As opioid prescriptions fall in the US are pain-related deaths on the increase?

Against a background of continued political pressure targeted at the prescription of opioids, a national study in the US has revealed that in 2017, the number of prescriptions for opioids fell by 10.2%.

The study, by IQVIA Institute for Human Data Science, recorded the fifth consecutive annual fall, which had previously increased annually since 1992. The Institute said that among the factors driving the reduction were “major clinical guideline shifts, payer reimbursement controls, intensive medical education efforts by state/specialty medical societies, as well as regulatory and legislative restrictions.”

They say the evidence “suggests that health-care professionals are prescribing opioids less often for pain treatment.” New opioid prescriptions fell by almost 8% during 2017 while medications prescribed for opioid dependency nearly doubled.

Illegal sources

However, as many hail the ‘success’ of tighter legislation and guidelines, the Centers for Disease Control and Prevention report that the number of deaths from illegal heroin and synthetic fentanyl has increased since 2015. There is strong evidence that many people who are now unable to obtain a prescription for opioids for chronic pain are turning instead to illegal sources, sometimes with fatal consequences.

Deaths

Social media, if not the mainstream press, is full of terrible accounts of people in the US whose opioids for chronic pain have been withdrawn. One commentator said “the news media just aren’t interested until somebody takes their own life.” Figures for pain-related suicide are not available in the US, but it is widely thought that numbers have increased dramatically.

In her poignant article on chronic pain and suicide, Libby Parfitt considered the effect of the US war on opioids:

“The terrible, life-ending problem with this initiative is that it abandons the genuine chronic pain patient, the person, exactly like me, who is absolutely reliant on strong painkillers to live their life. These people are patients, not addicts; how dare anyone who signs the Hippocratic oath treat them with such callous and cruel indifference? “Complaining” about your new prescriptions won’t change anything. “Arguing” will have no effect either. How far do we have to go to be heard? Will you listen to me if I put a gun to my head?”