Misguided Opioid Narrative Takes On More Water

Jeffrey A. Singer

The seemingly unsinkable prevailing narrative that the opioid overdose crisis was caused by health care practitioners ‘hooking” their pain patients on opioids just took on more water.

Researchers in the surgery departments at Case Western Reserve University, University of Alabama at Birmingham, and American University of Antigua College of Medicine expected that opioids used to manage pain in trauma patients would lead to a higher rate of injury‐​related deaths—including the subcategories of suicide, homicide, and “unintentional deaths” (a leading cause of which is drug overdoses). Using state‐​level data provided by the Centers for Disease Control and Prevention and the U.S. Department of Justice from 2006 to 2017, they used opioid shipment reports as a proxy for local opioid consumption, and converted all prescription opioids, such as oxycodone and hydrocodone, into morphine‐​equivalent doses (MEDs).

Reporting in the peer‐​reviewed medical journal Injury, their findings confirmed what the CDC had previously reported: “opioid deliveries increased through 2012 and then declined.” But more importantly, they found “Opioid MEDs did not show a consistent or statistically significant relationship with injury‐​related mortality, including with any subgroups of unintentional deaths, suicides, and homicides.”

The researchers concluded:

In every state examined, there was no consistent relationship between the amount of prescription opioids delivered and total injury‐​related mortality or any subgroups, suggesting that there is not a direct association between prescription opioids and injury‐​related mortality. This is the first study to combine national mortality and opioid data to investigate the relationship between legally obtained opioids and injury‐​related mortality. The US opioid epidemic remains a significant challenge that requires ongoing attention from all stakeholders in our medical and public health systems. (emphasis added)

Writing last month in General Surgery News, Josh Bloom and I criticized the recrudescent opiophobia sweeping the medical profession fueled by the prevailing—and wrong—narrative. Surgeons have been encouraged to use intravenous acetaminophen (Tylenol) to treat postoperative pain, rather than risk “hooking” their patients on opioids. We cited research that shows intravenous acetaminophen is ineffective for controlling postoperative pain. This latest study will hopefully further convince surgeons to shake off their opiophobia.

In a 2019 paper published in the Journal of Pain Research, Jacob Sullum, Michael Schatman, and I used data from the CDC and the National Survey on Drug Use and Health to demonstrate the absence of any correlation between the opioid prescription rate and the non‐​medical use of opioids or opioid addiction. Now we add that there is no correlation between the opioid prescription rate and injury‐​induced mortality, including suicide, homicide, and drug overdose deaths.

Despite the evidence, politicians and policymakers seem intent on further restricting the use of opioids to treat pain, inserting their misguided biases into the decision‐​making processes used by health care professionals. In the process they make patients suffer needlessly while driving up overdose deaths by sending non‐​medical users to more dangerous drugs on the black market.