Misinterpretation of the “Overdose Crisis” Continues to Fuel Misunderstanding of the Role of Prescription Opioids

Bettinger, Jeffrey J; Amarquaye, William; Fudin, Jeffrey; Schatman, Michael E

doi:10.2147/jpr.s367753

Cited by 6 publications

(5 citation statements)

References 62 publications

(66 reference statements)

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“…In the version accessible now, 12 a large headline proclaims, “toxicity of supply continues to be a major driver of the crisis” and notes, “Of all accidental apparent opioid toxicity deaths in 2022 (January–December), 79% involved opioids that were only non-pharmaceutical.” More studies are reporting an increase in overdoses from illegal opioids, even as the use of prescription opioids is declining. 13 Implying that palliative care is partly responsible for the opioid crisis is a misreading of the evidence and disregards the complex nature of the problem.…”

Section: Suggesting Palliative Care Is Culpable For Unintended Deathsmentioning

confidence: 99%

Response to Medical Assistance in Dying, Palliative Care, Safety, and Structural Vulnerability

Gallagher,

Coelho,

Violette

et al. 2023

Journal of Palliative Medicine

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This report, signed by >170 scholars, clinicians, and researchers in palliative care and related fields, refutes the claims made by the previously published Medical Assistance in Dying, Palliative Care, Safety, and Structural Vulnerability . That report attempted to argue that structural vulnerability was not a concern in the provision of assisted dying (AD) by a selective review of evidence in medical literature and population studies. It claimed that palliative care has its own safety concerns, and that “misuse” of palliative care led to reports of wrongful death. We and our signatories do not feel that the conclusions reached are supported by the evidence provided in the contested report. The latter concluded that the logical policy response would be to address the root causes of structural vulnerability rather than restrict access to AD. Our report, endorsed by an international community of palliative care professionals, believes that public policy should aim to reduce structural vulnerability and, at the same time, respond to evidence-based cautions about AD given the potential harm.

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Section: Suggesting Palliative Care Is Culpable For Unintended Deathsmentioning

confidence: 99%

Response to Medical Assistance in Dying, Palliative Care, Safety, and Structural Vulnerability

Gallagher,

Coelho,

Violette

et al. 2023

Journal of Palliative Medicine

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“…Most observers agree that illicitly manufactured fentanyl and heroin, not legally prescribed opioids, are fueling current morbidity and mortality rates in the United States and Canada. 6 An extensive epidemiological 2019 study of the history of the ongoing North American opioid crisis concluded that ‘the current overdose crisis is rooted in the intersection of long-term psychosocial and cultural trends with the lucrative opportunities offered by drug prohibition’. 7 People with substance use disorder and their families, as well as patients with clinical pathologies whose pain is now under-treated as a result of over-zealous application of federal pain guidelines issued in 2016, just updated in November 2022, are experiencing serious health-related suffering as a result of the bureaucratic weaknesses and oversight failures that precipitated the North American epidemic.…”

Section: Introduction: the Two Crisesmentioning

confidence: 99%

Parallel opioid crises: brakes on sustainable development?

Pettus

Radbruch

2023

Palliat�Care

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This Review perspective analyzes the parallel ‘opioid crises’ – one of access, the other of excess – affecting different demographic groups in distinct regions of the world, in terms of a knowledge gap between the founding 20th-century regulatory frameworks around ‘drugs’, including opioids, and evolving 21st-century clinical developments in public health, palliative care, addiction medicine, and regulatory sciences. Identifying the parallel crises as such is a positive step that can enable governance and science to catch up to one another and realign. As it is now, the opioid crises are acting as brakes on development as defined by the United Nations (UN) 2030 Agenda for Sustainable Development (SDGs). Both crises affect UN member states’ ability to reach the Goal 3 ‘Ensure healthy lives and promote well-being for all at all ages’ of the Sustainable Development Goals (SDGs). Among the nine targets for Goal 3, the two opioid crises affect progress toward Target 3.5, on strengthening the prevention and treatment of substance abuse, including narcotic drug abuse, and Target 3.8, providing Universal Health Coverage (UHC), and adequate access to essential medicines. The parallel opioid crises, which both represent misalignment between anachronistic governance structures and epistemic developments, have several things in common beyond the opioid molecules themselves: regulatory and health system deficits that interact pathologically with baked in cultural stigma around psychoactive substances, stigma evident in the designation of these substances in international law as ‘narcotic drugs’. Community regeneration, educational development, and governance reforms can now replace politicized rather than evidence-based and public health–promoting drug policies that block progress toward both SDG 3 targets in different countries for different reasons. Quantification of serious health-related suffering (SHS) pertaining to a range of health conditions and demographic groups now provides the epidemiological evidence to legitimate such a timely paradigm shift.

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“…In 2016, the CDC enacted strict guidelines on prescribing opioids, with the intention of reversing the effects of overprescribing in the prior decades. However, the guidelines resulted in unintended consequences such as under-treatment of persons with chronic pain and too rapid tapering off of prescribed opioids, potentially hastening the transition to illegally purchased opioids [12] , [13] . Research has found that the stricter guidelines resulted in increased overdoses and ED-related visits for opioid poisoning.…”

Section: Introductionmentioning

confidence: 99%

Mental health and substance use disorder comorbidities among Medicaid beneficiaries: Associations with opioid use disorder and prescription opioid misuse

Swartz,

Franceschini,

Scamperle

2023

AIMSPH

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<abstract><sec> <title>Background</title> Medicaid presently insures about one-fourth of the US population and disproportionately insures about 38 % of non-elderly adults with an opioid use disorder (OUD). Owing to Medicaid's prominent role insuring persons with an OUD and that Medicaid coverage includes pharmaceutical benefits, there has been considerable interest in studying potential prescription opioid misuse among Medicaid beneficiaries and identifying subpopulations at higher risk for misuse and possible progression to an OUD. </sec><sec> <title>Methods</title> The study goals were to explore the associations among prescription opioid misuse, OUD, and co-occurring mental health and other substance use disorders (SUD). We analyzed Illinois Medicaid 2018 claims data for 1102479 adult beneficiaries 18 to 64 years of age. Using algorithms based on previous studies, we first determined either the presence or absence of nine SUDS (including OUD), nine mental health disorders and likely prescription opioid misuse. Then, we subdivided the beneficiary sample into five groups: those who were prescribed opioids and evidenced either no, possible, or probable misuse; those evidencing an OUD; and those evidencing no opioid use or misuse. </sec><sec> <title>Results</title> Bivariate analyses, upset plots, and multinomial logistic regressions were used to compare the five subgroups on the prevalence of co-occurring SUDS and mental health disorders. Those with an OUD or with probable prescription opioid misuse had the highest prevalence of most co-occurring conditions with beneficiaries with an OUD the most likely to evidence co-occurring SUDS, particularly tobacco use disorder, whereas those with probable misuse had elevated prevalence rates of co-occurring mental health disorders comparable to those with an OUD. </sec><sec> <title>Conclusion</title> The medical complexity of persons with an OUD or misusing prescription opioids are considered in light of recent attempts to expand buprenorphine provision as a medication for OUD among Medicaid beneficiaries. Additionally, we consider the possibility of gender, co-occurring mental health disorders, and tobacco use disorder as important risk factors for progressing to prescription opioid misuse and an OUD. </sec></abstract>

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Misinterpretation of the “Overdose Crisis” Continues to Fuel Misunderstanding of the Role of Prescription Opioids

Cited by 6 publications

References 62 publications

Response to Medical Assistance in Dying, Palliative Care, Safety, and Structural Vulnerability

Response to Medical Assistance in Dying, Palliative Care, Safety, and Structural Vulnerability

Parallel opioid crises: brakes on sustainable development?

Mental health and substance use disorder comorbidities among Medicaid beneficiaries: Associations with opioid use disorder and prescription opioid misuse

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