FALSE NARRATIVES & MANUFACTURED CONTROVERSIES ABOUT THE OPIOID CRISIS
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FALSE NARRATIVES & MANUFACTURED CONTROVERSIES ABOUT THE OPIOID CRISIS Andrew Kolodny, MD Vice President, Federal Affairs Physicians for Responsible Opioid Prescribing Medical Director, Opioid Policy Research Collaborative Heller School for Social Policy and Management Brandeis University
Myths & False Narratives
• PROP is a group of anti-opioid zealots
• CDC Opioid Guideline was secretly written by PROP
• CDC Guideline forced millions of patients off opioids
resulting in an epidemic of suicides
• CDC Opioid Guideline/reduced prescribing caused an
increased in opioid overdose deaths
• Policy responses to the opioid crisis have been limited to
reducing prescriptions
• The pendulum has swung too far – opioids are now
under-prescribed
2
What Is the Opioid Crisis?
3
Drug overdose deaths jump
in 2019 to nearly 71,000, a
record high, CDC says
4
Primary non-heroin opiates/synthetics admission rates, by State
(per 100,000 population aged 12 and over)
5
Primary non-heroin opiates/synthetics admission rates, by State
(per 100,000 population aged 12 and over)
6
Primary non-heroin opiates/synthetics admission rates, by State
(per 100,000 population aged 12 and over)
7
Primary non-heroin opiates/synthetics admission rates, by State
(per 100,000 population aged 12 and over)
8
Primary non-heroin opiates/synthetics admission rates, by State
(per 100,000 population aged 12 and over)
9
Primary non-heroin opiates/synthetics admission rates, by State
(per 100,000 population aged 12 and over)
10How the opioid lobby frames the problem
“We have to hammer on the abusers in
every way possible. They are the culprits
and the problem. They are reckless
criminals.”
Richard Sackler, MD
Purdue Pharma
February 1, 2001
Source: Confidential email made public in Massachusetts lawsuit against Purdue Pharma 12
and members of Sackler family.13 Source: Confidential document released by Oklahoma court
• “Studies consistently show that pain patients taking opiates are no more likely
to become addicts than people in the general population.”
• “Even after a decades-long fight by advocates, more than half of dying
patients still don’t get adequate relief, let alone chronic-pain sufferers.”
• “… the fact that alternative drugs such as ibuprofen and similar medications
are more likely to kill patients through side effects like bleeding if taken long-
term as directed, while opiates are rarely deadly unless abused.”
14
Source: https://slate.com/technology/2004/03/the-myth-of-the-accidental-oxycontin-addict.htmlOxyContin doesn't cause addiction. Its abusers are already addicts.
“The most worrisome consequence of the hype about OxyContin's dangers is
that patients, and some doctors, have become fearful of it. The American Pain
Foundation receives calls from patients who are doing well on the medication
but are afraid to continue even though it is well established that addiction--the
compulsive use of a drug to regulate one's mood--occurs infrequently among
individuals who take OxyContin as prescribed.”
“The problem isn't OxyContin itself, but its deliberate misuse. The Sentinel
apologized for having "created the misleading impression that most
oxycodone overdoses resulted from patients' taking the drug to relieve pain
from medical conditions." That misimpression has caused a lot of
unnecessary pain.”
15
Source: https://www.forbes.com/forbes/2004/0906/048.html#f246f7e6e362How the opioid lobby frames the problem Source: Slide presented by Dr. Lynn Webster at FDA meeting on hydrocodone upscheduling, Jan 25th, 2013.
17
18 Source: https://finance.yahoo.com/news/nations-top-pain-doctors-face-scores-opioid-lawsuits-160906369.html
Interactive Graphic Used in the Oklahoma Opioid Trial, July 2019
19Interactive Graphic Used in the Oklahoma Opioid Trial, July 2019
20Source: Corrupting influence: Purdue and the WHO. May 2019. Available at https://katherineclark.house.gov/_cache/files/a/a/aaa7536a-6db3-
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4192-b943-364e7c599d10/818172D42793504DD9DFE64B77A77C0E.5.22.19-who-purdue-report-final.pdf22
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28 Fueling an epidemic (report two): Exposing the financial ties between opioid manufacturers and third party advocacy groups. US Senate Committee on Homeland Security & Governmental Affairs; 12 Feb 2018
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Myth
“The CDC Guideline caused an increased in opioid
overdose deaths.”33
National Drug-Involved Overdose Deaths by Specific Category—Number
Among All Ages, 1999-2019Heroin treatment admissions : 2003-2013 SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 01.23.15.
Three Opioid-Addicted Cohorts
1. 20-40 y/o, disproportionately white, significant heroin use, opioid
addiction began with Rx use (addicted after 1995)
2. 40 y/o & up, disproportionately white, mostly Rx opioids, opioid
addiction began with Rx use (addicted after 1995)
3. 50 y/o & up, disproportionately non-white, mostly heroin users, opioid
addiction began in teen years with heroin use (addicted before 1995)
36Trends in Heroin Treatment Admissions Show
Differences by Age and Race, 2000 to 2017
Source: Warren EC, Kolodny A. Trends in Heroin Treatment Admissions in the United States by Race, Sex, and
Age. JAMA Netw Open. 2021 Feb 1;4(2):e2036640Myth
“Efforts to curb the course of the opioid overdose
epidemic have principally focused on restricting the
supply of prescription opioid analgesics...”
Chen Q., et al. Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States
JAMA Network Open. 2019;2(2):e187621.Lee B, Zhao W, Yang KC, Ahn YY, Perry BL. Systematic Evaluation of State Policy Interventions Targeting the US Opioid Epidemic, 2007-2018. JAMA Netw Open. 2021 Feb 1;4(2):e2036687. doi: 39 10.1001/jamanetworkopen.2020.36687.
Myth
“The pendulum has swung too far. Opioids are
under-prescribed.”
Chen Q., et al. Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States
JAMA Network Open. 2019;2(2):e187621.41
In 2018, the US, with 4%
of the World’s population
consumed the bulk of the
opioid supply:
Hydrocodone: 99%
Oxycodone: 63%
Morphine: 40%
Methadone: 40%
Fentanyl: 21%
Codeine: 8%
Source: International Narcotics Control
Board
42Kaafarani HMA, Han K, El Moheb M, et al. Opioids After Surgery in the United States Versus the Rest of the World: The International Patterns of Opioid Prescribing (iPOP) Multicenter Study [published online ahead of print, 2020 Jul 9]. Ann Surg.
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