USA, inevitably influences the rest of the world at a later date. The politicians and the media are happy to influence your thinking but maybe that your views should be your own and articles such as this one may help balance out the arguments. Rather than trying to sum up the article, it's probably wisest to read it and make your own mind up. Definitely worth the effort.

The DEA Is to Blame for America’s Opioid Overdose Epidemic 
Cathy Reisenwitz Monday, December 05, 2016

Many of these deaths result not from painkillers, but from the DEA’s war on painkillers.

Heroin overdose rates doubled in 28 states between 2010 and 2012, according to the Centers for Disease Control and Prevention. A record-breaking 28,000 Americans died of opioid overdoses in 2014. In 2000, the age-adjusted drug overdose death rate was 6.2 per 100,000 persons. By 2014, it had increased to 9, according to the CDC.

What happened?

The truth is that many of those deaths are completely preventable and result not from painkillers, but from the Drug Enforcement Administration’s war on painkillers.

This week, the Senate is likely to pass the 21st Century Cures Act. Among other things, it allocates $1 billion to help states “combat heroin and painkiller addiction and recovery.” Policymakers would be wise to make sure that states don’t use that $1 billion to make the problem worse.

Who’s Taking Opioids?

Marine corporal Craig Schroeder served in Iraq. In the so-called “Triangle of Death” region, south of Baghdad, a makeshift-bomb explosion left him with traumatic brain injury. Schroeder returned home with a broken foot and ankle and a herniated disc in his back. He suffers from chronic pain in addition to hearing and memory loss.

And the regulations keep coming.

A study in the Journal of the American Medical Association showed that half of all troops who return from Iraq and Afghanistan suffer from chronic pain.

This isn’t a new phenomenon. During maneuvers in Germany in 1979, retired Army corporal Mike Davis shattered his left arm from the elbow to the fingertips when he fell from a Pershing missile. He’s needed painkillers ever since.

Accidents, failed surgery, degenerative conditions, or all of the above can cause chronic pain. It can hit anyone at any time. In an unpublished paper, Dr. Harvey L. Rose told the story of a 28-year-old man with persistent leg pain caused by a work accident that lumbar disc surgery couldn’t fix. Rose also treated a 78-year-old woman left with chronic back pain after surgery for degenerative cervical disk disease didn’t work.

Forcing Users into the Black Market

The Drug Enforcement Administration actively prevents patients from getting the prescription painkillers they need. It started in the 1970s, when the DEA’s reporting requirements made many doctors decide to stop prescribing painkillers altogether. Why go through the hassle of ordering triplicate forms and turning them over to the government? Many others stopped out of fear. The DEA sent armed men to arrest Ronald Blum, associate director of New York University's Kaplan Comprehensive Cancer Center. It turned out he’d done nothing wrong, other than accidentally filling out his forms incorrectly. That mistake cost him $10,000 in legal fees.

Even in 1973, pain undertreatment was endemic, according to Psychiatrists Richard M. Marks and Edward J. Sachar, writing in the February Annals of Internal Medicine.

And the regulations keep coming. In 2015, the DEA decided to require patients to see their doctor, in person, every month in order to get refills for hydrocodone-based medicine. Earlier this year the CDC released guidelines that discourage clinicians from prescribing opioids. The agency recommended doctors prescribe the “lowest effective dose” and “no greater quantity than needed.”

The Black Market Solution

Opioids work by mimicking chemicals our brains produce naturally. The problem for long-term users is that the brain stops producing them if it doesn’t have to. Stopping medication leaves sufferers “constantly sore, sensitive to pain, depressed, fatigued but unable to sleep,” according to Siegel.

Thanks to the DEA, men and women who lost limbs serving in Iraq and Afghanistan are needlessly entering withdrawal.

Chronic pain sufferers who can’t get their medication experience withdrawal symptoms that “feel like a panic attack and the flu at the same time,” according to the Washington Post.

Going without painkillers isn’t an option for many people who need them. Dr. Rose’s 28-year-old patient turned to alcohol and street drugs after his doctor prescribed an antidepressant instead of a painkiller.

He later hanged himself in his garage.

The 78-year-old woman Rose got into her bathtub with an electric mixer after a series of physicians refused to prescribe an effective dose of painkillers. In all she tried to kill herself four times, slashing her wrists and overdosing on Valium and heart medication.

Thanks to the DEA, men and women who lost limbs serving in Iraq and Afghanistan are needlessly entering withdrawal. After the DEA rules change, Schroeder’s VA doctor couldn’t see him for nearly five months. This isn’t unusual. Schroeder spent those months bedridden in crippling pain and opioid withdrawal. Another Iraq vet can’t drive due to shrapnel in his femur and pelvis. Getting his medications requires a monthly two-hour bus ride for “a one-minute consult.”

Patients who can’t find legal opioids because of the DEA turn to heroin and other black market opioids. With legal prescription opioid medication, chronic pain sufferers know their dose. Without accurate labeling, they must estimate their drugs’ purity, which varies according to source. When they guess wrong, they overdose. Even worse, heroin has a smaller margin of error than prescription opioids. Meaning if you guess wrong with heroin, you’re more likely to die.

The CDC suspects that many, if not most, of the people who died of opioid overdoses in 2014 were taking black-market fentanyl. Many drug dealers add fentanyl to heroin without letting users know.

When the CDC reports on opioid deaths, that includes street drugs like heroin and synthetic opioids. Toxicology tests used by coroners and medical examiners can’t distinguish black-market fentanyl and prescription fentanyl. But we do know that there was more of the illegally-manufactured, synthetic opioid-derived fentanyl available in 2014 than in previous years, according to law enforcement reports. This coincided with the 2014 jump in deaths from opioid overdoses.

Yet the DEA keeps patients from getting methadone and buprenorphine treatment.

In addition, we know that patients combine drugs when they can’t get enough painkiller. Combinations of opioids and drugs like alcohol make up 60% of deaths ruled opioid overdoses by the CDC. New York City government data shows that more than 90% of opioid overdose deaths involve mixtures of opioids with other drugs.

The toxicology tests did reveal that almost none of the opioid deaths involved methadone. Methadone and buprenorphine are synthetic and semi-synthetic opioids that are proven to divert patients away from the black market. Whether a person is no longer in chronic pain, doesn’t like the side effects of opioids, or is caught in a lifestyle they don’t enjoy, these drugs safely keep withdrawal symptoms at bay.

The key, again, is dosing. Under close medical supervision, methadone activates your brain’s opioid receptors just enough to prevent withdrawal, but not enough to get the user high.

Zachary Siegel is a MA candidate at the University of Southern California’s Annenberg School for Communication and Journalism and has been treated for opioid addiction.

“This gives the brain, and most importantly, one’s connection with the world, a chance to rebuild,” Siegel wrote of his experience with the drugs. “Simply put, these medications hydrate a thirsty system. Synthetic and semi-synthetic opioids help stabilize users and stanch these side effects while giving the brain a chance to heal. On these drugs we can work, drive, and behave virtually indistinguishably from ordinary Janes and Joes.”

Yet the DEA keeps patients from getting methadone and buprenorphine treatment. The DEA forbids doctors outside of highly regulated clinics to prescribe these drugs. The DEA meddles in buprenorphine prescriptions to an unprecedented degree. Even in those clinics, only doctors who’ve completed an eight-hour course and applied for a special license from the DEA are legally allowed to prescribe buprenorphine. And even those doctors can only prescribe it to 275 patients. This is all part of why three-quarters of U.S. opioid-use disorder patients don’t get these medicines.

Dependence Isn’t Addiction

Jacob Sullum pointed out that bureaucrats accept “dependence” on heart or cholesterol medicine. Nobody talks about being addicted to Lipitor. But the government is willing to make criminals of people who depend on certain types of painkillers.

This moralizing and dearth of empathy fuels policies that spend tax dollars to make our lives more difficult and painful.

This is nothing new. In 1973, Drs. Marks and Sachar looked at why patients were complaining about pain after doctors gave them medication. They found that, in “virtually every case.” doctors and nurses were under-prescribing pain medication. Further surveys of patients and doctors found "a general pattern of undertreatment of pain with narcotic analgesics, leading to widespread and significant distress." The problem was, and is, that doctors don’t understand the difference between tolerance and physical dependence, causing "excessive and unrealistic concern about the danger of addiction."

An article in a 1993 National Institute on Drug Abuse newsletter said narcotics “are rarely abused when used for medical purposes" and lamented that "thousands of patients suffer needlessly."

“It’s just insulting to the veteran to assume they are abusing these drugs,” Linda Davis said of her husband Mike Davis. “I’m fully aware that people doctor-shop, some docs overprescribe. But I think they need to realize that there’s a real difference between addiction and dependence.” VA patients suffer nearly double the overdoses of the national average, according to a 2011 American Public Health Association study.

This moralizing and dearth of empathy fuels policies that spend tax dollars to “make our lives more difficult and painful,” Sullum wrote.

We Know How to Cure Addiction and Save Lives

If the goal is to prevent overdoses, we already know how to do that.

The data is clear. By making methadone or buprenorphine harder to get, the DEA has caused death, disease, and crime.

A 2015 U.K.-based study found that opioid-dependent patients treated with medication like methadone and buprenorphine were half as likely to die of an overdose within four years as counseling-only patients. Australia found similar results in their 2014 study of opioid-dependent patients leaving prison. Methadone or buprenorphine treatment reduced their risk of overdose death by 75 percent.

The World Health Organization calls methadone or buprenorphine “essential” for keeping people out of the black market for opioids, which besides saving lives, also reduces crime and the spread of infectious diseases. France allowed doctors to prescribe methadone and buprenorphine when they deemed it necessary during the 1995 HIV outbreak. In the years since, France reduced their overdose deaths by 80 percent. Baltimore cut overdose deaths by 66% by 2008 after making methadone or buprenorphine move available in 1995.

The data is clear. By making methadone or buprenorphine harder to get, the DEA has caused death, disease, and crime.

Will this Money Fund More of the Same?

The DEA wants you to think that overprescribing opioids leads to addiction. Even Huffington Post reporters are buying the story, reporting that the pharmaceutical industry has spent billions of dollars over the last decade encouraging doctors to prescribe OxyContin and other opioids. True as that may be, that’s not the reason opioid pain reliever deaths are up.

This causes overdoses. Not only is it intuitively obvious to anyone who bothers to think about it, it’s even backed up by CDC data.

The irony of blaming prescriptions of OxyContin for opioid deaths is twofold. First, opioids are still underprescribed. Jacob Sullum reports that prescription painkiller has declined recently.

Second, opioids are actually safer than most other pharmaceuticals. The most serious common side effect of long-term opioid use? Constipation.

Aggressive DEA enforcement causes opioid underprescribing. This means patients can’t access safe pain medicine. Facing chronic pain and withdrawal, patients take black-market opioids. The reduction in prescription painkiller use has been accompanied by an increase in heroin use.

A 2014 JAMA Psychiatry study found that most young heroin addicts entering treatment had previously been on prescription painkillers, and more than 90% of them switched to heroin because it was cheaper and easier to get.

This causes overdoses. Not only is it intuitively obvious to anyone who bothers to think about it, it’s even backed up by CDC data.

People simply don’t overdose on prescription painkillers under medical supervision. They overdose when they can’t get the medicine they need and turn to the black market for help. The DEA’s efforts to keep chronic pain sufferers from accessing prescription painkillers and methadone is literally killing them.

And yet lawmakers and reporters keep buying the DEA’s lies that prescription opioids cause overdose deaths. New Hampshire Senator Jeanne Shaheen said of the 21st Century Cures Act, “My goal has been trying to get funding to address the heroin and opioid epidemic. And there is significant funding in this bill.” She also supports increasing federal funding “for all aspects of Drug War.”

The 21st Century Cures Act looks likely to pass, with bipartisan support and the Obama administration’s blessing. But if we want to end the opioid overdose epidemic, we don’t actually need to spend $1 billion. We could just abolish the DEA, which would also free up $28 billion.

Think that sounds crazy? Portugal decriminalized heroin, along with every other drug, in 2001.

Check out what happened to their overdose deaths:



In Portugal, three out of a million people die each year by overdosing on any drug. Just as a reminder, each year in America 9 out of every 100,000 people die of an opioid overdose. Sure, decriminalization demonstrably and unambiguously saves lives. But won’t it lead to more drug use?

No. In Portugal after 2001, fewer people reported doing drugs in the past year and the past month. New HIV infections are also significantly down.

The other key to preventing overdose deaths is legalizing over-the-counter sales of naloxone nationwide. In the same way that you use an EpiPen to reverse anaphylactic shock, naloxone reverses opioid overdoses. It still requires a prescription in most states and is outright banned in three. We should also make sure people who call the ambulance when their friend overdoses won’t face criminal charges.

Since most opioid-related deaths involve alcohol or other drugs, awareness campaigns about the dangers of combining opioids could help. But more important than teaching people not to combine is giving them access to enough safe drugs that they aren’t tempted to.

The best thing the Trump administration could do to end the overdose epidemic is to stop the war on painkillers. Psychiatrist Jerome H. Jaffe, Richard Nixon's drug czar, himself said, “No patient should ever wish for death because of his physician's reluctance to use adequate amounts of potent narcotics."

 
Cathy Reisenwitz

Cathy Reisenwitz is a D.C.-based writer. She is Editor-in-Chief of Sex and the State and her writing has appeared in The Week, Forbes, the Chicago Tribune, The Daily Beast, VICE Motherboard, Reason magazine, Talking Points Memo and other publications.

https://fee.org/articles/the-dea-is-to-blame-for-america-s-opioid-overdose-epidemic/