The Overdose Crisis Is Not Just About Rx Opioids

By Roger Chriss, PNN Columnist

The CDC last week released its latest report on drug overdoses in 2017.  The death toll was the highest recorded, with over 70,000 Americans dying from drug poisoning. Deaths involving illicit fentanyl and other black market synthetic opioids surged 45 percent, while deaths involving opioid pain medication remained unchanged.

Although the death toll for 2018 may be a bit lower, it is premature to declare as the Washington Post did that “the opioid epidemic may be receding.”

Instead, the crisis is evolving.

“Fentanyl deaths are up, a 45 percent increase; that is not a success,” Dan Ciccarone, PhD, a professor at the University of California, San Francisco, told the New York Times. “We have a heroin and synthetic opioid epidemic that is out of control and needs to be addressed.”

The available data for 2018 supports this. There have been over 1,500 overdoses in Massachusetts so far this year and the details of those deaths are sobering. Fentanyl was present in 90 percent of toxicology reports during the second quarter of 2018, a three-fold increase since 2014. Prescription drugs of any form were found in only 17 percent of reports.

Public health data from Connecticut is similar. Illicit opioids were found in nearly 80 percent of the 867 people who died of an unintentional opioid overdose in 2016.

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Current data is also showing that drugs like methamphetamine are having a significant impact on overdose rates. Kaiser Health News reports that amphetamine related hospitalizations – mostly involving meth – are surging and that more than 10,000 people died of meth-related drug overdoses last year.

The opioid overdose crisis is no longer primarily about prescription opioids used medically, or even exclusively about opioids. And studies of long-term opioid therapy are not showing increasing rates of overdose.

Medscape reported on a recent study that found cancer patients had a much lower risk of dying from an opioid overdose than the general population. The study looked at opioid deaths from 2006 through 2016, a period that saw rapidly rising overdose rates. Opioid death rates jumped from 5.33 to 8.97 per 100,000 people in the general population during that period, but among cancer patients, opioid deaths rose from 0.52 to 0.66 per 100,000.

Another recent study found that the use of opioids in treating pain from sickle cell disease was “safe” and rarely results in overdoses  

“What our study uniquely shows is that, using this large nationwide database, that deaths in a hospital setting related to opioid toxicity or overdose almost never happen among those with sickle cell disease," Oladimeji Akinola Akinboro, MBBS, of Boston University School of Medicine told Medpage. "This suggests that current patterns of opioid use in this population is safe, assuming we continue the same risk-mitigation strategies."

In other words, long-term pain management in disorders like cancer and sickle cell disease is not associated with increased rates of fatal overdose. Both of these studies have important limitations, in particular the possibility that some overdose deaths went uncounted. But the low rates of overdose in these groups suggests that with careful patient screening and monitoring, opioids can be used safely.

More can and should be done. Opioids are being prescribed more cautiously to children and teens. This is important, in light of a new JAMA study on wisdom tooth extraction, which found that over 5% of young people who had their wisdom teeth removed and received opioids for pain control went on to receive an opioid abuse-related diagnosis.

The overdose crisis is fast evolving into a poly-drug substance use problem. Addiction expert Michael Botticelli, the former director of National Drug Control Policy, told WBUR that a better understanding is needed of why people use drugs, not just which drugs they use.

"The data are pretty clear that we have a drug use epidemic and a drug overdose epidemic,” he said. “I think we have to really be careful that our strategies speak to all of those issues.”

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Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.