Feds Battle Opioid Abuse With A Circular Firing Squad
In her classic treatise on blunders in public policy, Barbara Tuchman famously wrote:
Mankind, it seems, makes a poorer performance of government than of almost any other human activity. In this sphere, wisdom, which may be defined as the exercise of judgment acting on experience, common sense and available information, is less operative and more frustrated than it should be.
She could have been anticipating our government’s inept attempts to control the opioid epidemic. The most recent evidence was an article in the August 22 edition of the journal JAMA Surgery.
Following the Drug Enforcement Administration’s bumping of hydrocodone-containing medications into a more highly regulated classification — specifically, in order to curb opioid use — “there was an immediate significant increase” in the mean number of initial postoperative prescriptions for opioids and that that effect was sustained for a year.
A more recent misstep was President Trump’s asking Attorney General Jeff Sessions to sue opioid manufacturers, the latest attack on the wrong enemy: prescription painkillers.
The president’s grammatically and factually erroneous accusation that U.S. drug companies “are really sending opioids at a level that it [sic] shouldn’t be happening” is only one of many examples of federal bungling.
These efforts, largely fueled by deeply flawed advice from the Centers for Disease Control and Prevention, have been either unproductive or counterproductive, and in the process, bureaucrats have quietly usurped control of patient care from physicians.
The Department of Justice has also misfired. A recent final rule gives the DEA unprecedented authority to set annual opioid production limits: “If DEA believes that that a particular opioid or a particular company’s opioids are being diverted for misuse, this allows DEA to reduce the amount that can be produced in a given year.”
And on August 16, the feds, in fact, proposed cutting manufacturing quotas for six commonly abused prescription opioids by an average of 10 percent for 2019. That will succeed only in increasing the price of the drugs and creating an even bigger market for illegal, dangerous imports.
Alarmingly, bureaucrats are now dictating what constitutes not only acceptable prescribing practices of opioid painkillers but also how much can be manufactured. (So much for supply-demand and market forces.) This power grab is both unprecedented and disturbing, and patients who need these pain medications, which are unrivaled for efficacy, will suffer.
Common misconceptions about the nature, extent and causes of opioid addition have led to this wrong-headed government interference. For example, President Trump has said, “People go to the hospital for a period of a week and they come out and they’re drug addicts,” but neither that scenario nor the government’s interpretation of statistics is accurate.
The CDC has steadfastly maintained that roughly 60,000 people die each year from drug overdoses. Most people probably assume that that number represents opioid overdoses. But that isn’t true, as is evident from even a cursory examination of the agency’s own data.
The 60,000 figure refers to overdoses of all drugs combined — prescription, licit and illicit. Yet the agency continues to repeat that number, making little effort to clarify what it really means.
An article by four CDC staffers goes partway, stating that “63,632 persons died of a drug overdose in the United States; 66.4 percent (42,249) involved an opioid.”
Even that number is greatly inflated, since it includes both prescription pills, such as Vicodin, as well as street drugs like heroin and illicit fentanyl and its analogs. This is the CDC’s (and the DOJ’s) most egregious “accounting” error: Heroin and illicit fentanyl together account for about two-thirds of the opioid overdose deaths, but these street drugs in no way belong in the same category as Vicodin, because they are far more potent and dangerous, not to mention illegal.
By lumping together the two dissimilar groups, the CDC can technically claim that more than 40,000 people die each year from opioid overdoses, once again implying that this number refers to prescription medication. It does not. After subtracting illegal injectables the number drops to the 10,000-15,000 range. But even that number is inflated.
The CDC’s own data show that in 2015 half of the overdose deaths involving prescription opioids also involved a benzodiazepine, such as Valium. Other published data have shown that alcohol and methamphetamine are often involved as well.
Thus, it can reasonably be assumed that the number of deaths from opioid pills alone is probably about 5,000, roughly as many people who die each year from bicycle and bicycle-related accidents. But we don’t hear scaremongering alerts about a bicycle-accident epidemic; nor is the Department of Justice limiting bicycle production.
These distorted figures are important, and for reasons other than simple headline-grabbing.
News organizations have unquestioningly parroted the CDC figures and thereby have helped shape the current popular narrative – that doctors prescribed too many opioid drugs to pain patients who then became addicted. But this narrative, although plausible, is not supported by the evidence.
Addiction in pain patients is rare. Many high-quality reviews conclude that the addiction rate even of patients who have required long-term opioid medication for severe pain due to injury or illness is less than 1 percent. Today’s death toll from opioid use is largely the result of abuse, not medical use, of these drugs.
Clinicians know that individual patients differ significantly in their response to specific opioid analgesics such as codeine or morphine. This can be explained by genetic variation in the number or characteristics of opioid receptors; differences in their ability to metabolize the drugs as well as medical conditions such as reduced liver or kidney function. In similar clinical situations, the dose of morphine needed to control pain can vary as much as 15-fold.
Thus, the need for higher doses of opioids may not be drug-seeking behavior or tolerance from past use of opioids but may be a function of innate biological differences between people.
Since bureaucrats and elected officials discovered they were confronting an unwinnable battle against addiction, in the name of appearing to be trying to solve an insoluble problem they declared a new enemy: opioid pills.
Increasingly, there are laws that limit the prescribed duration and/or dose of these drugs, even for post-surgical patients with slow, painful recoveries decisions that should be made by physicians. Bureaucrats’ ability to arbitrarily limit production of opioids will limit supplies, raise prices and probably create at least spot shortages.
Once the false narrative is peeled away, the policy flaws and the suffering they cause become evident.
Deaths from appropriate and responsible use of opioid pain medications are, in fact, relatively uncommon, but the politicians and bureaucrats soldier on. Their one-size-fits-all remedies cannot succeed, and they will fail spectacularly.
While pain patients suffer needlessly, addicts will die in increasing numbers as they migrate to deadly street drugs. This is government at its most inept.
Henry I. Miller, a physician and molecular biologist, is the Robert Wesson Fellow in Scientific Philosophy and Public Policy at Stanford University’s Hoover Institution. Josh Bloom is the Director of Chemical and Pharmaceutical Sciences at the American Council on Science and Health.
The views and opinions expressed in this commentary are those of the author and do not reflect the official position of The Daily Caller.