Authors: Bettinger JJ, Amarquaye W, Fudin J , Schatman ME
Published 29 March 2022
We endorse responsible prescribing and dispensing of medications of all types, including opioids; however we do not endorse propagating hysteria, deceitful use of clinical evidence or lack thereof, nor trying to influence the current pharmaceutical market for self-gain. The PROP News Release13 to which we refer throughout this analysis is fraught with gross inaccuracies, misrepresentation of data, and disregard for scientific integrity to the extent that we find it to be unconscionable. As we personally know many of the individuals responsible for this news release, we believe that at least a few of them are sufficiently adequate scientists to the extent that the picture that they have tried to paint was an intentionally inaccurate one, and that they should know better than to use deceit simply to express their misguided opinions. From an ethical perspective, we are deeply concerned that such egregious efforts are potentially damaging to vulnerable chronic pain sufferers who are already stigmatized and marginalized, thereby exacerbating their plight. Sadly, we do not believe that this analysis will serve as a catalyst for disingenuous anti-opioidists to change their ways. However, we hope that by continuing to expose the continuing falsehoods that are damaging to so many patients, the tide against opioids and those who suffer from intractable chronic pain will begin to turn in a more moderatist direction.
This editorial is yet another in a plethora of studies trying to reverse the damage that the false narrative that prescription opioids are/were responsible for the US Opioid epidemic has caused. They refer to the narrative as “disturbing” and “disproportionate”.
From the study:
“Despite the multifactorial nature of the current overdose epidemic, there continues to be a disturbing and disproportionate narrative pertaining to the involvement and overall influence of opioid prescribing. A trend in misinformation has affected almost all facets of society, from politics to healthcare.”
The authors then allude to the financial incentives driving the ongoing lawsuits, saying:
“One of the most notorious groups that continues to perpetuate false narratives regarding the prescribing of opioids is Physicians for Responsible Opioid Prescribing (PROP).”
“This editorial will address several ongoing false narratives regarding opioid prescribing and its involvement in the ongoing overdose epidemic. We utilize specific quotations excerpted from a recent press release by the PROP organization that best highlight the falsehoods that too many legislators and media outlets are sadly accepting as accurate information.”
A dispassionate analysis of the situation shows:
“99% of fentanyl-related deaths now involve illicitly synthesized fentalogues.”
“It is well-accepted in scientific circles that current overdose deaths involve fentanyl-related compounds that are illicitly manufactured and not FDA approved pharmaceutical fentanyl (or its FDA approved chemical derivatives alfentanil, remifentanil, and sufentanil) used in both acute and chronic settings.”
“ This is a distinction that must be accurately described in order to diminish untoward apprehension in prescribing pharmaceutical fentanyl and its related compounds safely in a both monitored clinical settings and for home use.”
The opioid crisis has been characterised as being driven by prescription opioids however:
“there is usually no way (or attempt) to actually verify whether patients overdosed on opioids that were prescribed to them, opioids that were prescribed to someone else that they obtained illicitly, opioids manufactured illicitly, or a combination thereof.1 “
The statistics simply are not collected in a way that allows for this kind of analysis.
The study demonstrates that most overdoses are due to polypharmacy, not due to opioids alone and the numbers of ‘opioid’ induced deaths are inflated by including all deaths where opioids were found on toxicology, but may not have been the cause of death.:
“When one examines toxicology reports, multiple drugs are generally found postmortem in the deceased, particularly when an opioid is involved. “
“ One of the more recent of these studies, by Hannah et al in 2017,26 determined that among death certificates examined in Marin County, California the average number of drugs identified in the toxicology screens of all 34 drug overdose deaths attributed to opioids was 6. Despite all of this evidence, the Centers for Disease Control (CDC) acknowledges that when overdose deaths involve more than one drug, a single death will be included in more than one category,1 creating greater confusion when actually attempting to label any given overdose.”
And to give a bigger picture of an actiual opiate overdose by a pain patient which we already know are few and far between, are usually patients who are on a low ineffective dose for there condition who out of utter dispaer will try two tablets to see how there pain travels and find it very helpful. This is when undertreated pain can have devastating consequences like an unintentional overdose. On a bad pain flare up day these patients are more likely to increase the amount of there low strengh pain reliever to combat there pain for a short period but take too much like many people do with panadol and die.
But for long term legacy chronic pain patients on effective amounts of optaite based pain relief medications don’t have any need to try and look for that much needed relief from undertreated pure agony in a pain flare up that one would rather be dead than spend another minute suffering need to go to such serious lengths of finding much needed relief, because we with our doctors have found the balance between the two and for decades can manage a somewhat normal healthy lifestyle. So there is no addiction, no misuse, and the side effects you here from anti opiate medication zealots are all gone by the first few months of being on treatment. So there are not the bad side effects at all.
Taking these life saving medications away from us will lead to death. Not the other way round.