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Are Opioids the New Religion of the Masses?

Did Americans suffer four times as much chronic pain in 2007 as in 1999? Probably not; but (according to the November 18 edition of the New England Journal of Medicine) they were four times as likely to die of accidental overdoses of opioid medication prescribed by doctors to treat pain. Indeed, in the state of Washington, death from overdose of medication is now the leading cause of accidental death, exceeding road traffic accidents.  Moreover, it seems that the legal prescription of pain killers has introduced abuse of opioids into rural areas where it hardly existed before.

In Oklahoma, for example, methadone (the drug most commonly used as a substitute for morphine or heroin in the treatment of addicts, and also used as an analgesic) was implicated in the deaths of 21 people between 1994 and 1996; but between 2004 and 2006 it was implicated in the deaths of 377 people. (I take the figures from the October 2010 edition of the American Journal of Preventive Medicine.) The figures in the same state in the same years for hydrocodone were 9 and 220, for oxycodone 1 and 220, and for fentanyl 2 and 78, respectively. It seems that abuse of such drugs on a large scale is now happening, and diversion on to the black market also.

Most deaths associated with opioid analgesics occur when the person is taking other drugs as well, notably benzodiazepine anxiolytics (drugs like valium). Either doctors continue to prescribe combinations of drugs known to be dangerous, or patients consult different doctors and deceive them as to what they are already taking (or, of course, they resort to the black, or open, market).

It might be argued that the 11,499 deaths in the U.S. caused by opioid drugs in 2007 (mainly of people between the ages of 35 and 54) were a small price to pay for the increase in pain relief that such drugs give. After all, four million Americans receive such a drug in the course of a year; only slightly more than a quarter of one per cent of them die as a result. All benefits have risks attached; in any case, is a doctor his patient’s keeper?

In my experience as a prescriber, however, which is also supported by a lot of scientific evidence, opioids are not very effective at relieving the kind of chronic pain of which 35- to 54 year-olds complain. Methadone is particularly poor in this respect, and yet it is not only frequently prescribed but implicated in 31 per cent of all opioid deaths, more frequently than any of the others. It is difficult to resist the conclusion that relief of pain is not really what the drugs are being prescribed for.

The nearest analogy I can think of is with the increase in sickness benefits paid out by the British state. As the population became healthier and healthier in the 1990s, as demonstrated by objective measures, so it included more and more people allegedly incapable of work for health reasons. The British welfare state thus achieved the miracle of producing more invalids than the First World War: millions of them in fact.

Could it be that one of the largest causes of chronic pain among 35- to 54-year-old Americans is access to opioid drugs?

Originally published in Pajamas Media.