Deaths from Opioid Overdoses Decline

Deaths from Opioid Overdoses Decline

A new report from the Centers for Disease Control and Prevention has documented the first significant decline in the number of overdose deaths caused by prescription opioid painkillers.

From 2010 to 2012, the number of deaths in 28 states caused by opioids declined from 10,427 to 9,869 deaths – a drop of 5.4 percent – according to the CDC’s Morbidity and Mortality Weekly Report. Seven states had decreases in opioid deaths rates, five states had increases, and sixteen states had no change.

bigstock-American-Drugs-4379874Despite the encouraging results about opioid deaths, the CDC issued a press release that focused instead on a sharp increase in the number of heroin deaths, which the agency blamed on the overprescribing of opioid pain medication.

“Reducing inappropriate opioid prescribing remains a crucial public health strategy to address both prescription opioid and heroin overdoses,” said CDC Director Tom Frieden, MD, in the press release. “Addressing prescription opioid abuse by changing prescribing is likely to prevent heroin use in the long term.”

From 2010 to 2012, the number of heroin deaths in the same 28 states doubled from 1,779 to 3,635 deaths. The agency blamed the rising number of heroin deaths on “widespread prescription opioid exposure and increasing rates of opioid addiction.”

“While the majority of prescription opioid users do not become heroin users, previous research found that approximately 3 out of 4 new heroin users report having abused prescription opioids prior to using heroin,” the agency said. “This relationship between prescription opioid abuse and heroin is not surprising; heroin is an opioid, and both drugs act on the same receptors in the brain to produce similar effects. Heroin often costs less than prescription opioids and is increasingly available.”

“This study is another reminder of the seriousness of the prescription opioid overdose epidemic and the connection to heroin overdoses,” said Grant Baldwin, PhD, Director of the CDC’s Division of Unintentional Injury Prevention.

A recent study by Ameritox, one of the nation’s largest drug screening companies, detected heroin in 1.3% of the urine samples from over 170,000 chronic pain patients. That compares to 0.3% in the general population that use heroin.

The CDC admitted there are some significant limitations in the overdose data collected from the 28 states. One in five (22%) of the death certificates studied did not identify the drugs involved. Some heroin deaths may have also been misclassified as opioid deaths.

“The findings in this report indicate a growing problem with heroin overdoses superimposed on a continuing problem with OPR (opioid pain reliever) overdoses. Increasing use of heroin is especially concerning because it might represent increasing injection drug use,” the agency said.

“The small decline in OPR overdose mortality is encouraging given its steep increase during 1999–2010, but efforts to address opioid abuse need to continue to further reduce overdose mortality and avoid further enlarging the number of OPR users who might use heroin when it is available.”

Authored by: Pat Anson, Editor

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Johnna Stahl

On 10/15/14 in USAToday, we have this from Michael Botticelli (acting director of the White House’s Office of National Drug Control Policy): “Clamping down on one drug doesn’t drive people to another,” Botticelli says.

I guess Botticelli is feeling a little defensive about the heroin epidemic, although he seems rather mystified as to its cause.

As it turns out, the opioid “epidemic” is about mixing pain meds with benzodiazepines and alcohol. In fact, according to one of the charts included with the CDC article (named below), benzodiazepines are a much bigger problem than pain medications.

(Alcohol Involvement in Opioid Pain Reliever and Benzodiazepine Drug Abuse–Related Emergency Department Visits and Drug-Related Deaths — United States, 2010)

Botticelli, in Maine earlier this month (passing out more federal money for the drug war), goes on to look even more ridiculous (as reported by the Portland Press Herald):

“In remarks made Wednesday ahead of the town hall meeting, Botticelli said the nationwide trend toward legalization of marijuana is making it harder for health care and law enforcement officials to fight the nation’s most dangerous drug problem – rampant abuse of prescription opioids. Botticelli’s visit to the state came less than a month before voters in South Portland and Lewiston will decide whether to join Maine’s largest city in legalizing marijuana for recreational use by adults.”

Comparing marijuana to prescription opioid abuse? Please.

But it gets better, as Botticelli continues: “Fewer than 5% of prescription painkiller abusers move on to heroin, and the proportion of deaths from the drug is much smaller,” he says.

Sure, I was taken in by the reports of the connection between chronic pain patients and the heroin “epidemic” — but not any longer.

Johnna Stahl

BL said: “You’re saying blame the drugs not the people.”

No, I would never say that, and I’m sorry if you got that impression. Drugs are just chemicals and should not be blamed for abuse and addiction, just like it’s not the car’s fault when a drunk driver crashes.

But not every case of drug abuse or addiction is the total fault of the individual either. Personal responsibility is a wonderful thing, as long as every person has an equal chance to learn, test, and use this attribute. But not only are people on different intellectual and economic levels, they are also restrained by their own DNA and brain malfunctions — things they have no control over.

BL

Johnna Stahl, from what I’ve read at this site and others, the majority of chronic pain patients do blame those who abuse these meds and are adducted to them for what they have to go through with drug screens, pill counts, looks at the oharmacy, etc. It is not the chronic pain patients who Do Not abuse/divert these meds who are to blame. Chronic pain patients who Do Not abuse/divet or are addicted to these meds shoud Not be treated like they are. If you get rxs for pain meds and you abuse/divert or are addicted to these meds, you do need to be treated differently, because you are different.

You’re saying blame the drugs not the people. Well, that is what has brought about stricter laws and regulations. Blaming the drug is why so many chronic pain patients are having to get use to trying to function either without the same level of meds or without meds at all. As well as having to get use to being treated like they are addicts or abuse.divet these meds.

If someone gets behind the wheel of a car and drives drunk. The person that got behind the wheel of the car drunk is responsible for their own behavior. If someone gets pain meds and overdoses on them or becomes addicted to them, that person is responsible for their actions. If they don’t choose to seek help for their problems, that is also that persons responsibility.

Johnna Stahl

BL said: “Chronic pain patients will [n]ever be heard as long as they argue how destructive it is to abuse alcohol and/or cigarette[s] or how ma[n]y lives are taken due to gun violence and lack of responsibility involving guns or the lack of proper medical care for those who suffer mental illness/addiction.” Comparisons are often used to see the true scope of a problem, and seeing as how (a) alcohol and cigarettes are also drugs, and (b) both drugs and guns kill people — the comparisons are valid ones. (And I, for one, have an easier time learning when comparisons are used.) Every chronic pain patient needs to be aware of the behavioral issues (including addiction) that can come from the use of certain treatments, along with the comorbid conditions that can accompany pain syndromes. Depression, anxiety, anger, PTSD: These are all conditions that can (and often do) affect a large number of pain patients. No one can deny that adequate access to health care is a major problem in this country — for everyone, not only chronic pain patients (but especially for those that suffer from addiction). And while it would be great if pain patients weren’t automatically considered drug addicts, I think it’s way too late for that. In other words, you can no longer separate the two issues… that’s just reality. The number of chronic pain patients who look down their noses at those who suffer from addiction, or other behavioral health issues, is very upsetting to me. (And there, but for the grace of god, go I…) Blaming addicts for all the problems that chronic pain patients continue to face is… well, I’m just going to say it… it’s just ignorant. It’s like blaming drugs for abuse or overdoses — one of the reasons the drug war has failed. (Do you blame the car when a drunk driver has an accident?) “The focus had to be on the reasons patients are not able to receive proper pain management.” I don’t understand why you think you can dictate which issues pain patients should focus on. And to only include chronic pain patients in this fight — without adding anyone else who suffers from pain — I think is rather elitist, as the majority of chronic pain patients are white and (formerly) middle class. You know, those with access to insurance and “standard” medical care. “Chronic pain patients can’t reasonablely expect to have the same life living with chronic pain that they had before.” I’m not sure what you mean by this… Are there chronic pain patients running around saying they expect to live pain free? (Which is the life they had before.) Chronic pain patients have to alter their life every single day, so I don’t understand what you are getting at here. Are you suggesting that chronic pain patients should become use to low expectations for the availability of opioid treatment? Become use to managing pain without relief? Expect to continue to have less and less… Read more »

BL

Johnna Stahl, There are many more chronic pain patients who won’t even try marijuana for pain because it is illegal where they live, then there are patients who use it. If they won’t try marijuana because it is illegal, they aren’t going to try other illegal substances either. Taking heroin is a gamble in many ways. You never know how it will affect you. Or what the differences are between what you took the last time and what you take now. If it puts you out of it, you can’t function any better than you could feeling the pain.

I have always felt it was an insult to all chronic pain patients for the FDA, DEA, etc to says that many of those on heroin are chronic pain patients who can’t get their pain meds. It just paints the picture that chronic pain patients are really addicts/abusers who choose to use pain meds to get high. The only thing that is worse than these agencies promoting this, is when chronic pain patients themselves promote it. If a chronic pain patient thinks it’s hard for them to get their pain meds and/or they don’t like being treated like drug addicts and abusers. After being arrested for possession of heroin, at least they can’t complain about the way they are treated and not being able to get their meds. Do you think children would rather explain to their friends why their Mom can’t come to an event or why she was arrested for possession of heroin ? What about the spouse having to explain that to their boss and co workers ? If you’re thinking not everyone who uses heroin gets arrested, your’re correct. Not all of them do. But, why take the chance. The only thing the belief that chronic pain patients turn to heroin when they cant get their meds proves is that the FDA & DEA, etc are right. That pain meds for chronic pain patients ruin and rule thier life, the pain meds don’t allow them to function, it prevents them from functioning and using good judgement. All they care about is the drugs and not anything or anyone else. This may be you. But, it definately is not the majority of chronic pain patients who aren’t able to receive proper treatment for their pain.

Johnna Stahl

Hey, BL, do you think that heroin is the only illegal substance out there that people can use for chronic pain? Because I’m thinking that there are more illegal options which pain patients will turn to if and when they are denied legal access.

Of course, if chronic pain patients could turn to cannabis, that would be great. But even with almost half of the U.S. developing medical cannabis programs, it is still hard to come by for a lot of people. Especially the economically disadvantaged, which I assume would include many people who suffer from behavioral health issues. And unfortunately, many medical marijuana programs require patients — especially pain (and PTSD) patients –to have tried all other standard treatments first. Not many people can afford to do that.

And Toni is right: Animals are often treated better than chronic pain patients. Heck, if you live in the U.S., the same could be said for many trying to access adequate health care. Seriously, I’ve read about how much it costs for drugs to treat cancer and other serious health conditions, and I know I will never be able to afford that kind of expense.

Really, the only solution is… Free bud for everyone. 🙂

BL

Chronic pain patients will ever be heard as long as they argue how destructive it is to abuse alcohol and/or cigarette or how may lives are taken due to gun violence and lack of responsibility involving guns or the lack of proper medical care for those who suffer mental illness/addiction. The focus had to be on the reasons patients are not able to receive proper pain management. It also will be a waste of time to complain about things like pain contracts, drug screens and seeing your dr every 30 days. What the focus needs to be on is the difference in the quality of life that pain meds bring to chronic pain patients vs the quality of life they have without them. Chronic pain patients can’t reasonablely expect to have the same life living with chronic pain that they had before. And if they want to complain about how they don’t want to alter their lifestyle, they won’t be heard. Everyone has to alter their lifestyle when they have health problems, chronic pain is no different.

Johnna Stahl

The CDC would also like you to know of other “epidemics” facing our great country:

In 2005, JAMA reported that MRSA was responsible for an estimated 18,650 deaths in the U.S.

(What was that? Isn’t that more deaths than have been linked to opioids? See also the number of gun deaths each year. And where’s the CDC’s dire warnings about deaths related to alcohol? I read recently that there are 20 million alcoholics in the U.S, and a full 50% of them began drinking as teenagers.)

What used to be a hospital-spread virus is now just showing up in people who weren’t infected while in the hospital. But 2005 is the last year for which I can find actual numbers for MRSA deaths. And although the CDC says the numbers are declining, I’m not sure everyone agrees with that.

A 2013 study released in the New England Journal of Medicine found that “germ-killing soaps and ointments” used in ICU’s reduced cases of MRSA by 40%. (As reported by CNN.) But since cleanliness is only part of the problem, it doesn’t make sense that the incidence of staph infections is really decreasing — especially since antibiotic immunity is a serious health issue (and constantly in the news).

Then, what do you know, in 2014, the FDA approved a new drug to treat bacterial skin infections like MRSA. Where are the new (not just reformulated) drugs to treat pain? (And I’m not talking about experimental treatments like neurosurgical interventions, or recently approved “treatments” by the FDA, like the TENS, PENS, or MPS devices… Let me strap one of those things on someone at the CDC after they just had dental surgery, and see if it really reduces pain.)

Why doesn’t the CDC keep statistics on the casualties of the drug war? Specifically? And do the statistics that the CDC collects include those from the Veteran’s Administration?

Johnna Stahl

Trudy McGee says: “Isn’t there a direct correlation between the increasing lack of mental health availability in this country and the increase in these statistics??”

Thanks for pointing that out, Trudy. The budget cuts of the last few years to an already insufficient mental healthcare system have undoubtedly caused a rise in drug abuse, addiction, and overdoses, including suicide.

I saw an interesting chart recently that shows the unemployment rate is now directly correlated to the suicide rate, although that was not always the case. (I saved a copy of the chart, but not the link, sorry.) The chart maps suicide rates from 1979 to 2009, and shows a sharp increase since about 2006. (Pain patients will have no trouble correlating this time frame to an increase in DEA enforcement.)

The most recent CDC statistics are from 2011, but they show that suicide rates have continued to rise. When looking back from 1979, the suicide rates haven’t been as high as they are now since about 20 years ago.

Since the CDC categorizes suicides separately from “nonintentional” deaths, we’ll never know which overdoses were on purpose and which were not.

But if the CDC is looking to decrease suicide and overdose rates, do they really think this is the way to do it? Why is everyone trying to make the problem worse, and focusing on just one small part of the whole equation?

Are pain patients (and their doctors) to blame for the mental healthcare crisis in this country, or the lack of living-wage jobs? Are we to blame for the failed drug war, and all its casualties?

Then why are pain patients the ones being punished?

BL

Toni Krese, I agree with you. Chronic pain patients aren’t going to turn to heroin. There are too many unknown risks, not to mention being arrested.

This report continues to put emphasis on regulation on opioids, which means continued emphasis on regulating the care of chronic pain patients to the point of ridiculousness. We continue to pay for the drug addicts who are voluntarily obtaining drugs in any number of nefarious ways and then VOLUNTARILY overdosing on them.

Nobody has yet to explain how me suffering on a daily basis is going to stop this. I can tell by the poor showing of the numbers above, that they are, and always have been, barking up the wrong tree. Punishing legitimate pain patients for drugs addicts’ careless and voluntary actions, considering no chronic pain patients asked for their lot in life, is cruel, inhumane and certainly not what Hippocrates had in mind.

Kaylee

I would think that making prescription opioids much more difficult to obtain, or, in many cases, impossible to obtain by pain patients would lead to them seeking illegal drugs.

I think the supposed link between prescription drugs and future heroin abuse is bogus. People who want to abuse drugs will find a way, no matter what it is. They’ll just find what ever happens to be available where they live for the lowest price. That used to be opioids a few years back in many places. Now they’ll take whatever they can get their hands on. In many instances it’s heroin.

Toni Krese

To quote BL: “I wonder if they abused their own prescription meds or someone else? I also wonder if not stipulating the source wasn’t deliberate so the general public would assune they were abusing their own meds.” I also wonder this! For those of us who never abused opioids for pain yet now have to suffer daily with pain because doctors are afraid of the many moronic people such as Kolodny as well as too many morons in government, where else can we turn for something that WILL reduce our pain? I, myself, will not turn to heroin, but I can understand many doing so. However, actual abusers will abuse anything. Chronic debilitating pain sufferers only want less pain in order to have at least somewhat of a “normal” life. We don’t “abuse”; we don’t take opioids for a “high”‘; we don’t turn to “heroin” – we are not morons like the ones doing the studies are and like the plethora of morons within our government. We ONLY want pain relief and for myriad people it is found that opioids are the ONLY medication(s) that works for most of our pains. The “war on drugs” is a complete farce. Addicts will get their drug(s) of choice. Law-abiding citizens, that live with chronic debilitating pain, are forced to suffer to the point we can not have fulfilling lives. When did “Quality of Life” for human beings not matter anymore to those in power? Have insurance companies also played a part in trying to get opioids banned for those in chronic debilitating pain? Did they “do the math” and not like the results and thus struck out against those in chronic debilitating pain? They do have heavy lobbying power in Washington D.C. and they are who decides what treatments they will cover or not. As I have said in other comments on other articles: We are human beings – animals get better treatment than we do.

Trudy McGee

Isn’t there a direct correlation between the increasing lack of mental health availability in this country and the increase in these statistics?? Just a thought, oh, but that would require money from the government for those parasites.

Marty

It’s sad that people in real pain can’t get what they need half the time but at the same time you can’t blame the doctors. I would not want to be in their shoes of having to decide who is for real or not or if they are using them as prescribed. In speaking with a doctor the other day the other day they have to look at the “ER” goers who make it a weekly quest and then you have the ones who complain they don’t get enough opioids to control their pain and in the next moment they are using their medications to try to kill themselves which I have seen at least 3 times this week in different groups. They are part of the problem that makes it look so bad for the rest of us.

Tina

This is the CDC trying to prevent their own guilt in what they are doing to people with chronic pain, which is killing them and helping to turn pain patients into heroin users because they are cutting the availability (including the DEA) for these patients to get prescriptions for pain medication; therefore, patients, after being refused medication/opioids are in so much pain that they feel they have no other option than to turn to heroin, because it is cheaper than opioids on the street. They are not abusing their medication, they cannot get their medication. Most patients in chronic pain are on disability and can no longer work, so they cannot afford opioids at street market prices, but can try and afford the cheaper, even more dangerous drug, heroin. Like this article explains patients are being cut off from getting pain medication. Unfortunately, many without any warning. If you talk to many pain patients, they will tell you their doctor is not giving them opioids any longer and they are hurting and in tears. The huge excuse the doctors give is they are afraid to lose their medical license. If doctors cannot treat their patients the way they see fit than why have doctors. We all should just self medicate anyway and for everything. As I have experienced, many doctors are miserable people and do not want to take the time to help their patients any longer. In addition, they are being told what they can prescribe, what tests they can and cannot do on a patient, and have to pay such high cost malpractice insurance. I feel doctors do not care anymore and are just trying to get through the day, like many people do at their jobs. This so called war on drugs is a joke and when will the government ever learn that they are fighting a losing battle? They try to focus on one drug at a time while the other drugs go crazy on the streets. The main problem is, in this case, with opioids, they are hurting a lot of people in such horrible chronic pain, who are in need of these medications to just get dressed, or to eat, or go to the doctor. This government and the CDC, and the DEA make me sick. I do not know how they look at themselves in the mirror or sleep at night. The fact is, the DEA, and CDC who are taking part in this reduction of availability for chronic pain patients to get their opioids by a physician who can drug test their patients, and control their medication supply through their care, are the ones responsible or the increase in heroin use. It is not true that people who turn to heroin where 100 percent opioid abusers. The CDC is 100 percent full of excuses and giving the public the wrong data and facts. They are blaming someone else, they are blaming opioids and the people who use opioids for pain management, not… Read more »

HR

Being a patient of pain management due to a back surgery gone horribly wrong , it concerns me where some of these numbers and statics come from. Are they ” self reports” of prior abuse of opiates ? Were they the reporting person’s ? Or did they buy or steal them from someone else ? Perhaps go to a ” pill clinic ” or even online . It honestly makes it very difficult for those of us who suffer REAL and chronic pain who have tried EVERYTHING else available to us with NO RELIEF. I would gladly give up my medications for a ” normal , pain free ” life again, unfortunately according to some of the top neurosurgeons in the country – this will not happen for me

kay

This is absolutely insane how pain patients are being tortured and not treated because of others. They act like it isn’t hurting chronic pain patients, but they are quite mistaken. This is hurting innocent people.

It’s amazing, isn’t it, that the current scourge of humanity, in this instance opioid medicines for those looking for even the minimal surcease from pain, is no longer the main threat to humanity. Once again, heroin, cheaper than Oxycontin, is now the enemy of humanity. Why? It’s cheaper. Just as opioids were a cheaper high in the 90s.

Even with this new upsurge A. Kolodny blames the heroin “epidemic” on the over prescribing of opioids. It apparently has not occurred to him and others that many drugs cycle through the addiction world with the most purchased always being the least expensive. People are people and historically have always sought out the most inexpensive high.

The truth in that is overshadowed by Kolodny and others working assiduously to ever shrink the number of pain patients who can benefit from opioids in conjunction with other therapies to reduce the misery of chronic, refractive to most treatments save opioid therapy, to beat back their pain.

It is no wonder that cheaper heroin is dominating the market for those suffering from addiction. It is also no wonder that Kolodny et. al. blame the heroin crisis on those 1st “addicted” to opioids that are, according to him, over prescribed.

The simple fact is that a continuing large minority will become addicted to whatever cheap high is available. There is no chance of dealing with this problem by strangling the availability of drugs that can make people high and addicted.

What is sorely needed is an end to the war on drugs, and the ancillary war on pain patients, to put that, heretofore, wasted money into education and “on demand” treatment for those addicted who wish to be clean. Going after X,Y or Z drugs is a thorough waste of huge amounts of public dollars dumped into the same maw of failure.

It must also be stated that addiction “specialists” know in there hearts that addiction will always be with us and that being a specialist in ongoing world of illicit and legal drugs is a gold mine for those employed in that industry. They are simply not to be trusted.

BL

When it says “approximately 3 out of 4 new heroin users report having abused prescription opioids prior to using heroin” I wonder if they abused their own prescription meds or someone else ? I also wonder if not stipulating the source wasn’t deliberate so the general public would assune they were abusing their own meds.