Opioid Death and the Real Culprit

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It is no secret today that we are experiencing a serious opioid crisis, particularly in a time of isolation related to COVID-19 and associated isolation. What is characterized as the “opioid crisis” continues to ravish communities and families across the U.S. Based on the most recent provisional data from the CDC/National Center for Health Statistics (NCHS), approximately 81,230 drug overdose deaths occurred in the United States in the 12 months ending in May 20201. Over the years I have continued to survey the landscape of this discussion surrounding the opioid crisis, and I have realized how complex and nuanced this topic really is. When presenting statistics as outlined above and discussing overdose deaths, individuals tend to speak in broad terms and characterize overdose deaths as mostly attributed to prescription opioids.

The consequence of certain narratives can have detrimental effects on different segments of patients in our society that depend on the medical use of long-term opioid therapy for their disease states. In a report published by the CDC on December 17, 2020 via the CDC Health Alert Network they were astute to note that synthetic opioids (in which they defined as illicit fentanyl analogues, aka “fentalogues”) was the primary driver of those overdose deaths2. Fentalogues are chemically different than pharmaceutical fentanyl, the latter of which is used medically in inpatient and outpatient settings, depending on the formulation (intravenous vs. transdermal patch vs. transmucosal immediate release fentanyl). Data on state drug confiscations per the National Forensic Laboratory Information system (NFLIS) showed significant increase in the number of reported fentalogue drug confiscations reported by forensic laboratories around the country from 2012 to 20143.

Another important aspect to consider is the polysubstance nature of overdose deaths. The combination of multiple illicit drugs is another driving factor of overdose death that we need to understand and consider. The CDC Health Network Advisory Report of December 2020 also pointed out that overdose deaths involving cocaine and psychostimulants such as methamphetamine have increased 26.5% and 34.8% from the 12-months ending in June 2019 to the 12-months ending in May 20202. Calcaterra et al in a 2013 study sought to examine demographic trends, and describe common combinations of substances involved in opioid related overdose deaths. In this study they found that the death rate related to pharmaceutical opioids and benzodiazepines was the highest, followed by cocaine, alcohol, and antidepressants when used in combination4. Diversion is another variable that often gets missed when discussing overdose deaths. In a 2015 National survey on drug use and health they found among adults with misuse, 40.8% obtained prescription opioids from friends or relatives for their most recent episode of misuse or abuse5.

It should be apparent by now that it is important to understand exactly what drugs are involved when assessing overdose deaths. A few questions should come to mind when looking at the data:

How many drugs were involved?

Were the drugs involved attained from an Rx or illicit source?

What risk factors did the individual have that contributed to the increased risk of overdose death?

As we have seen, with the increase of an adulterated drug supply, it is important to properly characterize what is going on during this crisis. As we continue to see overdose deaths, and lives being affected by this crisis it will be imperative that we properly identify the true culprits involved.

As usual, comments and questions are welcome!


This guest post is written by Dr. William Amarquaye, a graduate of University of South Florida with a bachelor’s in biomedical sciences and a Doctor of Pharmacy in 2017. He currently practices as a Clinical Pharmacist at Brandon Regional Hospital in Brandon/Tampa area, Florida.

References

  1. Ahmad FB, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2020 accessed at: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
  2. Increase in Fatal Drug Overdoses Across the United States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic. Updated March 27, 2020. Accessed February 12, 2021. https://emergency.cdc.gov/han/2020/han00438.asp
  3. Centers for Disease Control and Prevention. CDC Health Advisory: Increases in Fentanyl Drug Confiscations and Fentanyl-related Overdose Fatalities. HAN Health Advisory. October 26, 2015. Accessed: https://emergency.cdc.gov/han/han00384.asp
  4. Calcaterra S, Glanz J, Binswanger IA. National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999-2009. Drug Alcohol Depend. 2013;131(3):263-270. doi: 10.1016/j.drugalcdep.2012.11.018
  5. Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health. Ann Intern Med. 2017;167(5):293-301. doi:10.7326/M17-0865

 

 

21 thoughts on “Opioid Death and the Real Culprit

  1. At the rate legitimate, INCURABLE, abandoned severe pain sufferers (TEN-MILLION) are SUFFERING, …for now overdosers (Eighty-thousand) and OUDs MUST BE DISCOUNTED…

  2. It was just a misinformation tool by leaving out the term ILLICIT. Thereby letting PROP to get involved to make their money on the backs of chronic pain patients and their doctors. Don’t forget the contribution made by the DEA with assets forfeitures and the taking physicians licenses. Vets, cancer and all chronic and acute pain patients are dying. Discrimination against cpp’s disabilities.

  3. It has always been an HEROIN & ILLICIT FENTANYL CRISIS. pain patients have paid the price for over 5 years, and getting worse.
    There is no individualized care, heck there’s hardly any pain physicians available to see!
    So many patients could be working, taking care of their families, etc but they have been forced to be home bound or bed ridden. Way before Covid made most home bound.
    Pain medication does not elevate all pain, but it does reduce enough to be able to work & take care of family, self, etc. Is it a crime if someone in pain actually has a”good day” or is out enjoying themselves? We wouldn’t want someone with diabetes or any other disease to be home bound with no quality of life.
    Patient Responsibility & Accountability is expected of all prescriptions. How have millions of pain patients not overdosed? How have millions of patients left a hospital & not became addicted to opiates? How have millions of patients received a one time script for injury, dental or other minor procedure and not became addicted? It just doesn’t work like that, never has, never will.

  4. The CDC’S 2016 guidelines have harmed chronic pain patients. Taking away opioid medication and doses that patients have been on for years without problems. Tom Friedman and Andrew Kolodny are responsible for the 2016 CDC guidelines written in secret, redacted so that the American public can’t read. The American Medical Association has said the CDC has harmed pain patients, yet the CDC continues its harms against pain patients. Pain patients who have lost opioid medication treatment, some have committed suicide!! Is cruel and inhumane treatment to make people suffer. Make people suffer when they don’t have to suffer. Because OUR GOVERNMENT is PRACTICING MEDICINE, the DEA now is involved in prosecuting doctors, instead of going after illegal illicit fentanyl, methamphetamines, cocaine drug dealers or the supply coming in from China and Mexico. The DEA is too busy prosecuting doctors that their not stopping the supply of deadly drugs killing Americans. These overdoses are up 1042 °/. While legal opioid prescriptions are down by 57 °/. Doctors being prosecuted for treating pain. Being given 20-40 years in prison! Their only crime is being a doctor that treated pain patients! .Medical examiners have added fuel to the fire too. If a pain patient has a heart attack and dies, the death from a heart attack? Its wrongfully labeled as an opioid overdose. Even if that patient on took what was prescribed. Where did it go wrong? PROP started with Andrew Kolodny going to his buddy, Tom Friedman at the CDC, and the invention of the 2016 guidelines. A magical number 90 was chosen. Why 90? No two people are alike, one size doesn’t fit all. Yet the CDC guidelines except all pain to be treated below 90 morphine equivalent. The doctor- patient relationship has been destroyed now, and pain undertreated now more than ever or not treated at All!!

    1. You’re so right, Kim!
      Another layer in this “crime against intractable pain patients” is the fact that many one-time street dealers are now able to afford to buy large quantity pill presses online overseas, and press out enough pills, (many with the brand stamps included), to cause mass havoc and even death.

      In addition are the dealers who add their own “special unknown ingredient$”, (such as meth, and God only knows what else)? in order to make what they’re selling “pack a good punch”, that may even include death, and of course, a very hefty profit margin for themselves too.

      It had never occurred to me, as a long time “intractable pain patient”, dependent on opioid pain medicines in order to function semi-normally, and have a fairly decent quality of life, that the doctor who’s RX’D my necessary pain meds for almost nine years, would decide that the “pressure is now just too great” for him to continue prescribing my long ago, well titrated, never abused, two opioid pain medications anymore.

      I wish all the MD’S who are fine with doing this to their trusted and trusting patients, either through Government force or intimidation, would just kill us, rather than subjecting us to a slow, painful death…

      (It’s about to be “Soilent Green” time up in here)! A life of pain, frustration, and helplessness, without the ability to have our constant pain somewhat alleviated, is not a life worth living…

    2. The horrific side effect of this, is our mental health. Looking at days of unrelenting pain and sleepless nights are slowly killing us. I never used to have suicidal ideations before and never in my life, before 2016, have I been made to feel like I am a drug abuser, a drug seeker, and a liar by the medical community and even some friends and family who do not understand what’s happening. They think if we needed it, the dr would rx.

  5. As we have seen, with the increase of an adulterated drug supply, it is important to properly characterize what is going on during this crisis. As we continue to see overdose deaths, and lives being affected by this crisis it will be imperative that we properly identify the true culprits involved. This was take right from this article. Trashing the very meds, that Complex Legacy Pain Patients rely on for any type of quality of life, on the evening news will surely have detrimental results to these patients and their families, including death !

  6. We were told that our meds were being taken away to decrease ODs. ODs have increased while prescriptions have dramatically decreased. Turned out that the CDC combined all opioids in their numbers, so the ODs due to prescriptions barely change and were never the problem. I don’t like to believe in conspiracies, but a lot of different people and shady data came together to drop the hammer on patients with the CDC Opioid Prescribing Guidelines. Just as likely an explanation is that the CDC is just as unscientific as any other gov’t organization. Patients have been screaming at the top of our lungs for years to ask them to withdraw the guidelines, but no one will listen. When the failure of such an important policy is blatant, and we can’t get our government to change course, we truly are lost. In another five years we’ll look back at the suffering and death and really wonder how we could allow our gov’t to do this to such a disease ridden and vulnerable population. I hope at that time that we can sue the employees of the CDC and the committee that wrote the guidelines. I believe the Supreme Court recently ruled that some gov’t employees can be legally liable for hurting people. Let’s hope – it’s the only way things will change. Take away their money and power..

  7. Hello. I appreciate you. I suffer chronic pancreatitis, and am on fentanyl. ( I have a 1 month old medtronix pain pump). Thank you for this article. I’m so tired of doctors being forced to hurt pain patients. I am lucky enough to have an empathetic, good doctor. I just hope things can change for the better soon! Thank you! Bram Cast

  8. 996 out 1000 NEVER “addict”. It is a genetic predisposition to hyper-react in the reward center. Opiates never addicted ANYONE. They can only trigger TRUE “addiction” in a very few so disposed. Withdrawing, which is just as bad as it looks, is NOT “addiction” of ANY KIND.

    Abusers must COMPLETE withdrawal to escape the use/withdrawal, use/arrest, use/overdose cycles. …Then they will whistle again…

    NONE of the “opiate use disorders” or the tiny risk for “TRUE addiction” provide a rationale to cut-off nearly 20 million incurable SEVERE PAIN sufferers, which is what has happened and IS the unintended consequence.

    Legitimate, incurable severe pain sufferers encounter OUD or overdose at %0.6 (zero point six).

    We are talking; Lupus, Lyme, Cancer, Rheumatoid Arthritis, Fibromyalgia, Migraine, Crohn’s, Interstitial Cystitis, CRPS, crushed spine, amputation, stenosis, Muscular Dystrophy, Multiple Sclerosis, Sickle Cell Anemia, failed surgery, adhesions, endometriosis, burns, Adhesive Subarachnoiditis, etc.

    Please see everything at Youtube by Dr. Thomas Kline.
    Regards

  9. Now if we can just separate those who gather and report opiate use/abuse from their preconceived belief and agenda from the TRUTH and get them to report the truth the “opiate crisis” would take on a whole different perception. If it became common knowledge that 0.6% of legit chronic pain pts become substance abusers…. that would sure be a culture shock to the DEA since they would have to go after the real sources of substances that people OD on

    1. It was all part of the plan to blame Doctors and so easy to make the math work in your favor when dealing with %’s But you can’t beat honesty and truth. Prescriptions have been going down for 12 years and yet they criminalized pain patients. Dependence is not addiction , Other countries teach this truth. Every Rx comes with a paper telling you the proper way to take and store your meds. Some people like Prop want to blame others for abusing drugs when it’s a personal responsibility, Not the doctor. There should not be a war against pain patients, greedy lawyers have made it worse , wait till there loved ones are dieing from cancer and they get to watch them suffer. The CDC needs to be held accountable for the harms they have caused. No respectable Doctor would follow there guidelines of misery.. Why is no one reporting this?? Collusion and conspiracy it’s time for the suffering to stop. Why are our vets dieing ? Coming home to suffer ? It’s time the dead patients names are posted on line! Post the names of patients who lost there care and there doctor harassed , thrown to the street and left to suffer! WHY?

      1. Most of us are fine with the correct label, “Psychologically Dependent”, but do the labels, “Drug Seeker”, “Addict”, (or worse), seem to be feeling kind of “personal” lately!?

        If only the “powers that be” could catch some real “drug dealers” every now and then, maybe they’d feel less compulsion to rob legitimate pain patients of their dignity, abilities, and possibly even their lives?

        The cartels and the backwoods meth cooks can all sleep soundly again tonight…

  10. Hello,
    In reading this article the first thing that came to my mind was, it’s about time. It’s about time that someone, especially the CDC and the DEA, learns the difference between illicit street drug users and those who depend on prescription opioids to participate in even day to day life, maintain a steady income, and care for their families. When the CDC implemented their 2016 guidelines they cut an entire community of people off at the knees and many have lost their homes and families because they were denied the necessary medication. It would be like taking blood pressure medication, or a diabetics medication away, they would not be able to function.
    Illicit drug users have an entirely different agenda than that of CPP’s. Their agenda is to get high, the exact opposite of function. Whereas a CPP depends on their medications to enable them to work, care for their family, and participate in life. Our medications are closely monitored thru doctors records and the pharmacy records; every medication is closely monitored. However, what has resulted from these guidelines has actually caused more overdoses due to the fentanyl used illicit drug dealers. The result is another generation of drug addicts who have found cheaper methods of getting high. Moreover, it is imperative for everyone involved to understand the difference between addiction and dependence. An addict is searching for a high, a CPP is searching for relief. There is no high involved for a CPP, however, there is a dependence involved and they are two very different things.
    I had a life before this all started, I worked, paid my bills, and took care of my elderly mother. Today as a result of this misunderstood opioid crisis, I have none of that. I have lost everything I had ever worked so hard for because I cant function at the level my job requires.

    Thank You,
    Pam Iles

    1. Yes Pamela, I concur. Simply put…
      Main difference between an addict & a ccp is:
      an addict takes pain medication to get HIGH;
      a ccp takes pain medication to be able to FUNCTION in their life.

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