Columns

Doctor: Most Opioid Overdoses Not a Result of Addicted Patients

Image Courtesy of Shutterstock

WASHINGTON – A common narrative cited in discussions about the opioid crisis – that a medical patient is prescribed painkillers, gets addicted and dies of an overdose – is a myth, an expert on the topic argued Wednesday.

During a discussion at the Cato Institute, Phoenix-based general surgeon Jeffrey Singer cited studies from the Centers for Disease Control and Prevention, JAMA Psychiatry and various municipalities supporting his claim. According to the CDC, the opioid-related overdose death rate for patients prescribed pain medication by doctors is 0.2 percent. A 2014 JAMA study showed that out of 136,000 patients treated for opioid overdoses in emergency rooms around the country, 13 percent involved chronic pain patients.

And though the U.S. recorded 33,000 opioid-related overdose deaths (including heroin) in 2015, Singer said that the vast majority of those deaths can be attributed to people mixing narcotics with other substances. New York City reported in 2013 that 94 percent of its residents who died from heroin or opioid abuse had multiple drugs in their system.

“It’s not like doctors are prescribing a painkiller for a patient in pain, who then gets hooked and becomes a heroin addict. That’s not the usual way,” Singer said.

While lawmakers like Sens. Joe Manchin (D-W.Va.) and Rob Portman (R-Ohio) grapple with skyrocketing overdose rates in their states and potential policies to address the issue, Singer had a piece of advice: Let doctors prescribe pain medication at their discretion, without strict oversight from regulators. Singer argued that policies limiting and monitoring opioid prescriptions have a chilling effect on treatment, to the point where doctors are afraid to prescribe too much, which leads to patients seeking illicit alleviation on the black market and heroin use. By Singer’s estimate, doctors, who are morally obligated to serve their patients’ best interests, are the best judges when it comes to opioid prescriptions.

Joining Singer was Adam Bates, a policy analyst for Cato’s Project on Criminal Justice and a member of the Oklahoma Bar Association. He spoke from the perspective of law enforcement while raising several issues with America’s war on drugs, which to date has cost more than $1 trillion. He argued that prohibition creates more danger for drug use, while blasting Attorney General Jeff Sessions’ stance that the U.S. should ramp up the war on drugs. America’s top cop has called the drug trade inherently violent.

Bates agreed that the drug trade is unacceptably violent, but he said it’s because of the legal crackdown, not anything inherent in the substances or the people involved. Drug traffickers are unable to settle their disputes in a formal setting like a court of law, so they settle their disputes in the streets with weapons. It’s no different, Bates said, than the bootleggers who terrorized cities in the 1920s, settling their disagreements with Tommy Guns. With the lifting of alcohol prohibition, alcohol cartels have disappeared, he said, and that’s because there’s no way for them to compete with legal alcohol dispensers.

“If you told Anheuser-Busch they were involved in an inherently violent business, they would laugh in your face,” Bates said.

While there were 33,000 opioid-related overdose deaths in 2015, there are about 90,000 alcohol-related deaths each year in the U.S. An endless stream of arguments can be made about the dangers of each substance, but Bates believes the illegality and stigmas that come along with drugs have only made them more dangerous.

“There’s no movement to re-prohibit alcohol,” Bates said. “We’ve already been there, and we already figured out that that doesn’t work and that just throwing people in cages for consuming or manufacturing alcohol is not a good policy solution.”