One Opioid Crisis or Many?

 

https://atipusa.org/mdocs-posts/analysis-of-us-opioid-mortality-and-er-visit-data-powerpoint-document/”One Opioid Crisis or Many?” by Richard “Red” Lawhern, Ph.D. was published this morning on the American Council for Science and Health’s Website. This article is extracted from a 2400 word manuscript now in review by our ATIP medical professional associates.  

The heart of the article reviews data extracted from the CDC’s Wonder database, the CDC’s Prescribing Data, the Agency for Healthcare Research Quality and the Organization for Economic Cooperation and Development for non-US data.  A very technical analysis of the data is found by reading a presentation of the data summary.

Based on the current media narrative, we expected to find a correlation between the overdose rates and opioid prescriptions if we analyze the data state-by-state.  Articles such as Vox’s recent article showing how Virginia’s approach has been successful lead you to believe that reducing opioid prescriptions and moving chronic pain patients into rehab is a simple solution to a very complex problem.  The reality couldn’t be further from the truth.  As Red points out in his article, there is absolutely no relationship between the amount of opioids prescribed in a given state and the number of overdoses.  

Opioid Deaths per Opioid Prescriptions
There were major variations but no trends in opioid OD death rates and opioid prescription rates from State to State in 2016

In fact, if we consider Emergency Room visits by state, the picture becomes even murkier:  as states DECREASE opioid prescriptions, emergency room visits INCREASE.

Opioid Prescriptions vs ER visits
         As opioid prescriptions fall, ER visits rise.

Finally, if we look at age variation, a different view of the opioid crisis unfolds.  Opioid deaths in 50-70 year olds have been falling slightly since 2005-2006.  Almost all of the increases in overdose deaths are within the 35 and younger age group.    This fact has not been studied in detail, but goes against the grain of forcing stable patients on opioids off their medication.  The vast majority of these patients are 50 and older, not in the under 35 age group.

Opioid Deaths by Age Group
Opioid deaths among those over the age of 50 have been stable or falling since 1999.

Jacob Sullum picked up Red’s article and published a summary in “Reason”:   http://reason.com/blog/2018/05/14/opioid-death-rates-are-not-correlated-with-prescription-rates

Efforts to reduce opioid-related deaths by restricting access to pain medication seem to be backfiring by driving people toward more dangerous drugs. Two analyses published today provide more reason to be skeptical of this approach, showing there is no clear relationship between pain pill prescriptions and drug poisoning.

The full analysis is available in our “Documents” section of the ATIP site:  https://atipusa.org/mdocs-posts/us-opioid-prescribing-vs-overdose-deaths-and-hospital-er-visits-implications-for-public-policy-pdf/

Updated Documents May 15:

US Opioid Prescribing vs. Overdose Deaths and Hospital ER Visits Implications for Public Policy (PDF)

Analysis of US Opioid Mortality and ER Visit Data (PDF)

Opioid Prescribing vs Mortality : Raw Data