What Is the Truth About Opioid Deaths?

In its 2015 Report Overview, the Clinton Foundation calls prescription drug abuse (leading to overdose) an imminent public health threat that kills “more people than motor vehicle accidents.”

The CDC reports that, during 2014, a total of 47,055 drug overdose deaths occurred in the United States. Indeed, that is a large number of tragic deaths.

Is There More to This Problem Than Prescription Drugs?

But a closer look at that statistic reveals that these deaths were caused by all drugs, not just prescription drugs, which is what those who relay statistics to the public often imply. Furthermore, the number also includes overdoses of illicit drugs along with over-the-counter medications.

In 2014, 61% of 47,055 (28,647) drug overdose deaths involved some type of opioid, including heroin. Note that even this figure is about one third fewer than the number of motor vehicle deaths reported for the same year.

In fact, National Safety Council reports that, in 2015, “38,300 people were killed on U.S. roads, and 4.4 million were seriously injured.” That number makes the Clinton Foundation’s statement that prescription drug abuse kills more people than motor vehicle accidents alarming.

3 Reasons Why the Clinton Foundation Is Wrong

But the statement by the Clinton Foundation is inaccurate for three reasons.

First, the Clinton Foundation apparently puts all drug overdoses into the category of prescription drug overdoses. Many drugs contributing to the overdose statistic are not prescription drugs. For example, acetaminophen, ecstasy, and ibuprofen are not prescription drugs but contribute to the mortality stats.

Second, of the drug overdoses that are related to prescription drugs, many resulted from drugs other than opioids. Antidepressants, antipsychotics, and amphetamines are common examples.

Third, opioid-related drug overdoses comprise prescription opioids (including Oxycontin and Methadone) and illicit, non-prescription opioids (such as heroin and synthetic fentanyl).

All overdoses are bad, but it is important not to misrepresent the data. In order to curb the opioid epidemic, we have to understand the statistics that could drive policy.

The actual number of prescription opioid overdose deaths was closer to 14,000 in 2014 and has been on the decline since 2011, despite an increase in the number of illicit opioid deaths (mainly due to heroin and synthetic fentanyl opioids).

The Clinton Foundation is correct when it calls prescription drug abuse a serious public health threat. Unfortunately, this is interpreted and reported by many as predominately a prescription opioid problem.

This isn’t to trivialize the points that the Clinton Foundation is making. Any drug overdose is devastating to a family of a decedent. However, to suggest that all of these deaths are due to prescription opioids just muddies the water and confuses the issue. Even the CDC cannot determine from death statistics whether an opioid is responsible for a death or whether it’s only associated with the death.

When an opioid is involved, it’s rarely possible to determine from the statistics the degree to which these overdoses were caused by a prescription opioid or other factors. Most people die from polysubstance abuse rather than just one drug. Ignoring the other factors that contribute to deaths means we have only part of the information we need to develop appropriate interventions.

An example is the report that 40% of people who use opioids also use prescription benzodiazepines. An FDA review found, “the growing combined use of opioid medicines with benzodiazepines or other drugs that depress the central nervous system (CNS) has resulted in serious side effects, including slowed or difficult breathing and deaths.”

Questionable reporting and mischaracterized, unclear statistics have lead policymakers to blame prescription opioids as the main culprit in the overdose epidemic. Prescription opioids have contributed to a large number of overdoses, but they have not come close to exceeding the number of deaths from motor vehicle accidents.

So neither prescription drugs nor prescription opioids cause more deaths than motor vehicle accidents.

In an attempt to curb the opioid crisis, people in pain are being ignored or told by physicians that nothing can be done for them. This is happening partly because of the misunderstandings of the data that lead to statements such as the Clinton Foundation’s and public policy. Solving the opioid crisis is important, but efforts to reverse the problem should not be based on misinformation. Policy should be based on fact and not a catchy headline.

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Copyright 2016, Lynn Webster, MD

Originally published at thepainfultruthbook.com.