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FACTS

Many people appropriately require and rely on opioid medication to manage pain.

Between 8 and 13 Million Americans take opioids regularly for pain.

Reports and studies emerging show the dangers of the way opioid dose reduction or discontinuation is happening to people with pain.

• Human Rights Watch found that people living with pain were  having their medication  tapered or discontinued because doctors feared outside pressure and oversight. The decisions were often made against their best medical judgment and in patients they believed benefited from opioids. (2018) 

• One study of Medicaid patients on opioids for more than 90 days found discontinuation often happened abruptly, in 24 hours, with almost half such cases resulting in hospitalization or an ER visit (2019)

• One study found just changing a patients’ dose resulted in a three-fold increased risk of overdose death. (2019)

• Tapering resulted in an increased risk of death in primary care settings (2019)

• Tapering happens more often to women and people of color (2019)

• Veterans who were tapered experienced a higher risk of death from overdose or suicide (2020)

• Discontinuation of opioids in patients stable on opioids is on the rise and happens too abruptly (2021)

   

Other studies show that people who use opioids to manage pain have challenges finding healthcare at all.

• A survey of clinics in nine states found more than 50% of primary care clinicians are unwilling to take on a new patient who uses opioids regularly to manage pain (2021).

• 81% of physicians are reluctant to see a patient who uses opioids to manage pain (2019).

• Opioid tapering is associated with later termination of care relationships (2020).

Addiction and overdose risks among pain patients are smaller than what is conventionally believed.

• There is a critical difference between addiction to and physiological dependence on a medication. Addiction is compulsive use that continues despite harmful consequences. Dependence lacks the destructive behavioral component of addiction; people who appropriately use medication typically have helpful consequences.

• Most people who misuse prescription opioids did not get them directly from a doctor but rather bought, stole or borrowed medication that was prescribed to others.

• The risk of addiction to people who are prescribed opioids varies considerably according to risk factors that should be screened for in prescribing but generally the risk varies from 0.6% to less than 8%.

• The risk of overdose death in patients prescribed opioids for pain is also relatively low. One study of 2.2 Million people found the risk of death at less than .022%.

• Most overdose deaths involve multiple drugs--legal and illegal--used in combination; one study found that the average number of substances in the system of someone who died of overdose was 6.

• Opioid prescribing in the US has fallen since 2012, while overdose deaths have risen exponentially (by 57%) since that time with deaths related to illicit fentanyl up more than 1000%. 

• The overdose crisis of the last decade is driven by heroin, illegal fentanyl and its potent analogs and stimulants like cocaine and methamphetamines.

ARTICLES

Mainstream Media

1. Washington Post: A program tried to cut opioid addiction among veterans. Did it cause suicides? (2021)

2. Washington Monthly: The Opioid Crackdown is Hurting People in Pain (2021)

3. LA Times: The clampdown on opioid prescriptions is hurting pain patients (2019)

4. NY Times: Over 100 doctors call for the CDC to address harm to pain patients (2019)

5. NY Times: When the Cure is Worse than the Disease (2019)

6. Washington Post: The problems with one-size-fits-all laws on opioid prescriptions (2019)

7. Fox News: Series on harm to pain patients, including information on suicides, doctors’ predicament, and solutions and other reading (2018)

8. Reuters: Rapidly taking patients off opioids might not be a good idea, experts say (2018)

9. Harpers: The Pain Refugees (2018)

Reports & Academic Journals

1. Human Rights Watch: Chronic Pain, the Overdose Crisis, and Unintended Harms in the US (2018)

2. American Journal of Law and Medicine, Nicholson & Hellman, Opioid Prescribing and the Ethical Duty to Do No Harm (2020)

3. Journal of Pain Research, Duensing et al., An Examination of State and Federal Opioid Analgesic and Continuing Education Policies: 2016–2018 (2020)

4. Pain Medicine, International Stakeholder Community of Pain Experts and Leaders Call for an Urgent Action on Forced Opioid Tapering (2018)

5. Substance Abuse Journal, Kertesz Turning the Tide or Riptide: The Changing Opioid Epidemic (2016)

6. Canadian Family Physician, Clarke, Canada’s Hidden Opioid Crisis: Fallout from the 2017 Canadian Opioid Guidelines (2019)

7. Pain Management Nursing, Oliver et al., Misperceptions about the ‘Opioid Epidemic:’ Exploring the Facts (2019)

8. Columbia Journalism Review, Szalavitz, What the Media Gets Wrong About Opioids (2018)