By Ed Coghlan
Another report has been issued that concludes that the CDC strategy of targeting legal prescriptions to reduce opioid overdose deaths is not working.
In fact, Dr. John Lilly of Springfield, Missouri argues it may increase them by driving more users to illegal sources.
Dr. Lilly’s study–published online by the Association of American Physicians and Surgeons– reviewed existing government data. After looking at the Centers for Disease Control and Prevention (CDC) Wonder data base, Dr. Lilly sorts out the deaths associated with illicit fentanyl. Until 2013, deaths attributed to synthetic opioids were fairly stable, but a sharp upward trend began then, with an increase of 635% from 2014 to 2016.
Notably, the spike in deaths has occurred while opioid prescribing is being heavily discouraged and placed under increasingly severe constraints. Dr. Lilly concludes that these policies are apparently driving opioid misusers from legally prescribed drugs to illicit drugs, which are far deadlier because of high potency and unreliable dosing.
Dr. Lilly’s study is the latest in a number of analyses that indicate the CDC action has been misdirected.
One of the critics is Dr. Terri Lewis; a public health advocate shared her feelings with the National Pain Report.
“Since the CDC Guidelines were a cloud on the horizon, persons with chronic and intractable pain have questioned the assumptions that CDCs guidelines are predicated upon. The ultimate error is to base wholesale changes to public policy without accounting for all of the data – including the missing data.
“If fewer than 2% of persons who rely on opiates get into trouble, what’s to be said about the 98% of users for whom opiates have made a profound difference in the quality of their days? Checking that assumption is something that our government has been profoundly uninterested in, choosing to respond to the loudest voices in the room.
“The obvious conflation of pain care with the needs of other user groups has predictably led to catastrophic care failure for persons with crises of pain and substance abuse even as user groups have been pitted against each in the competition for public funds.
“When we ask the wrong questions we get the wrong answers. The recent analyses by Michael Schatman and Stephen Ziegler, Stefan Kertesz, Josh Bloom, and now John Lilly make it abundantly clear that not only is CDC’s recent mea culpa insufficient, but it is still wrong from a design of data perspective. It demands that the systemic error installed throughout the entire system must be addressed to right the wrong course of public policy so that we can get back to the business of caring for patients instead of servicing errors.”