The conflation of all opioids has resulted in an unwarranted focus on prescription opioids and medical use as the root cause of the “problem” of accidental drug overdoses, even though overdose deaths from prescription opioids are a small and decreasing fraction of the total. The result is policies that fail to address the problem they were intended to solve—illicit drug use and accidental drug overdoses. Further, these policies have harmed medically fragile patients with chronic, high-impact, intractable pain who need prescription opioid medication to maintain quality of life and basic function levels.
Why did a narrative that is at odds with science become dominant, despite the harm it causes to people with substance use disorder and to medically fragile patients? The answer lies in the complex incentives that face policymakers, law enforcement and families of overdose victims, particularly as illicit drugs have edged into upper-income suburbs. The result of the “opioid crisis” narrative has been disastrous for the most vulnerable and powerless: Americans struggling with complex medical conditions and constant pain.
The dominant narrative runs something like this: Doctors overprescribed opioids from the late 1990s through approximately 2012, resulting in addiction to prescription painkillers. When prescriptions ran out, these patients turned to street drugs. This overprescribing was responsible for an increase in substance use disorder rates and overdose fatalities. The appropriate policy response was, therefore, to tighten restrictions on opioid prescribing. Very plausible, very straightforward—and almost entirely contradicted by the facts.
Much of our country is run by heavyhanded incompetent morons, but that goes double for food and drug regulation.