Study: Prescription Crackdown Won't Do Much to Stop Crisis

Policymakers must think bigger to stop opioid deaths

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February 7, 2019

Cutting the supply of prescription opioids has been a popular intervention to fight the drug crisis. But, according to a study released last week by the Journal of the American Medical Association, these interventions are likely to cut opioid deaths by only 3 to 6 percent by 2025.

Of the 70,000 drug overdose deaths in 2017, opioid drugs were involved in just south of 50,000. A substantial portion of these were from the illicit, synthetic opioid fentanyl (and its analogs), but many deaths also involved heroin and "natural or semisynthetic" opioids—drugs like oxycodone and hydrocodone, which users primarily source from the prescription drug market.

To combat the opioid crisis, policymakers have leaned heavily on policies controlling the supply of prescription opioids. This is not necessarily because of its efficacy, but because of its ease—the entire prescription opioid infrastructure falls under the oversight of the DEA, which sets national quotas for production every year. As a result of conscious reductions in supply, the number of opioid prescriptions has fallen steadily since 2012. Other interventions, like Prescription Drug Monitoring Programs, are similarly focused on the prescription opioid supply.

How much will these interventions actually affect the trajectory of the opioid crisis? To answer this question, the JAMA study's authors used publicly available data on opioid use and overdose to build a model of how the crisis will play out.

Using their model, the researchers projected the opioid crisis to 2025. They predict that the number of opioid overdose deaths will rise to 81,700 by 2025, assuming no change in current trends. That rate of increase will account for a total of 700,400 deaths between 2016 and 2025. Most tellingly, 80 percent of those deaths will be attributable to illicit opioids, primarily meaning heroin or fentanyl.

In other words, most actual overdose deaths are attributable to these illicit drugs, not to prescriptions. In fact, the researchers find that if prescription opioid misuse continues to decline at the rate it declined from 2008 to 2015—about 7.5 percent per year—the total number of opioid deaths between 2016 and 2025 will be reduced by just 3.8 percent. Faster rates of decline still led to only a 5 percent overall reduction; even in a hypothetical where prescription opioid abuse abates entirely after 2015, total overdoses would only fall by 17.3 percent.

What this means practically is that simply targeting the prescription drug supply is not enough to stop the drug crisis. In fact, there is evidence that the current crackdown actually exacerbated it: Analysis of drug deaths indicates that the reformulation of the opioid drug OxyContin to be tamper proof was directly linked to the rise in heroin overdose deaths.

Effective drug policy intervention therefore needs to look elsewhere in order to try to combat the still surging crisis. The influx of drugs over the border calls for more effective interdiction. Further action on the part of the Chinese government to stop the production of fentanyl is also needed. Policymakers also need to consider harm reduction and treatment strategies, including those more radical than previously used.

"Under current conditions the opioid crisis is likely to substantially worsen," the authors conclude. "Interventions such as prescription drug monitoring programs are unlikely to lead to major decreases in the number of deaths from opioid overdose in the near future. Given these findings, policymakers will need to take a stronger and multipronged approach … to curb the trajectory of the opioid overdose epidemic in the United States."