New research suggests street drugs, rather than prescriptions, are fueling the opioid crisis.
A new Australian study published in the Pain News Network produced fascinating new results about opioid addiction. Contrary to popular beliefs about “how a single prescription can lead to long term use,” the study found that of 3.5 million Australians who were prescribed opioids for the first time, only 3% needed higher doses or became persistent users. These findings are opposite the previously accepted research which estimated long term use risk as high as 57%. The Australian study was conducted differently than most of the existing research, by accounting for comorbidities (cancer, depression, anxiety, etc.) and defining more clearly several trajectories of long-term use rather than categorizing them together.
Opioids can be useful and necessary in treating patients with chronic pain, cancer, and other long term health conditions. Concurrently, opioid abuse is a rising problem and extremely deadly. Australian researchers posit that the most problematic opioid abuse is found in street drug users rather than those who were prescribed opioids. The CDC launched a large-scale advertising campaign in 2017 emphasizing the risks of prescription opioids, but the newest research suggests that most overdose deaths are caused by fentanyl and other street opioid use separate from these medications.
Researchers in JAMA wrote, “Opioids are essential drugs for acute and cancer pain, and many people with CNCP (chronic non-cancer pain) benefit from opioids. Continued focus and policy responses based on findings from a small group of people with increased risk of harm run the risk of limiting access to people who safely derive objective benefits from opioids.”
A lack of reliable data complicates the opioid crisis. All studies to date are retroactive, and fentanyl distribution is constantly evolving and difficult to monitor. Following the CDC campaign, many U.S. patients lost access to prescription opioids, which may not have been a reasonable response despite deaths rising dramatically. It seems more focused and detailed research on street drugs as compared to prescription opioids must be completed before the crisis can be addressed.
One solution that may be more effective than limiting prescription opioids is the increased use and availability of naloxone, which can reverse opioid overdose and save lives. The CDC recommends carrying naloxone for people who use opioids, especially illicit drugs. Anyone can use naloxone, even without medical training, much like an EpiPen. Community organizations such as NEXT Distro provide samples and aim to increase awareness about the drug.
Some may be averse to the idea that organizations such as NEXT provide services to active drug users. However, providing naloxone to active users is much more effective in reducing overdose deaths than trying to get every individual into treatment programs. NEXT says “Drug use, and the various reasons why people choose to use drugs is complex. We don’t believe in a one-size-fits-all model of treatment or template idea of what wellness is.”
Ultimately, the opioid crisis is extremely complex and deadly. New ways of administering care should be prioritized without limiting others’ healthcare needs. Safe prescription opioid use may be possible for some individuals and should not be limited unnecessarily. Meanwhile, street drug users should be given as many tools as possible to reduce harm and death even if they don’t choose to go into treatment.