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WASHINGTON — The rhetoric has come from lawmakers and doctors, entertainers and academics, and even from President Trump: The pharmaceutical industry, all have said, is in large part to blame for the ongoing opioid crisis.

But even amid an epidemic that took nearly 50,000 American lives in 2016, lawmakers have remained reluctant to bring pharmaceutical executives to Capitol Hill and question them face to face.

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  • It is shocking that a congressional committee is acting on and disseminating exaggerated estimates about the role of prescription analgesics in fatal ODs. Early in the “opioid crisis,” the “CDC Guideline for Prescribing Opioids…” (McDowell et al., 2016) implied such exaggerations along with a singular focus on reducing prescriptions as the singular mode for preventing fatal ODs. However, it has since been recognized that a substantial majority of fatal ODs are due to illicit “opioids” that are actually illicit “street drugs,”and/or mixtures of illicit drugs with other substances. Even among the minority of ODs involving prescription opioids, most involve toxic mixtures with other medications or diversion to individuals other than the patient who was (hopefully) screened and for whom the prescription was intended. Moreover, after approximately a decade of regulations, the number of prescriptions for opioid medications was reduced to the lowest number on record by 2016; nonetheless, during that decade, the number of OD fatalities rose steadily and reached the highest number. Contrary to the CDC’s popular suggestion, reducing prescriptions for opioid analgesics has not prevented ODs. In addition, the few, well- conducted empirical studies reveal that exposure to brief periods of opioid medications does not predict later addiction nor ODs. Finally, addiction (versus dependence) occurs among < 2% of patients who are treated with long-term opioids for chronic pain, if those with prior substance abuse problems are excluded. The members of the congressional committee should have been better informed, and this is especially important because their false assumptions are producing terrible consequences for pain patients who have legitimate need for analgesics, and because fatal ODs involving street drugs should be prevented using approaches that have actually been found to be effective.

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