The May 23 Sunday Valley News story “Hoping for relief: Strafford woman navigates cancer, chronic pain as the opioid crisis complicates treatment” included New Hampshire drug overdose death numbers for the year 2020 without providing a breakdown of which drugs directly caused these overdose deaths.
The use of gross numbers while not explaining the breakdown helps create an environment that leads elected officials, appointed board members, and hospital and heath care practice directors and providers to conclude that prescription medication is the cause of these overdose deaths.
These officials then seek to restrict the use of legal opioid medications, even where the data show that they are not only the most effective and safest option for managing pain, but also that legitimate patients rarely develop an addiction to the medication.
Individual patients are suspected of drug-seeking behavior or accused of being addicted. In this environment, patients who get a level of pain relief through the use of legal opioid analgesic medications — allowing for an improved quality of life and the ability to participate in many activities of daily living — find themselves denied this medication and, in many cases, are limited to a life in bed, adding to the hardship experienced by both patient and family.
According to the Centers for Disease Control and Prevention’s public database known as WONDER (for Wide-ranging Online Data for Epidemiologic Research), pain pills by themselves — that is, not combined with other drugs — accounted for less than 6% of opioid-related deaths and no more 4% of all drug-related deaths nationally.
In New Hampshire, drug overdose death data reported by the Chief Medical Examiner’s Office and based on actual toxicology results for the year 2020 show that 92.4% of all drug overdose deaths are directly attributed to the use of illicit fentanyl, heroin or other drugs that are not prescription opioids, and poly-substance use (the mixing of various drugs including cocaine, methamphetamine, benzodiazepine, over-the-counter medications and alcohol).
Only 7.6% of drug overdose deaths in New Hampshire are attributed to prescription opioid medication. However, for these deaths, the state Prescription Drug Monitoring Program database is not reviewed to establish how many of these 31 individuals had a legal prescription for the medication. It is therefore not known how many of these deaths were of patients legally using medication prescribed to them.
This data, from 2020, is consistent with the trend shown for the previous three years.
As an active patient advocate in the Granite State for many years, I believe a review of the Prescription Drug Monitoring Program database would show that few if any of these 31 overdose deaths were caused by legal use of opioid medication prescribed to a patient.
Unfortunately many elected officials, including New Hampshire U.S. Sens. Maggie Hassan and Jeanne Shaheen and Reps. Annie Kuster and Chris Pappas, continue to conclude that legal use of prescription opioid medication is the top cause of addiction and leads to increased overdose rates. Instead of focusing their efforts on preventing the illegal import of illicit fentanyl into our country, they continue to push policies that would restrict the use of legal medications.
This position is not supported by the data and only helps to complicate life for patients in pain, such as the woman from Strafford described in the May 23 story.
All data reported in recent years show the onset of addiction is primarily driven by genetics and family biology, a family history of drug and alcohol abuse, mental health disorders, socioeconomic stressors and other such conditions having little to do with the substance itself.
The old thinking that 4 out of 5 heroin users began down the path of addiction through the legal use of prescribed pain medication has proven untrue.
Data from the National Survey on Drug Use and Health indicate that only about 2% of people who had used prescription opioids in the previous year might qualify for a diagnosis of “substance use disorder,” a broad category of drug-related problems that includes what used to be called “substance abuse” and “substance dependence.”
By comparison, according to the latest national survey results, about 8% of past-year drinkers experienced an “alcohol use disorder.”
Exposure to opioids obviously is not a sufficient explanation for opioid addiction, just as exposure to alcohol is not a sufficient explanation for alcoholism.
The conventional narrative blames the “opioid crisis” on an oversupply of pain pills. However, a 2019 report on “deaths of despair” from the Joint Economic Committee of the U.S. Congress noted that “drug-related deaths have been rising since the late 1950s.” When it comes to drug-related “deaths of despair,” the root problem is the despair, not the drugs.
Most current studies show that those suffering with severe pain from disease or injury rarely struggle with addiction, becoming addicted at a rate of less than 2.1%. Likewise, those who benefit from the short-term relief of acute pain, as in the case of post-operative or emergency room trauma pain, become addicted at a rate less than 0.6%.
The days of “pill mills” are far behind us. In the current environment, a person suffering pain will rarely find a health care provider who will prescribe anything stronger than prescription-strength ibuprofen.
Physicians and patients alike have been under assault for far too long. It is time we place our trust in licensed physicians to carefully provide individualized care for each of their patients without the constant fear of reprimand or loss of license.
It is time we return some level of quality of life to those trapped in bodies besieged by severe pain.
It is time we focus our resources on the illicit drug trade and those who sell these drugs and stop the pursuit of restrictions on the legal, legitimate and monitored use of opioid medication for the purpose of treating documented, diagnosed disease and injury.
Bill Murphy, of Manchester, is a longtime volunteer patient advocate, a member of the New Hampshire Pain Collaborative and the New Hampshire state organizer of the Don’t Punish Pain organization.