
Who Is Telling the Truth About Prescription Opioid Deaths? - tomcam
https://www.acsh.org/news/2018/11/05/who-telling-truth-about-prescription-opioid-deaths-dea-cdc-neither-13569
======
freyir
The claim here is that opioids are not as bad as you've been led to believe.
I'll let the article speak for itself, but note that ACSH has been frequently
criticized for taking a pro-industry stance on issues:

* In 1979, the information director of the FDA said, "Whelan just makes blanket endorsements of food additives. Her organization is a sham, an industry front."

* Ralph Nader claimed: "ACSH is a consumer front organization for its business backers. It has seized the language and style of the existing consumer organizations, but its real purpose, you might say, is to glove the hand that feeds it."

* The Center for Science in the Public Interest stated: "ACSH seems to arrive at conclusions before conducting studies. Through voodoo or alchemy, bodies of scientific knowledge are transmogrified into industry-oriented position statements.

They previously sought funding from Philip Morris. Recent donors include
Chevron, Coca-Cola, Bristol-Myers Squibb, Dr Pepper Snapple Group, Bayer
Cropscience, Procter & Gamble, Syngenta, 3M, McDonald's and Altria.

~~~
cookiecaper
Like most drugs, opioids are easy to demonize, at least up until you or
someone close to you depends on them.

It's naive to assume that the industry dislikes the focus on the "opioid
epidemic". It works to their advantage in a variety of ways, but one of the
biggest is the formation and reinforcement of a whole new class of specialized
clinicians called "pain management specialists". In Florida for example, a law
went into effect this past July that effectively barred any non-pain-
management specialists from issuing an opioid Rx that exceeds a 72 hour
supply.

Even before this law went into effect, the sentiment it conveyed directly
impacted the willingness of ordinary docs and medical facilities to reasonably
treat pain in persons without a chronic condition that would be handled by a
pain management specialist, like postpartum women. My wife was left with only
lightweight OTC pain relievers because the hospital said it was too risky to
write anything stronger unless there were clear complications.

The outcome of the campaign against the "opioid epidemic"? There is now a
specialized clique of doctors for the pharmaceutical sales reps to focus their
attention on, there are more flurries of codes to bill for, and there is a
niche for enterprising doctors to exploit desperate people to make _literal
millions_ for themselves while setting their own hours, just like
psychiatrists. In fact, the industry is trying to reshape pain management to
be the spitting image of psychiatry, which, especially over the last 5 years
or so, has become astronomically lucrative for the industry all around.

The long and short of it is that restrictive regulation for this type of drug
is bad news only for the sick people who depend on their medication to
function. It will be much harder and much more expensive to get and keep a
steady stream of the drugs that allow them to work and live a semblance of a
normal life, all so the incumbent political dynasty has a talking point in the
next election cycle.

But, err, yeah, let's write off anyone who sees this as a pro-pharma shill...

~~~
biehl
> But, err, yeah, let's write off anyone who sees this as a pro-pharma
> shill...

ACSH does not seem like “anyone” but rather a documented pro-any-paying-
industry-shill...

------
tempaccount2736
Take this article with a grain of salt - ACSH looks to potentially be
something of an industry PR group.

From some sources that may themselves be biased:

"Council on Science and Health is a Corporate Front Group"
[https://usrtk.org/hall-of-shame/why-you-cant-trust-the-
ameri...](https://usrtk.org/hall-of-shame/why-you-cant-trust-the-american-
council-on-science-and-health/)

[https://www.sourcewatch.org/index.php/American_Council_on_Sc...](https://www.sourcewatch.org/index.php/American_Council_on_Science_and_Health)

~~~
akurusawa
As per wiki
[https://en.wikipedia.org/wiki/American_Council_on_Science_an...](https://en.wikipedia.org/wiki/American_Council_on_Science_and_Health)

------
dools
The whole "opioid" shit fight can be summarised as:

Pharmaceutical companies needed a way to profit from developing alternatives
to morphine so they developed a bunch of dangerous bullshit then convinced
everyone it was safer than morphine even though it's not.

Morphine is awesome and has as its only long term side effect constipation.

If it ain't broke, don't fix it. Prescribe morphine, including to heroin
addicts who are, after all, simply addicted to morphine which isn't actually
that dangerous. The only thing that makes heroin dangerous is the fact that
it's not prescribed by a licensed pharmacist.

Think about it: if you're addicted to pain medication maybe you're
experiencing some pain. So like, prescribe them the pain medication, then help
them deal with the cause of the pain.

Drug policy is so stupid.

~~~
devwastaken
I think you're massively downplaying addiction. Sometimes it is physical pain
at first, but you get hooked on it. Not everyone does heroin because they
actually need that level of pain medication. They do it because it feels
amazing. They get dependence on it, and then keep doing it. Read the Heroin
diaries by Nikki Sixx of Motley Crue if you want a good look into that.

I don't know where you're getting that morphine isn't dangerous. It's highly
addictive and deadly if dosed wrong, and you absolutely build tolerance over
time which changes your dosing.

~~~
dools
A substance's addictive ness does not equate to lethality. The reason it's
dosed incorrectly is because it is manufactured and sold in an unregulated
environment.

That is the cause of its lethality.

Also I'm not referring exclusively to physical pain, but trauma or lack of
emotional and social connection.

~~~
eletious
The addictive nature of the substance combined with the body's growing
resistance to it leads to users of the substance to use larger doses to
achieve the same high, in some cases not exercising any caution about dosage,
leading to overdose.

~~~
cookiecaper
This is a reason to continue to prescribe drugs through a licensed medical
professional. Most long-term medications can't just be stopped without serious
adverse effects.

By and large, drugs will be a large social problem until going to the doctor
to get a monitored, controlled dose is the easiest way to get a fix. If we
keep pharmacists and doctors in control, they can ween dependent users off in
a controlled, gradual environment.

Prohibition keeps drug abuse firing on all cylinders until the addict slams
into a brick wall (which, very often, is simply death), instead of giving them
the equivalent of a "runaway truck" ramp that will allow them to gradually
slow the pace and return to a normal existence.

------
DanBC
This article misses several points.

When we ask people with a substance misuse disorder who use opioids what they
started on we find, very often, that they started on meds prescribed by a
doctor. Those meds may not have been prescribed to them - they may have been
prescribed to a neighbour or family member - but they were prescribed.

This is why the massive over-prescription of opioids is a problem. It floods
American homes with opioids that people keep "just in case" and that are
experimented with by family members or handed out to neighbours to help out.

Opioids may be a good choice for some people with long term pain (I personaly
don't think they are), but that would be in a carefully controled setting
being closely monitored by a doctor. It's definitely not using opioids that
your neighbour has given you for your dodgy back.

The article makes an incoherent point about what is classed as a CPD. Benzos
are dangerous (especially in combination with other meds or alcohol) but far
fewer people are dying from benzos than from opioids.

~~~
GordonS
> Opioids may be a good choice for some people with long term pain (I
> personaly don't think they are)

They definately are for _some_ people, because I'm one of them. I've tried
_everything_ else, and nothing even touches the pain.

I've tried numerous anticonvulsants (carbamazepine, lamotrigine, topiramate,
levetiracetam, gabapentin, pregbalin...), tricyclics (amitriptyline,
nortriptyline, dosulepin...), muscle-relaxants (tizanidine, diazepam...),
anti-depressants (venlafaxine, reboxetine, duloxetine...), as well as NSAIDs
like diclofenac, and assorted things like topical capsaicin and topical
gabapentin. A lot of these made me dizzy and uncoordinated, where I couldn't
function normally, and some made me extremely nauseous - while not touching
the pain. The rest did _nothing_.

I realise I'm probably a statistical outlier, but I resent the idea that I
should be left to suffer because my body and genetics don't conform to some p
value from a meta-analysis.

Opioids should of course not be the first choice for chronic or neuropathic
pain, because statistically other things are more effective and safer (e.g.
pregbalin) - but doctors should not be prohibited from prescribing opioids
when pain cannot be adequately controlled by other means.

If I had to deal with my chronic pain 24/7 without any pain relief... well,
opioids have likely saved my life. I've been taking them for years now, and
while I will obviously be physically dependant on them now (that's just how
receptors work), I feel absolutely no psychological addiction to them
whatsoever.

~~~
DanBC
> > > Opioids may be a good choice for some people

> I realise I'm probably a statistical outlier,

Do you think you might be who I'm referring to to here?

The US massively over-prescribes opioids. They could probably reduce
prescribing by 75% and it wouldn't affect people like you, other than having
to go to a specialist pain clinic. Since you have specialist pain you deserve
best quality treatment from specialist.

> Opioids should of course not be the first choice for chronic or neuropathic
> pain, because statistically other things are more effective and safer

Isn't this just agreeing with what I said?

~~~
GordonS
> Do you think you might be who I'm referring to to here?

That sentence continued with "(I personaly don't think they are)".

> Isn't this just agreeing with what I said?

Well, no, because you explicitly stated that you personally _didn 't_ agree.

I realise that the US has a huge problem with over-prescribing opioids. I
think that great care needs to be taken in how that is reduced - there are
many instances of a heavy-handed approach being used, and those that have a
genuine need have their pain relief removed. The consequences of this can be
disastrous.

------
l33tbro
> The American Council on Science and Health is a research and education
> organization operating under Section 501(c)(3) of the Internal Revenue Code.
> Contributions are fully tax-deductible. ACSH does not accept government
> grants or contracts, nor do we have an endowment. We raise our funds each
> year primarily from individuals and foundations.

Hmm.

~~~
eletious
Yeah, I don't trust this article. The only point it makes that I can agree
with is that the opioid crisis isn't resolved yet, which is a very easy
conclusion to reach.

------
cm2012
This is a really important article, and a good complement to
[https://fivethirtyeight.com/features/what-science-says-to-
do...](https://fivethirtyeight.com/features/what-science-says-to-do-if-your-
loved-one-has-an-opioid-addiction/).

~~~
DanBC
Your fivethirtyeight article is good. The submitted article is pretty poor.

------
xorfish
I wonder how many death could be prevented by legalizing and regulating
opioids and other drugs and educate users on different opioids and safe use.

~~~
sintaxi
Opioids are not stigmatized enough. They destroy lives plain and simple.

~~~
Vinnl
I don't think anyone disputes that they destroy lives; what people wonder is
what is the most effective way to prevent them from doing that, and what to do
with cases where they are already doing that.

One can seriously question whether "stigma" is that most effective way.

~~~
sintaxi
It worked wonders for smoking cigarettes. Stigmatizing tobacco played a huge
part in lowering the number of people using it.

~~~
Vinnl
Maybe, though the stigma there took the form of legalising it, allowing people
to openly come forward and seek help, and levying heavy taxes. I'd say drugs
are even more stigmatised (to the point of being largely illegal), which so
far hasn't really result in lowering usage numbers.

~~~
sintaxi
44% of Americans are prescribed opioids each year.

------
sureaboutthis
I don't get it. I read people blaming the drugs. I read people blaming the
drug companies. But how are people getting the drugs to overdose or get
dependent? Aren't doctors prescribing these and aren't doctors supposed to be
monitoring them? Pharmacies too?

Whether that happens or not doesn't matter. My point is that if people are
getting hooked on these drugs and overdosing, the fault lies with who gets
them the drugs and no one else.

------
JudasGoat
The article focuses on which substance killed the drug addict. It would be
more honest if it identified the opiate that led to addiction in the first
place.

------
gjmacd
Am I missing something. Or did the definition change when Sessions appointed
Uttam Dhillon? Why are we not surprised and why is this even open for debate?

------
acct1771
The parents.

