There is no opiate epidemic. We have a societal problem that isn’t going to be solved by restricting prescribing. Despite overwhelming evidence that the majority of opioid-induced deaths involves the use of non-prescribed opioids such as fentanyl and heroin, much of the focus has been on prescription opioids. Over the last two decades illicit fentanyl deaths have increased 520% and heroin deaths have increased by 533%. Over the same time period prescription opioid deaths increased by less than 20%.
Rather than sensationalizing opiate deaths, we should ask why the use of mind-altering drugs is increasing and whether that is good or bad.
More and more mind-altering drugs are becoming available over the counter (OTC), under the counter and online making the therapeutic role of physicians as guardians of mind-altering substances largely irrelevant. One in three adults use daily medicines that don’t require prescriptions. Non-prescribed pain killers come in fourth in the list of most frequently used drugs.
There are fine lines between dependence, addiction and treatment. In part, the lines are drawn according to age and the type of problem. In adults, chronic problems account for much of their opiate use. Adults who have more than two health problems are likely to receive a prescription for a painkiller at least once every six months.
It is not people with chronic problems who are most likely to overdose on opiates. Prescribing for pain relief is legitimate for adults with ongoing problems because addiction is not the major concern.
However, for adolescents who use pain killers for recreational use, the progression to unmanageable dependence is the major problem. Ten percent of teenagers use addictive, legal painkillers ever year and they are the main attenders of addiction clinics. Adolescents are known to raid home medicine chests for unused pain killers. Nearly three quarters of all adolescents have unsupervised access to medications that are potentially addictive.
Rather than sensationalizing opiate deaths, we should be examining why there is increasing use of mind-altering drugs and whether that is good or bad. Pain, whether it is psychological, physiological or both can be endured if it is transient, but once it becomes well established, becomes a medical problem.
It is only in the last two decades that opiates have become a societal problem. Legislation, not prohibition, is the answer. This strategy has largely proved effective with other mind-altering substances like alcohol and tobacco. Opiates should be responsibly dispensed to those for whom they convey a benefit.