As the death toll from opioid overdoses in Kentucky and the rest of the Midwest continues to soar, it’s truly disconcerting to see that policymakers are taking steps that are not only devoid of medical and common sense, but virtually guaranteed to make matters worse.
The recent passage of the ill-conceived House Bill 333, which imposes a three-day limit (with certain exceptions) on opioid prescribing, reflects a fundamental misunderstanding of the reasons behind the addiction epidemic.
All this new law will accomplish is to make matters worse for both pain patients and addicts. The former will suffer needlessly; the latter will die in even greater numbers.
The absence of common sense in Kentucky’s approach to this problem is mind-boggling. Lawmakers, who believe that further tightening of the already-stringent legal prescription practices of opioid painkillers will stop the wave of deaths that has hit the region so hard, have it dead wrong.
It is crystal clear in multiple states across the country that the overwhelming majority of opioid overdose deaths are not a result of pills. Death from opioid pills (in the absence of other drugs) is uncommon.
Perversely, the increase in deaths we are seeing now is a direct result of the difficulty in obtaining pills. Within the past decade, opioid pills became difficult to get and prohibitively expensive, which caused addicts to switch in droves to heroin. This is the root cause of soaring overdose deaths, not pills from pharmacies.
Second, and far worse, heroin is no longer the “safe” drug that it once was. Over the past three years, it has been increasingly mixed with, or replaced entirely by, fentanyl and its far more potent chemical cousins. It is this progression from pills to heroin to fentanyl that is responsible for the skyrocketing overdose deaths we are now seeing.
Although it is convenient and plausible to blame today’s crisis on prior over-prescription of pain medications, this is simply a false narrative. This is seen in multiple literature analyses, including a review of 30 studies in the journal Pain and a comprehensive Cochrane review, which examined 26 more.
Patients who are being treated responsibly for moderate-to-severe pain rarely become addicted. The Cochrane review found that only 0.46 percent of pain patients became addicted. The vast majority of today’s addicts became so by using opioid pills recreationally and later progressing to injectable opioids once the supply of pills dried up.
But the real victims here are pain patients.
Many of them, who have been treated for very painful chronic injuries or medical conditions for decades, are terrified of being cut off from the medicines that are essential for their survival. That’s because states are already beginning to impose arbitrary limits of maximum daily doses of the drugs.
That is both cruel and scientifically flawed, especially since it’s known there is a very wide range in how people metabolize opioids — as much as a 15-fold difference between individuals, which drastically affects blood levels of the drugs.
This ensures a “one-size-fits-all” approach is doomed to fail. Although anecdotal, stories involving suicides of pain patients who have been unable to obtain the drugs that they need just to exist are easy to find.
When states and government agencies crack down on a legally prescribed, essential medicine, they are not only addressing the wrong problem but also are making matters worse for both addicts and patients. Laws such as Kentucky’s may seem to make sense on the surface, but even a little digging reveals how flawed they really are. Everyone gets hurt.
Josh Bloom is director of chemical and pharmaceutical sciences at the American Council on Science and Health.
At issue: Herald-Leader article, “3-day limit on painkiller prescriptions among new laws taking effect Thursday” and Herald-Leader editorial, “Ky. opioid limits will save lives”