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A new study provides more evidence that the ongoing opioid epidemic in America has been fueled by doctors prescribing more painkillers than patients – leading to the most lethal drug overdose crisis in the world. 39, history of the United States.
For the study, published in JAMA Internal MedicineHarvard researchers examined overdoses that led to an emergency visit or hospitalization and asked if opioids had already been prescribed to the patient's family members.
They found that people whose family members had previously received an opioid prescription were about three times more likely to report an overdose ending with an emergency hospitalization or visit, compared to those whose family members did not have opioids. And the more a member of the family had been prescribed opioids, the higher the risk of overdose was.
In short: when a family member receives opioids, people are much more likely to overdose.
There are two contradictory explanations for the opioid crisis. According to one explanation, excessive prescribing of opioid analgesics has made drugs much more accessible to people, which has resulted in a rapid increase in misuse, addiction, overdoses and deaths. The other explanation focuses on "root causes" such as mental health problems, socio-economic factors or a general feeling of hopelessness, and suggests that prescribing practices were less important because people with these underlying problems were forced to use a drug, no matter the type.
Experts generally agree that both explanations played a role, but the question is which explanation played a bigger role. The new study strongly suggests that over-prescription has played a major role.
"The claim that opioid overdose is almost a" root cause "and not a drug supply can not be sustained in light of these findings," said drug expert Keith Humphreys. Stanford, who did not participate in the study, tweeted.
Since 1999, the United States has recorded more than 700,000 drug overdose deaths, most of which are opioid-related deaths.
The new study suggests that excessive prescribing was a powerful factor in these deaths. The study indicates, however, that it is not just patients who have been victims of prescription drugs, but even family members who can now borrow, buy or steal drugs from the person who gets the prescription. The proliferation of opioids resulted in increased availability for all and availability resulted in increased exposure and increased risk of addiction and overdose.
So without so many opioids, many overdoses could have been avoided.
The study examined health utilization data from 2004 to 2015, taken from Optum Clinformatics Data Mart. More than 2,300 people with opioid overdoses were identified and compared to more than 9,200 people who did not experience an overdose.
The study does not conclusively conclude that the presence of opioids prescribed to family members is directly responsible for the overdose, as it revealed only a correlation, not a causality. There may be underlying factors that have contributed to both the prescription of opioids and overdoses. The authors mentioned one possibility: "For example, people whose opioids have been prescribed to family members may be more likely to have access to illicit drugs, such as heroin or other opioids, and to take an overdose of these substances, obtained outside the family unit.
Yet, the study is very suggestive. And this is supported by other evidence: a previous working paper by economist Christopher Ruhm found that opioid supply – more than economic variables – was linked to more overdose deaths; this suggests that the supply of opioids has played an important role, beyond the "root causes" related to economic factors.
It's not just a scholarly debate. To know how to stop the epidemic of opioids, it is important to know its causes. The latest study shows that prescription targeting could help.
To stop drug crises, we need to know what causes them
The reason for this research is simple: if we want to end the opioid epidemic and prevent other similar crises, we need to know what the cause is and what the cause was. If overprescription plays a role, targeting excessive prescriptions, or even prescriptions in general, could help stop and prevent current and future drug overdose outbreaks.
One of the problems is that the opioid epidemic has evolved over time. Although prescription painkillers have been at one time the leading cause of overdoses, they have been replaced and surpassed in recent years by illicit drugs such as heroin including fentanyl, a synthetic opioid.
This raised fears that simply cutting drugs out of their prescriptions will not be enough. In fact, it could even work against you: if opioid addicts are cut off from their painkillers, some of them could use heroin or fentanyl to satisfy their craving. Since heroin and fentanyl are usually more dangerous, this could actually increase the number of overdoses – if enough people have followed this path.
And there is a risk that if opioid prescriptions are too small, people who really need pain medication will not be treated in harsh conditions. (That's what I called America's pain paradox.)
Experts have therefore advocated for a cautious reduction in opioid prescriptions – a measure that does not impose strict limits on drugs, but encourages and trains doctors to prescribe drugs only when they are needed and at the doses they need. Alternatives to opioids for the treatment of pain also need to be made more available and funded by insurance, so that patients can access safer approaches that may even be better for pain.
Even though opioid analgesics are withdrawn, experts also argue that drug treatment must be more easily accessible. The person who becomes addicted to the pain medication and who is then cut off will not go to heroin or fentanyl if the underlying addiction is being treated. To this end, there are evidence-based approaches, particularly treatment with anti-addiction drugs such as methadone and buprenorphine, which have a fairly good success rate.
But the treatment of drug addiction, especially drugs, remains inaccessible in the United States. Federal data suggest that 1 in 10 people with substance use disorder and 1 in 5 people with opioid use disorder benefit from specialized treatment. Even when a drug treatment clinic is available, less than half of the facilities offer opioid addiction medications. In other words, the treatment is sufficiently inaccessible that most people who need it do not get it, and even if treatment is available, it does not meet the highest standard of care.
In addition to prescription reductions and more treatments, experts say more efforts are being made to reduce the damage, such as increasing the number of needle exchanges and the availability of drugs. Antidote to overdose of opioids, naloxone, and the resolution of "root causes" of addiction, such as mental health problems and socio-economic desperation, could make a serious fall in the crisis.
Doing all this, however, will require a large national investment in the fight against the crisis – an investment proposed by some Democratic presidential candidates, but President Donald Trump and the Republicans have so far resisted. The current drug overdose crisis continues, killing tens of thousands of people every year.
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