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More opioids, more pain: Fueling the fire

July 8, 2019

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photo of Shafik Boyaji, MD

Shafik Boyaji, MD, Contributor

Dr. Boyaji earned his medical degree from University of Aleppo, Syria. He completed an Internal Medicine residency at Michigan State University and an Anesthesiology residency at the Brigham and Women’s Hospital. Currently he is in fellowship … See Full Bio
View all posts by Shafik Boyaji, MD
photo of David Boyce, MD

David Boyce, MD, Contributor

Dr. David Boyce is board-certified in general anesthesiology and pain medicine. After graduating from Tufts University School of Medicine, he completed his residency and a pain medicine fellowship at Brigham and Women’s Hospital in Boston. He … See Full Bio
View all posts by David Boyce, MD


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Shafik Boyaji
August 18, 2019

Stuart, while I applaud your efforts to pull these data, I think you are missing the big picture. The correct name of this epidemic is “Opioid-Addiction crisis”. And the word opioid here is a broader term that includes opioids/opiates and any substance, natural or synthetic, that binds to the brain’s opioid receptors (Hydrocodone, Oxycontin, Heroin, Methadone, etc). What you are pointing at, the increased number of overdose death by heroin and fentanyl, is only the dark end of the opioid-use disorder. You need to understand that these patients didn’t wake up one day and started injecting Heroin and Fentany, their unfortunate journey started many years ago, and as most facts reviling, it started with opioid prescriptions because there were abundance of these pills in the community over the last two decades. Just to put things into prospective and give a small example, it was estimated that, at one point, 21 million hydrocodone and oxycodone pills had been delivered to Williamson, WV, a town with fewer than 3,200 residents!
While you presented some facts “Opioid prescribing is presently at its lowest volume in the previous 15-years” it is still misleading. After 1995 with the aggressive marketing and liberalization of opioid prescription habits, the prescription numbers has increased many folds, that with all the efforts that has been done so far, the prescription numbers still more than three times the numbers in 1999 and overall it is nearly Four times as high the amount distributed in Europe*.
While you also presented straight-up misinformation “the lack of correlation between the number of opioid prescriptions and the number of overdoses”, it has been shown clearly that opioid–related overdose deaths increased substantially in parallel with increased prescribing of opioids**.
So if you looked at the big picture and studied the root of this crisis, it was the “opioid prescriptions” that fueled the crisis and created this large pool of individuals with opioid-use disorder that went later on to use illicit opioids.
Finally, and I think most importantly, you used many “inflammatory” phrases in your discussion, words like (and I am quoting you) “opioid hysteria” and “government’s misdirected prescription drug prohibition program”. No one is running a “prohibition” program, but there is a huge epidemic that declared more than 400,000 lives over the last two decades*** and all the efforts of the medical community are aiming toward correcting and treating this problem, while keeping in mind the safety and the well-being of chronic pain patients. Phrases like this will not help anyone, especially chronic pain patients.
* Guy GP Jr., Zhang K, Bohm MK, et al. Vital Signs: Changes in Opioid Prescribing in the United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017;66:697–704.
** Schuchat A, Houry D, Guy GP. New Data on Opioid Use and Prescribing in the United States. JAMA. 2017;318(5):425–426.
*** Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017. WR Morb Mortal Wkly Rep. ePub: 21 December 2018.

Lawrence Feldman
July 8, 2019

Something established in lab rodents, but infrequently found in human patients. Almost to the point of ‘Urban Myth’.

Shafik Boyaji
July 9, 2019

Lawerence, I don’t think you read the article well. This phenomenon FREQUENTLY found in humans, plenty of evidence out there in studies and clinical practice, please refer to the articles by the end. Mentality like this has lead to the opioid epidemic by ignoring and not respecting the evidence and the convention medical wisdom that accumulated over the years.

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