Opioids could kill nearly half a million people across America over the next decade as the crisis of addiction and overdose accelerates.
Deaths from opioids have been rising sharply for years, and drug overdoses already kill more Americans under age 50 than anything else. STAT asked leading public health experts at 10 universities to forecast the arc of the epidemic over the next decade. The consensus: It will get worse before it gets better.
There are now nearly 100 deaths a day from opioids, a swath of destruction that runs from tony New England suburbs to the farm country of California, from the beach towns of Florida to the Appalachian foothills.
Is there a reason you have not tried buprenorphine? Dr. Rust
I’m glad you asked:
“Naloxone blocks the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse. Buprenorphine and naloxone is a combination medicine used to treat narcotic (opiate) addiction. Buprenorphine and naloxone is not for use as a pain medication.”
Has anyone thought about the number of patients with severe chronic pain from diseases like Interstitial cystitis which I have had since 1989 which has no cure and no preferred treatment that works for patients like me. I have worked with my doctor for 22 years to come up with a pain treatment that has made my life bearable and now it’s getting more and more difficult to get my prescriptions. The supplier of my medicine has stopped making the drug so I just had to change to a different medicine and I don’t know if it will work or if I am going to have a reaction to it like I have with morphine where I itch everywhere. What is going to happen with patients that have severe pain that can’t get a doctor to prescribe pain medicine anymore is they will go to illegal drugs that are even more dangerous than prescription drugs. I personally couldn’t find a doctor that would prescribe pain medication until I found my current doctor. My life was total hell and I thought about suicide daily. The only thing that helped a little was a hot bath. I would be in the tub every hour or so and the other time I would be in bed in a fetal position. I don’t sleep very much even now because I am in the bathroom urinating every fifteen minutes 24 hours a day. I panic thinking about the day my doctor retires which could be within the next year or two or the next visit when he tells me he can no longer prescribe any pain medicine or my pain medicine is no longer availiable. I do know that I will not go back to a day without pain medication. I will end my life rather than suffer again. I hope all these lawyers suing the pharmaceutical companies understand the consequences of their actions because there are many patients that need those pain medicines and I hope they don’t find out what it is like having severe unrelenting pain.
Lest anyone read the above comment with skepticism, let me assure you this is absolutely real. Having to use the bathroom every 15 minutes around the clock is not unheard of for severe refractory IC.
The cause is unknown, but it’s thought to have multiple subtypes, based on the fact that no treatment helps more than 50-some percent of patients in clinical trials. The autoimmune subtype is particularly challenging, as the most effective treatment in clinical trials is cyclosporine – a long-term risk profile worse than long-term opioids.
The animal model of this disease involves catheterizing mice and injecting hydrochloric acid. (You can imagine how the mice react.)
However, with high-dose opioid pain medication, even IC patients who have failed 40-50 alternative treatments (including multidisciplinary pain programs) can live essentially normal lives, indistinguishable from anyone else.
Increasing access to addiction treatment, including medication for addiction, is essential. At the same time, any policy discussion involving opioid prescribing must also include people with physical disabilities. Opioid medication can be a necessary disability accommodation – allowing people to leave their homes, succeed in professional careers, and care for their families.
This passes as/for breaking, alarming “news” ?
The fact that America has a very nasty illegal drug use habit (cocaine, Methamphetamine, Alcohol) that accounts for 1,000X greater fatalities/deaths (and OD deaths) than ANY Physician-prescribed opiate regime EVER has -or will.
Soooo, maybe you should do some basic research and display/overlay the staggering data that cocaine, methamphetamine and alcohol abuses account for.
If you were to do this, opiate deaths -and nothing but prescribed opiates involved- the numbers would be comparatively near ZERO; it wouldn’t even register on a (visual) graph.
How about talking about the governments impotency in finding and prosecuting dangerous street-drug organizations that cater to illegal drug users and abusers ?
Instead, the media gets suckered into this (Opiate Crisis BS) diversion that has and will continue to DESTROY legitimate intractable pain sufferer’s lives.
It’s time for honesty, revealing the real issues, and initiating a sensible plan to address the alarming rise in illicit drug use -and deaths, that result.
peter jasz
Well-said, Richard. Legitimate chronic pain patients are NOT the problem. The misguided attempt to lump us all together with the illegal drug business and junkies who are determined to chase that next high anywhere and any way they can find it, is indicative of how little many people understand about the difference. All they hear is “Drugs… BAD!” I’m 70 years old, my back is wrecked, and my MRIs prove it. Now I’ve also got bursitis. I hurt every day, all the time, but my 45 mgs of oxycodone keep me functional… a dosage that hasn’t escalated in years. Why am I now made to feel like a junky when I go to get my prescription filled? Why am I lumped into the same category as junkies shooting up heroin or fentanyl that they purchased in some dark alley? At my age, does anybody think I should be terribly concerned about suddenly dying from a drug I’ve successfully taken for the last eight years. I’M not the problem here… the Government is.
Like some others in this comment thread, I have published extensively on issues of chronic pain and addiction. I am a technically trained non-physician patient advocate with 22 years experience moderating online forums and analyzing literature for chronic pain communities. From this background, I commend a reading of my recent article on the respected blog of Dr Lynn Webster, past president of the American Academy of Pain Medicine: “Over Prescribing Did Not Cause the Opioid Crisis”.
Published data of the CDC flat-out disprove the silly notion that doctors over-prescribing for people in pain “caused” our present public health crisis. Overdose mortality has no cause and effect relationship to prescribing rates, and the demographics of addiction versus chronic pain are almost entirely disjoint. Our crisis is instead driven by illegal street drugs aggressively marketed by cartels, in areas of the country where communities have been hollowed out by economic stagnation and despair. The contribution of medically managed opioids is so small that it gets lost in the noise. Even when metabolic byproducts of prescription-type opioids are found in postmortum tox screens, they are almost always found with alcohol and/or illegal drugs.
There is evidence enough of misbehavior in marketing by large pharma companies during the late 1990s through 2010. But despite this misbehavior, medically prescribed opioids have had almost no impact on overdose related mortality. NIDA Director Dr Nora Volkow has written with a coauthor that “unlike tolerance and physical dependence, addiction is not a predictable result of opioid prescribing. Addiction occurs in only a small percentage of persons who are exposed to opoids — even among those with pre-existing vulnerabilities.”
Likewise, “opioid-related hyperaestheia” has never been demonstrated in humans (only animal models). As in many other areas of human experience, in the so-called “opioid crisis”, it’s amazing how much of what everybody knows ain’t so.
It is not the prescription pharmaceutical opioids that is killing people it is the street opioid fentanyl that is killing people. Why do I know hear anyone saying this when it is the truth. Government wants to have patients who are on pain medication suffer and stop all opioid when the real problem is the street fentanyl that is the problem
Ken, what you are saying is so true. I have done many studies and research on opioid deaths and what I found is very few opioid deaths are caused by prescription Norco/Vicodin opioid drugs. Most opioid deaths are from illegal fentanyl opioid drugs. This is not fair to the millions of legitimate people in pain suffer. STOP THE SUFFERING
I have posted often on this site about the safety & benefits of buprenorphine, yet still see a lot of posts like Shirley’s. Any doc can Rx Sched lll meds for pain without a wavier. In 18 years, only one person died using buprenorphine alone, It is effective for most pain and develops little tolerance. Dosage varies with metabolic rates. Why aren’t you bugging your doc for it or talking to the pain docs about it? Wouldn’t have an epidemic if we were using it for pain. Slow withdrawal with med help works without significant withdrawal. Questions? Use email.
Thank you, doctor. Buprenorphine is also an important medication assisted treatment (MAT) drug. I am the author of 3 educational books for classrooms about the opioid epidemic and also have written some nonfiction articles for @medium about OxyContin Sacklers and the fentanyl crisis. The words that Shirley is using are almost the exact words used in internal Purdue Pharma documents which were meant to market increased prescriptions for OxyContin both to physicians and patients. I see and hear this same wording from long-term pain patients both as individuals, and through their advocacy websites, who believe they are being abandoned with no pain relief. Research seems to show that most opioids not only develop dependency, they also reduce the body’s ability to cope with pain, and increase sensitivity to pain. I find it unconscionable that this has been allowed to continue for 20+ years. Saddest of all is that, you are right – buprenorphine will likely help many people – but during this 20 year period, little to no research in other ways to relieve pain, whether through prescribed medication or other methods, was accomplished. I am glad to receive the verbal abuse from long-term pain patients who’ve been on ever-escalating prescriptions for opioids, up to fentanyl and in some cases, sufentanil if it means education will occur and there will be some future hope for actual pain relief without dire health consequences. Hey Shirley? You’re addicted. It’s not your fault, but you’re not just dependent, you are addicted by the nature of human biology, especially womens’ biology and these evil companies who made addicted drugs that by their nature – lose their effectiveness over time and create dependency and addiction. I’m sorry.
Clearly this article shows only one side of the opioid crisis being addressed!
There’s another side which involves patients like myself living with chronic pain. Where are the governments morals when it comes to us. I myself am long standing patient in pain management who through trail and error with several alternative treatments and medications, found pain medication the most effective. We don’t abuse medication, yet we’ve been grouped into the same category as addicts now. The stigma for them at least is diminishing and being seen as a disease. How about the The medically diagnosed patients left in sheer agony because the government has decided to adapt guidelines as law.
When will this side be addressed? Also where are the Guidelines for pain management doctors? PCPs have them for acute pain. Once that treatment runs it’s course of three months that patient is referred to a specialist. So how are they especially the ones already being treated for years after trial and error supposed to receive proper care? Most are having other health issues which have led to death! Symptoms that force them into the ERs and once there- still no relief because we’re labeled as addicts, drug seeking and worse.
How about you start focusing some needed attention on the law abiding citizens who have done nothing wrong except have a disease, disorder, complications from surgeries or better yet inherited causes.
Why doesn’t someone step up and begin to work with us instead of casting us aside to suffer? The CDCs guidelines clearly state that after treatment from PCPs for three months of acute pain they be referred to pain management- where’s their care? Along with everyone else already there for years and having gone through several alternatives unsuccessfully.
It is not the prescription pharmaceutical opioids that is killing people it is the street opioid fentanyl that is killing people. Why do I know hear anyone saying this when it is the truth. Government wants to have patients who are on pain medication suffer and stop all opioid when the real problem is the street fentanyl that is the problem
No. It is NOT “like cigarettes.” Cigarettes are not a required disability accommodation for any medical condition. Cigarettes cannot turn homebound chronically ill patients into functioning members of society after all other therapy fails. Opioid medication – when prescribed selectively and carefully, with appropriate safeguards – can.
Also, PLEASE stop using prescription bottle imagery for these articles. This imagery is ableist and stigmatizing to people who did nothing to deserve it (except be born with a rare, incurable, and excruciatingly painful disease).
It is not the prescription pharmaceutical opioids that is killing people it is the street opioid fentanyl that is killing people. Why do I know hear anyone saying this when it is the truth. Government wants to have patients who are on pain medication suffer and stop all opioid when the real problem is the street fentanyl that is the problem