In Massachusetts, as Elsewhere, It’s The Prohibition, Not The Prescriptions

Jeffrey A. Singer

Earlier this month, the Massachusetts Department of Public Health released Data Brief: Opioid‐​Related Overdose Deaths Among Massachusetts Residents. The report found that opioid‐​related overdose deaths remained essentially unchanged at roughly 2,000 per year since 2016. From 2001 thru 2010 the annual overdose rate was relatively stable and then began to accelerate in 2011. (Figure 1 and Figure 2 of the Data Brief).

While the overdose rate was 1 percent less in 2019 than in 2016, and 1 percent greater in 2020 than in 2019, neither change was statistically significant.

As with other states, the opioid dispensing rate per 100 persons has come down dramatically over time. Nationally, the overall rate dropped by roughly 43 percent, to 46.7 per 100 persons in 2019, from its peak of 81.2 per 100 persons in 2012. In Massachusetts, prescription opioids dispensed per 100 persons peaked in 2009 at 68.9 per 100 persons and dropped by 49 percent to 35.4 per 100 persons in 2019. From 2014 thru 2019 alone, the rate in the Commonwealth dropped 41 percent, from 59.6 to 35.4 per 100 persons.

The dramatic decline in doctors prescribing opioids to their patients in pain, beginning in 2009, did nothing to bring down the Massachusetts overdose rate. But the percentage of overdose deaths containing illicit fentanyl began to increase in 2014, soaring to over 91 percent by 2020 (Figure 4 and Figure 5 of the Data Brief). During that same time period, overdose deaths containing prescription opioids, including hydrocodone, oxycodone, hydromorphone, oxymorphone, and tramadol, remained relatively stable at roughly 15 percent. As the black market supply of diverted prescription opioids started dwindling around 2010, the proportion of overdose deaths attributable to prescription opioids stabilized and then gradually decreased, while deaths due to, first, heroin, and later fentanyl began to rise as these drugs filled the void.

The Massachusetts experience comports with research showing no correlation between prescription volume and non‐​medical use of prescription opioids or opioid use disorder. Furthermore, researchers at the University of Pittsburgh found the overdose rate actually began climbing well before the invention of OxyContin—as early as the 1970s—and has been growing exponentially ever since; all that has changed over time is the type of drug(s) predominating among the overdose deaths.

Despite the evidence, lawmakers and policymakers continue to focus efforts on reducing opioid prescribing to patients in pain. As I recently explained in writing to the Subcommittee on Health of the House Energy and Commerce Committee, this only causes patients to suffer needlessly while driving non‐​medical users to the black market, made dangerous and potentially lethal because of drug prohibition, driving up the death rate in the process.