One more piece of empirical evidence that the “overprescription of opioids caused the opioid ‘epidemic’” nonsense is fraudulent and flat out wrong — UponFurtherInvestigation
A November 2019 article in the journal Annals of Emergency Medicine, “Opioid Use During the Six Months After an Emergency Department Visit for Acute Pain: A Prospective Cohort Study”, once again demonstrated — empirically — that patients prescribed opioids when presenting to the emergency room for severe pain, do NOT become addicts. They don’t even tend to become addicted to opioids.
The study followed nearly 500 (484) opioid naive (body had not been exposed to opioids) patients who were prescribed opioids for acute pain upon release from the Emergency Department (ED). They were followed for six months with regular telephone interviews — if you are thinking, “Well of COURSE they’re going to lie and say they’re not abusing the medication” our response is a resounding “DUH!”. They also utilized the statewide prescription drug monitoring program, that keeps track of all drugs prescribed in the state, meaning that, if patients refilled their prescriptions, much less over filled opioid prescriptions, it would show up in the system.
The results showed that, after six months, fully 66% — most patients — filled only the initial prescription that they received from the ED. One in five — 21% — filled two or more prescriptions within the six-month period. Five patients out of the nearly 500 followed — approximately 1% -, met criteria for “persistent opioid use”, defined as filling equal to or greater than the 6 prescriptions during the six-month study period. That is not opioid abuse, it may simply mean they followed the prescription as prescribed, for chronic, ongoing pain conditions. Indeed, four of the five patients reported moderate or severe pain in the affected body part six months after their visit to the ED.
This prospective cohort study from the Department of Emergency Medicine at the Albert Einstein College of Medicine followed a much larger study in BMJ (The British Medical Journal) published January 17, 2018 (BMJ 2018;360;j5790), “ Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study.” The BMJ study sample included 1,015,116 opioid naive patients undergoing surgery, followed for a median of 2.67 years. Following surgery, 568,612 patients (56%) filled a prescription for a postoperative opioid medication, 90% of which were filled within three days of discharge. In the subsequent follow-up period (median of 2.67 years), misuse, a composite of dependence, abuse, or overdose, was identified in 5906 patients (0.6%). Misuse within one year of surgery was identified in 1857 patients (0.2%).
It is important to reiterate — In a study with over one million surgical patients, of whom over half a million were introduced to (filled a prescription for) postoperative opioid medication, 1857 — considerably less than 1% (0.2%) were identified as misusing medication within one year following surgery.
Given the hysteria surrounding opioid prescribing, one would think that nearly all patients introduced to opioid medication following surgery would end up abusing and perhaps addicted to opioids. If not nearly all patients, then at least half; if not half, then at least 10%. If not 10%, at least one percent! In fact in a study looking at a fairly huge sample size, not even one percent were identified a year later as misusing medication.
Compare this to the massive hysteria surrounding the CDC 2016 guidelines and consequent laws and other corrupt restrictions instituted following the release of those fraudulently created guidelines, the news media interviews with family members of individuals who “never had any problems” until they were prescribed an opioid pain medication, after which they became addicts and their lives were ruined and in many cases, prematurely ended by overdose. While any such story is tragic, how often does it happen? How many times have you seen or heard such stories? Compare that to coverage of either of these studies — who has even heard of these studies? Nevertheless, pain management has been decimated and turned on its ear by “addiction specialists” — indicating that addiction is such a problem with pain management that the field needs to be run by addiction specialists. How valid is that, given empirical indicators that abuse — not even addition — actually happens far less often than you have been lead to believe.
People have also been lead to believe the lie that reducing access to opioid pain medication will do away with the overdose epidemic. The CDC’s own data demonstrate that is patently false. Nevertheless, laws have been written with that goal in mind, law enforcement has been prosecuted with that goal in mind, when in fact, if the goal were truly to reduce or do away with the overdose epidemic, a complete overhaul of this mentality would need to occur.
But the other side of this terrible situation is the amount of unnecessary pain and suffering, up to and including suicide, caused to legitimate pain management patients. Physicians who prescribe amounts necessary for the control of pain in their patients have been targeted and indeed attacked for doing their job. Similarly, pharmacies that happen to be located in the midst of hospitals and other high-volume pain patient populations have been illegitimately targeted and attacked. Were there pill mills? Yes. They have been virtually closed down. Are there doctors who overprescribe? Yes. How many? Enough to fraudulently attack legitimate pain patients, their doctors or their pharmacies?
Apparently, those making and carrying out these policies have no earthly idea what the word “pain” means to these patients. Health providers tell patients that: Two Tylenol and they’re good as new! Well, that’s just peachy keen doc. That has NOTHING to do with the kind of pain these patients are suffering. The “one-to-ten” funny face measure of how patients describe their pain may work for comparing a patients current state to previous states, but in no way is it reliable or valid for comparing two different patients. Perhaps if there were more women who had given birth in charge, they would be able to imagine if not understand what it would be like to live, on a constant basis, with the kind of pain they experienced in labor. Some people have suffered severe tooth or mouth pain, the kind that has, in the past, made people literally shoot their jaw off or at least to try to rip their own tooth with a plier or a wrench. That is what these people mean by pain. If you have a cruel, bullying older sibling, perhaps you know what its like to have knuckle jammed into your spine — pressed into the vertebrae and repeatedly twisted back and forth. We are not talking about the kind of pain caused by muscle spasm, which can indeed be very painful. It is still not in the same league.
At the very least two things need to happen, to begin to address these problems: — First, to force a redefinition of the understanding of the word “pain” in the context of “pain management.” Second, to force lawmakers, policymakers, medical boards, and law enforcement, and to look at legitimate empirical studies before leaping on fraudulent bandwagons that have caused literally millions of Americans to suffer needlessly and thousands to die. Unnecessarily.
And then, finally, we need policy makers to actually consider real, empirical data, not some bogus polemical nonsense such as is noted by the committee that established the CDC 2016 “guidelines”. Like the studies mentioned here. That unequivocally demonstrate that the lies and deceit that have caused so much unnecessary pain, suffering, and death, are just that — lies and deceit. At the very least, the 2016 “guidelines” need to be rescinded, unequivocally, and in their place, guidelines already established by actual experts in pain and pain management. As. Soon. As. Possible.
Originally published at https://uponfurtherinvestigation.com on December 3, 2020.