Abstract: Don't demonise prescription opioids

Roehr, B., BMJ 359:j4727, October 19, 2017

The author, a biomedical journalist from Washington, DC, explains how a zero-tolerance policy to opioid prescribing will impede the delivery of care for patients with severe pain. He notes that he has used hydrocodone daily for nearly ten years for nerve damage due to knee replacement and spinal surgeries, and suggests that reports of the opioid epidemic “crisis” represent overblown rhetoric from persons with an interest in promoting a “war on drugs” agenda. In fact, research shows that while 38% of the US population used a prescription opioid in 2015, few of whom were being treated for cancer, only 0.8% were classified as drug abusers. The author considers himself dependent on hydrocodone in the same way that he is dependent on his blood pressure medication, and states that hydrocodone allows him to remain relatively pain-free and productive but without adverse effects. The dramatic rise in opioid-related deaths is fueled in part by fentanyl and other illicit street drugs. In fact, he contends that CDC mortality data are methodologically flawed because deaths due to street drugs including heroin are combined with deaths due to prescription opioids, while in fact prescription drug deaths have been decreasing over the past few years. Efforts to control the opioid supply with prescribing limits, prosecution of “pill mills,” and tamper-resistant formulations were all in place before the recent increases in opioid-related deaths. The author disputes the concept of opioids as gateway drugs, stating that the gateway theory has long been disproven, yet he acknowledges that patients who lose access to prescription opioids may turn to more accessible, black-market options such as street drugs containing fentanyl. He concludes that denial of opioids to everyone because some are abusers will mean that many patients with legitimate need will suffer unnecessarily. 4 references (bobroehr@aol.com – no reprints)