Share |

Arizona Lawmakers Are Addicted to Bad Opioid Policy

Jeffrey A. Singer

The governor of Arizona is calling on the Legislature this week
to enact prescription limits as well as other bureaucratic
intrusions into the doctor-patient relationship. Such policies are
nothing new: State lawmakers are addicted to the idea of
restricting doctors from providing opioids to patients in pain.

This strategy is premised on a false narrative. Contrary to what
many politicians suggest, the overdose crisis is not the product of
greedy pharmaceutical companies and careless physicians. It is
largely the result of non-medical users accessing opioids through
the illicit market. In fact, the National Survey on Drug Use and
Health reports less than 25 percent of non-medical users obtain
prescriptions from doctors.

Lawmakers are right to be
distressed by the rising overdose rate — increasingly due to
heroin and fentanyl. But they should resist the strong temptation
to “do something” when it is not evidence-based.

Even though the rate of prescription for high-dose opioids has
dropped 41 percent since 2010, and despite the Drug Enforcement
Administration ordering progressive reductions in opioid
production, the overdose rate continues to climb, growing 20
percent from 2015 to 2016.

Data reported by the Centers for Disease Control and Prevention
last month show that over 60 percent of opioid overdose deaths in
2016 were caused by heroin and fentanyl. The CDC reports that
fentanyl overdoses increased by 88 percent since 2013, and heroin
overdose deaths increased 33 percent per year from 2010-2014 and
have increased by 19 percent annually since then. Meanwhile,
prescription opioid overdose deaths have remained stable,
maintaining a steady 3 percent per year increase since 2009.

What’s causing the dramatic rise in overdose deaths from heroin
and fentanyl? Non-medical drug users are accessing opioids in the
illegal market. Meanwhile, there have been many reports of patients
in pain getting cut back or even cut off from their pain meds and
suffering needlessly. Some, in desperation, seek relief in the
dangerous illicit market. Some even resort to suicide.

That’s not stopping lawmakers from trying to legislate the
problem away. At least 17 states have limited initial duration and
supply of opioid prescriptions to patients in pain to anywhere from
3 to 7 days. The National Conference of State Legislatures reports
at least 24 states have enacted some sort of guidance or
restrictions on the dosage or duration of opioid prescriptions as
of August.

Lawmakers’ rationale for those moves is not evidence-based.
Researchers writing in the July journal Substance Abuse claim that
the rush to limit prescriptions was based on 2016 CDC guidelines
that recommended an individualized assessment of harm against
benefit when prescribing pain medication to patients.

And a Harvard study released this month analyzed more than 1
million patients receiving postoperative pain prescriptions from
2008 to 2016 who did not have a history of regular opioid use. It
found an overall incidence of all categories of opioid “misuse” of
just 0.6 percent, with a 0.2 percent incidence in those patients
one year after surgery.

This study is just the latest of numerous reports, including
2010 and 2012 Cochrane systematic reviews, as well as data from the
National Survey on Drug Use and Health that show the addiction risk
in medical — not non-medical — users of prescription
opioids consistently low, ranging from 1 to 2 percent.

Lawmakers are right to be distressed by the rising overdose rate
— increasingly due to heroin and fentanyl. But they should
resist the strong temptation to “do something” when it is not
evidence-based. Such action might only inflict unintended suffering
on patients in pain and do nothing to stop the surge in the street
use of heroin and fentanyl. They should heed the medical dictum,
“First do no harm.”

Dr. Jeffrey A.
Singer, MD
practices general surgery in Phoenix and is a senior
fellow at the Cato Institute.