Curbing pain prescriptions won't reduce overdoses. More drug treatment will

In March, the US Centers for Disease Control and Prevention announced the publication of new prescribing guidelines aimed at reducing the use of opioid medications to treat chronic pain, an attempt to curb what has become a national epidemic of overdose deaths.

But history shows that merely limiting supply is not likely to solve the problem – the connection between chronic pain treatment and heroin and other opioid addiction is far less direct than Americans have been led to believe. And focusing on this rather than expanding effective addiction care will do little to stem the epidemic here. The Obama administration is announcing further measures on Tuesday to increase treatment access, but they don’t go far enough.

The statistics look stark: the rise in opioid prescribing was directly paralleled by a rise in overdose deaths, and misusers of prescription pain medications are 40 times more likely to become addicted to heroin than those who don’t. But the primary source of prescription opioids for new misusers of these drugs is not doctors – it’s not necessarily those with prescriptions who are getting addicted.

The National Survey on Drug Use and Health consistently shows that 75% or more of those who start taking opioid medications for non-medical reasons obtain them not from their own prescription, but from friends, family members, dealers or other illicit sources.

Moreover, studies have found that the majority of people who misuse prescription opioids take other recreational drugs, too: for example, one study of over 1,000 people tracked from grade school into their 20s found that 75% of regular prescription opioid misusers had also taken cocaine, and two-thirds had taken psychedelics; earlier research on adults with Oxycontin addictions found similarly high proportions of other illegal drug use. The same research also showed that nearly 80% had previously been in addiction treatment. This suggests immersion in a drug-using subculture, not a life of doctor’s appointments and pain management.

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