Balance, Pain

“Deadly Dose:” Comments on the @sanjayguptacnn special


Have you ever been looking for that situation to include Bill Clinton in a paper, email or blog? Well it just happened with the former President’s appearance on the CNN Special, “Deadly Dose.”

President Clinton had, in fact contacted Sanjay Gupta because of a personal experience with the death of two younger men. These men had died as a result of misuse/abuse of opioids.  Their deaths and those of many others who have died in the USA, often through misadventure with these medicines, is tragic.  I know parents who are in this situation.  Yes, tragic and we should all be working to prevent these.

And as I watched Sanjay’s documentary, I appreciated that neither he or President Clinton neglected the needs of pain patients. For many patients with both acute and chronic pain, opioids may be an acceptable and reasonable choice for pain relief. And how the US addresses both pain management and non medical  use will have a huge impact on the 83% of the world’s people, primarily in low and middle income countries, who have access to only 10% of the world’s opioids.

We can discuss solutions, and there are clearly some out there to prevent these deaths, e.g naloxone.  But why is it I still don’t really feel I understand the root causes of the problem.  As the CDC has indicated, methadone is associated with 30% of these “overdose” deaths, but only represents 3% of the opioids consumed for pain. 60% of the deaths are associated with polypharmacy (multiple drugs; “stacking!”). Authors of a recent paper on the county by county prescribing of opioids say that their analysis, doesn’t explain much of the variability in prescriptions across the US. Is this a new problem, or with the presence of more common usage, are we just more aware of it?  So “Deadlydose” has me asking more and more questions.

I thought I would look at some CDC data, that is commonly used to communicate this current situation. IN reviewing a chart that presents the trends in opioid sales, associated-deaths and treatment admissions, I realized that the opioid death rate is per 100,000 persons, while the other two are per 10,000 persons.  Does this matter?  In bringing it all back to a common denominator of “per 10,000 people,” one can see more clearly that CDC stated fact, that opioid sales have increased approximately 600% whereas opioid associated deaths only by 300%.

Lets explore the data a little more.  I then divided the number of opioid associated deaths/10,000 by the number of Kg of Opioid Sales/10,000 to give “Opioid Associated deaths per Kg opioid Sale.”  Effectively we end up with a straight line.    In 1999 there were 0.078 opioid associated deaths/kg vs 2010 with 0.076 opioid associated deaths/kg.  Or to put it a term that that may be more understandable, every year from 1999 to 2010 there have been approximately 8 opioid associated deaths per 100 kg of opioids (measured in morphine equivalents) sold.

So #DeadlyDose has raised more questions for me than it answered?  What has changed in this major health problem facing the USA and other countries including Canada and Australia? Is it purely a result of more pills? What is the impact of medicines stolen from pharmacies, the medicines from Florida’s pill mills and the impact of medicines stored in our bathroom cupboards?  But I can’t believe there is much methadone hanging around in drug cupboards.  So more questions……

I hope that with Clinton Foundations support, we may be able to get some better answers and ensure balanced access to opioids in both the US and throughout the world .

About Pain policy & palliative care

Improving global pain relief by achieving balanced access to opioids worldwide

Discussion

One thought on ““Deadly Dose:” Comments on the @sanjayguptacnn special

  1. My apologies. I forgot to pay attribution to the changes in paragraph 5. While many noted this when the data was released, I would be remiss in not attributing this to Dr Stewart Levitt who raised this issue just over 1 year ago (Nov 5, 2011; http://updates.pain-topics.org/2011/11/are-opioid-pain-reliever-deaths.html). I was unable to plot this until this CDC set was made available this last week in a powerpoint at http://www.cdc.gov/primarycare/materials/opoidabuse/docs/pda-phperspective-508.ppt
    @jfclearywisc

    Posted by Pain policy & palliative care | November 21, 2012, 8:04 AM

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