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A Different Perspective on Opioid Deaths, and JAMA reports 20% of all deaths in 25-34 y/o age group due to overdoses in 2016, up from 4% in 2001. 345% overall increase and 745% increase in 55-65 y/o

2018-06-07

First, there were over 42,000 opioid-related deaths in 2016.  Second, increases were greatest among older age groups, including a 754% increase in the 55-64 y/o age group.  These figures were reported in JAMA open access journal for June 2018.

Third, the blame for these opioid-related deaths falls squarely on the unknown strengths of black-market “heroin”, which has recently received spiking with fentanyl (over 50 times as potent as heroin) to satisfy a saturated market with price drops making heroin cheaper than prescribed pain medications.  Fourth, partial blame lies with doctors who prescribe enough opioid pain-killers for patients to develop dependency (which differs from addiction in that the patient requires medication for near-normal functioning but does not display “addictive” behaviors) and then cutting them off, frequently cold turkey.  Such patients have no recourse but to turn to the black market, where injectable and nasally administered heroin is cheap, readily available, and highly potent.

A secondary cause of the the increase in opioid deaths is the aggressive marketing of Oxy-Contin for questionable indications and the claim by Purdue that it is always effective when given every twelve hours.  A significant percentage of patients have loss of effectiveness within eight hours and by twelve hours are suffering the pangs of withdrawal.  This finding has been covered up by Purdue and its pharmaceutical representatives to maintain their reputation as a twice-a-day drug.   By contrast, patients given high doses of heroin frequently are able to get by on single daily doses.  Use of OxyContin on an eight-hour schedule is not approved by the FDA and is not covered by insurance, so this is seldom a useful approach.

There has been considerable public outcry over the enrichment of a single family from the massive prescription use of OxyContin from Purdue.  This has led to public shaming and much discussion of the moral culpability of this super-wealthy family (whom I shall not name, as it is irrelevant to my purposes who they are).

The last factor in the opioid-death crisis is the shameful attitudes of many physicians, who have never suffered from chronic or intolerable non-cancer pain and do not appreciate the debilitating effects of overwhelming pain on a patient’s ability to function or enjoy life.  There is a widely held prejudice among physicians that opioids are unnecessary in the treatment of acute or chronic non-cancer pain unless massive trauma is present.  Many, many patients suffer in the half-light of intolerable pain that inhibits their abilities to perform activities of daily living, much less enjoy recreational or culture activities.  Some physicians are sympathetic, but most of these feel they are being shamed by doctors who have no personal experience of intolerable pain.  Those patients with severe, especially inflammatory arthritis, and spinal stenosis who are not served by non-opioid pain-killers are forced to doctor-shop and often never obtain adequate relief of pain.

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