"In 2010, there was an growing problem of people abusing painkillers such as OxyContin. Unfortunately, the steps taken to address the crisis may have made things even worse. A 2018 NBER study by William N. Evans, Ethan Lieber, and Patrick Power showed that when the pills were reformulated to reduce drug abuse, people switched to other drugs such as heroin, which were even more dangerous:
We attribute the recent quadrupling of heroin death rates to the August, 2010 reformulation of an oft-abused prescription opioid, OxyContin. The new abuse-deterrent formulation led many consumers to substitute to an inexpensive alternative, heroin. Using structural break techniques and variation in substitution risk, we find that opioid consumption stops rising in August, 2010, heroin deaths begin climbing the following month, and growth in heroin deaths was greater in areas with greater pre-reformulation access to heroin and opioids. The reformulation did not generate a reduction in combined heroin and opioid mortality—each prevented opioid death was replaced with a heroin death.
In addition, the government has begun pressuring doctors not to prescribe opioid painkillers.
The Economist has a graph showing that since this study, thing have gotten even worse:
Notice that fentanyl deaths are now far higher than before the government began cracking down on painkiller use. That’s because fentanyl is far more dangerous:
The drug’s potency makes it easy to misjudge dosage, especially for new users without a tolerance. Increasingly, counterfeit prescription pills, resembling oxycodone tablets or benzodiazepines such as Xanax, contain fentanyl. Brad Finegood, an adviser to the public-health department for Seattle and King County, says he has seen lots of unsuspecting people casually take a fentanyl-laced pill and die.
It sounds “responsible” to crack down on the abuse of addictive painkillers, but the unintended side effects may well be even worse than the original problem. Politico has an excellent piece on the effects of cutting off pain medication to those with severe chronic pain:
Last August, Jon Fowlkes told his wife he planned to kill himself.
The former law enforcement officer was in constant pain after his doctor had abruptly cut off the twice-a-day OxyContin that had helped him endure excruciating back pain from a motorcycle crash almost two decades ago that had left him nearly paralyzed despite multiple surgeries.
“I came into the office one day and he said, ‘You have to find another doctor. You can’t come here anymore,’” Fowlkes, 58, recalled. The doctor gave him one last prescription and sent him away.
Like many Americans with chronic, disabling pain, Fowlkes felt angry and betrayed as state and federal regulators, starting in the Obama years and intensifying under President Donald Trump, cracked down on opioid prescribing to reduce the toll of overdose deaths. Hundreds of patients responding to a POLITICO reader survey told similar stories of being suddenly refused prescriptions for medications they’d relied on for years — sometimes just to get out of bed in the morning — and left to suffer untreated pain on top of withdrawal symptoms like vomiting and insomnia.
More recently, the Washington Post has an article with lots of similar stories:
Saturday, June 5, 2021
Regulation can be painful (When OxyContin pills were reformulated to reduce drug abuse, people switched to other drugs such as heroin, which were even more dangerous)
By Scott Sumner.
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