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Digital Subscriptions > Skeptic > 24.1 > The Opioid Epidemic Misunderstood

The Opioid Epidemic Misunderstood

DRUG OVERDOSE IS NOW THE LEADING CAUSE OF death for Americans under the age of 50 and has lowered the average life expectancy in the United States.1 Over the next decade as many as half-a-million people in the United States will die from opioid substances that include heroin, pain-killers such as morphine and oxycodone, and synthetic agents such as fentanyl.2

Public policy to date has failed to counter this epidemic. Standing in the way of effective response are three mistaken approaches to the problem:

1. Misinterpreting correlation as causation.

2. Misunderstanding the physiology of addiction.

3. Overlooking the social psychology of addiction.

Mistake #1: Misinterpreting Correlation as Causation

Does epidemic opioid overuse result from too many prescriptions of medication for pain relief? In March of 2018 President Trump announced that his administration is “taking action to prevent addiction by addressing the problem of overprescribing…. We’re going to cut nationwide opioid prescriptions by one-third over the next three years.”3 The U.S. Centers for Disease Control and Prevention (CDC) also attribute the overuse of opioids and other addictive substances to prescription practices:

Drug overdose deaths in the United States more than tripled from 1999 to 2015. The current epidemic of drug overdoses began in the 1990s, driven by increasing deaths from prescription opioids that paralleled a dramatic increase in the prescribing of such drugs for chronic pain…. The problem with misuse of prescription drugs of various kinds is related to high levels of prescribing of such medications.4

This concern about excessive prescription is certainly legitimate. However, a close look at the historical data clarifies the causal role that prescription plays in the opioid epidemic.

The years of the steepest increase in overuse fatalities, 2012 to 2017, are also years in which prescription rates declined. This divergence between fatality and prescription rate trends is striking, even when we take into account that it might require several years for a lower prescription rate to result in significantly fewer overdose deaths. The sharp rise in recent years of opoid-induced deaths is in fact due to the consumption of drugs that are rarely used for medical pain management: As of 2015 the rate of overdose deaths due to illegally obtained heroin and synthetic opioids had gone up so much that they took more lives than did all of the other prescribed opioids combined.6 Synthetic opioids like fentanyl (a drug 50 times more potent than heroin) and carfentanil (5000 times more potent than heroin) are inexpensive to produce and easily shipped to customers through the mail. Moreover, heroin and other street drugs are often mixed with fentanyl and its derivatives, further raising fatal overdose rates.

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About Skeptic

BEHE’S LAST STAND COLUMNS The SkepDoc: Is Low-Dose Radiation Good for You? The Questionable Claims for Hormesis, by Harriet Hall, M.D. • The Gadfly: Define Your Terms (or, Here we Go Again), by Carol Tavris ARTICLES Making Gasoline from Water: John Andrews and the Invention of a Legend • Online Gaming: A Virtual Experiment in the Dark Side of Human Nature • Duped by Data Mining • How Science Will Explain and Fix Fake News • The Cult of Falun Gong: A Dance Troupe and Victimhood Raises Big Money • The Opioid Epidemic Misunderstood • Why the Human-Centered View Has Not Served us Well • Behe’s Last Stand: The Lion of Intelligent Design Roars Again • Straw Man on a Slippery Slope: The Case Against the Case Against Postmodernism • A Disproof of God’s Existence REVIEWS Reviews of: The Coddling of the American Mind: How Good Intentions and Bad Ideas are Setting Up a Generation for Failure; The Skeptics’ Guide to the Universe: How to Know What’s Really Real in a World Increasingly Full of Fake; Investigating Ghosts: The Scientific Search for Spirits; Bunk: The Rise of Hoaxes, Humbug, Plagiarists, Phonies, Post- Facts, and Fake News; Hoax: A History of Deception: 5000 Years of Fakes, Forgeries, and Fallacies; Truth’s Fool: Derek Freeman and the War Over Anthropology JUNIOR SKEPTIC Quest for the Truth about Dungeons and Dragons