Is this rational? Mostly, no.
It’s not that no one migrates from legitimate prescription to opioid use disorder (OUD) at all.
However, judging from news stories, the far greater part of the opioid crisis until 2013 arose from prescription pills diverted in large quantities to the drug-dealing black market. Since then, heroin, and lately, illicit fentanyl, have been the worst of the problem, while the diverted-pill problem continues to grow slightly.
The number of fatal overdoses of fentanyl and other synthetic opiates (not including methadone) soared from 3,105 in 2013 to 19,413 in 2016, a sixfold increase in just three years, according to the CDC. Heroin deaths rose from 2,399 in 2007 to 8,257 in 2013 and 15,469 in 2016, a more than six-fold increase in a decade. Deaths from opioids of the types prescribed by physicians (excluding methadone): 8,158 in 2007, 11,346 in 2013, and 14,487 in 2016, a smaller but still troubling 77% increase in a decade.
Dig past the headlines and it’s difficult, if not impossible, to establish a direct correlation between legitimate short-term opioid prescriptions for acute or post-operative pain and OUD.
Legitimate long-term prescriptions for chronic pain are a different story—but even the addictions arising from long-term prescriptions seem to be far too few to blame for the bulk of the opioid epidemic. A much more likely source: mass diversions of pills with no legitimate prescription involved. See below.
(Legitimate,” as used here, means prescriptions other than those written by the relatively few physicians who run so-called “pill mills.”)
Why Blame the Doc?
Then, why are physicians being blamed? To a large degree, it’s the politics of today, in which deep, complex facts matter less in the political world that winning a clickable headline by doing something, anything—or giving the appearance of doing something.
Also, the drug companies have been better at peddling influence in Washington than physician organizations have; pills are their bread and butter.
Both political parties are playing this clickbait game. To an extent, so are scientists. For this article, we ran across studies which lumped legitimate prescriptions with diverted pills as if they were the same phenomenon.
Statistics show that physicians are taking the opioid crisis seriously—perhaps even overreacting.
However, there are indications in the political wind that the heat on doctors (especially orthopedists and dentists, the leading prescribers for acute pain) will probably flare hotter when the 2017 opioid mortality statistics come out later this year. (CDC released the 2016 annual figures four days before Christmas in December 2017, so it’ll probably be a few months before the 2017 statistical shock wave hits.)
