Last updated : December 16, 2024
Physicians who prescribed synthetic opioids, such as oxycodone and oxycontin, along with other similar medications, for pain relief have been accused of being the culprits responsible for sparking the addiction crisis that is ripping our nation apart. However, the truth has a way of coming to light. It turns out they may have gotten a bum rap.
The Centers for Disease Control and Prevention (CDC) has long relied on creating its annual report using data compiled by the National Center for Health Statistics specifically organized as Underlying Cause of Death data. This data uses specific codes from the International Classification of Diseases (ICD).
It’s coming to light that as far back as 2018 the CDC along with the U.S. Bureau of Vital Statistics were forced to admit this wasn’t the case. A report compiled by four senior analysts of the CDC, including the CDC head of the Epidemiology and Surveillance Branch, concluded that these numbers, specifically targeting 2016 statistics, are erroneous. The reason was due to miscoding fentanyl deaths as being due to prescribed fentanyl.
Another area of concern
The mislabeling of fentanyl deaths wasn’t the only issue of concern, however, because the classification codes used to report the cause of drug-related deaths allow for up to ten ICD codes to be listed on a person’s death certificate.
The codes used are as follows:
- T40.0: Poisoning involving opium
- T40.1: Poisoning involving heroin
- T40.2: Poisoning involving other opioids
- T40.3: Poisoning involving methadone
- T40.4: Poisoning involving other synthetic narcotics
- T40.5: Poisoning involving cocaine
- T40.6: Poisoning involving other and unspecified narcotics
- T40.7: Poisoning involving cannabis (derivatives)
- T40.8: Poisoning involving lysergide [LSD]
- T40.9: Poisoning involving other and unspecified hallucinogens
The recording process, intended to break down the number of overdose deaths caused by either legal or illegal drugs wasn’t accurately reflecting the numbers. That’s because both illegal and legal drugs were represented in multiple reporting categories.
A new system implemented
In 2019, the CDC quietly rolled out a new reporting system. The State Unintentional Drug Overdose Reporting System (SUDORS) is independent of other CDC reporting systems requiring coroners and medical examiners to refine the way overdose deaths are recorded.
The problem is that, so far anyway, only 48% of states have received the funding for retraining.
Even so, the reporting received from those participating is shining a light.
Some statistics
According to the SUDORS data gathered from 2020 to 2022:
- More than 80% of all accidental drug overdose deaths involved some form of opioids.
- Over 50% of those deaths also involved a stimulant, such as methamphetamine or cocaine which are rarely used for medical reasons.
- Prescription drugs were a factor in only 12% to 18% of drug-related accidental deaths.
Not only does this report show that prescription drugs aren’t the primary reason for accidental overdose deaths during this time frame. Other data is proving that it was never the case.
Getting behind Science
Also in 2018, a report written by Hawre Lalal and others and published by Science, a reputable source in the medical community, revealed that between the years of 1978 to 2016, statistics taken from the CDC’s Multiple Cause-of-Death files strongly paralleled SUDORS findings.
Illegal substances were responsible for far more deaths by accidental overdose than prescription drugs every year. In fact, at no time during the 36-year time frame did prescription drugs contribute to more than 22% of reported deaths. Deaths involving illicit substances such as heroin, synthetic opioids, cocaine, methamphetimine, and other unspecified narcotics or drugs, however, rose exponentially.
Moreover, the U.S. Drug Enforcement Agency (DEA) reviewed Jalal’s findings during a 2019 training session for doctors who were renewing DEA licenses to prescribe controlled substances.
Why isn’t this message getting out to more physicians? Is it because there hasn’t been any support received from the CDC giving doctors the confidence to once again prescribe opioids to treat their patients who deserve to live pain-free lives?
Controversy continues
Pain treatment plans here in the United States are still being scrutinized by the medical community and others who have adopted the CDC’s incorrect summarization that prescription opioids are the largest contributor to accidental overdose deaths. CDC opioid prescribing guidelines published in 2016 and again in 2022 were clearly skewed. Doctors and other clinicians have not, nor have they ever, been writing prescriptions that lead their patients to addiction and, thereby, causing the greatest number of unintentional overdose deaths because they use these types of painkillers.
Granted, in 2022, the CDC added that each patient should be treated as an individual to the guidelines. Still, it also suggests that physicians heavily consider the risks of using opioid therapy versus the benefits patients receive. We’ll mention too that the word “risks” appears in the guidelines over 400 times. They are keen to encourage other treatments such as non-invasive and non-pharmacological therapies as being preferable to prescribing opioids.
Subsequently, the medical community is still hesitant to break free of the stigma attached to these drugs. This is despite the fact that there is no body of evidence to support these treatment methods are more beneficial than drugs for pain relief.
Physician beware
Many believe that the tone set by the CDC in its opioid prescribing guidelines is a “prescribe at your own risk” message. Moreover, they believe there is a strong undertone that the slightest error in judgment in an environment that is up in arms about the danger of prescribing these highly addictive drugs will continue to have physicians being placed under arrest.
People who live with constant pain do benefit from opioid treatment. The medication enables them to participate in family activities and continue enjoying hobbies that bring them joy. It allows them to partake in all facets of living a normal life.
Physicians should not have to live in fear of repercussions for helping someone who is suffering. The data proves that they aren’t responsible for this crisis.
People who are suffering often turn to the street when prescription medication isn’t available. That solution, however, puts them at far greater risk of an accidental overdose. Every type of street drug confiscated has been found to contain fentanyl. Only a small amount of this synthetic opioid proves lethal.
People are dying unnecessarily because physicians feel their hands are tied regarding writing a prescription. That needs to change.
