Overdose, opioid treatment admissions and prescription opioid pain reliever relationships: United States, 2010–2019

Abstract

Background“As part of the U.S. government's urgent response to the epidemic of overdose deaths (1)” the United States Centers for Disease Control and Prevention (CDC) issued the “CDC Guideline for Prescribing Opioids for Chronic Pain-United States, 2016 (2)” (guideline) followed by the “CDC Clinical Practice Guideline for Prescribing Opioids–United States, 2022 (3) (guideline update). ” The guideline and guideline update cite a direct correlation between prescription opioids sales (POS) and opioid treatment admissions (OTA) and prescription opioid deaths (POD), which was based on data from 1999 to 2010. This paper updates those relationships and includes the correlations between prescription opioid sales (POS) and any opioid deaths (AOD) and total overdose deaths (TOD) from 2010 to 2019.MethodsLinear regression models were fit to each response separately. Opioid sales (measured as MME (morphine milligram equivalent) per capita) was the independent variable. Total overdose deaths (TOD), any opioid overdose deaths (AOD), prescription opioid overdose deaths (POD) and opioid treatment admissions (OTA) were the dependent, response variables. The models were assessed using three criteria: the statistical significance of the model (Overall P-Value), the quality of the fit (R2), and the sign of the slope coefficient (positive or negative).ResultsThe analyses revealed that the direct correlations (i.e., significant, positive slopes) reported by the CDC based on data from 1999 to 2010 no longer exist. Based on data from 2010 to 2019, the relationships either have reversed (i.e., significant, negative slopes) or are non-existent (i.e., no significant model).ConclusionsThe guideline, guideline update, CDC's public, medical profession, and intergovernmental communications should be corrected/updated to state no direct correlation has existed between POS to OTA, POD, AOD, and TOD since 2010. Individualized patient care and public health policy should be amended accordingly.

The Two Opioid Crises Problems, Causes, and Potential Solutions: An Analytic Review

“…The concept that prescription opioids were responsible for the growing crisis was very effectively promoted by the PROP organization. In actual fact, however, there is not now and there never has been evidence that prescribing by conscientious physicians contributed significantly to the opioid crisis 4,49 .…”

“…Our prior analysis of the clinical evidence bearing on opioid use to treat chronic pain 4 revealed a number of additional false memes: that overprescribing of opioids is responsible for the opioid epidemic (there is actually no correlation at all between rates of prescribing and overdose deaths 49 ); that opioids are ineffective in treating chronic pain (the apparent lack of evidence of efficacy is an artifact of experimental designs that are inadequate to effectively test the effects 55 ); clinical use of opioids is associated with high risk of overdose and death (the risk has been shown to be low 56,57 -a false meme that derives from the CDC failure to distinguish prescription opioids from synthetic opioids (e.g., fentanyl); the risk of developing OUD is high (various papers differ by over 1000% in estimation of risk and a best estimate is actually about 3% 4 ); and nonmedical approaches to treating chronic pain are to be preferred (when, in the absence of comparative Two opioid crises effectiveness studies, it is impossible to gauge the absolute effectiveness of these methods).…”

Complications in Using Real-World Data to Study the Health of People Who Use Drugs

“…25 Conditioning on prescription opioid exposure may be invalid in recent years where prescription opioid deaths were replaced by illicit fentanyl overdose deaths. 26 Therefore, prescription opioid data should not be used as a proxy for drug or opioid use in general, particularly when applied in risk prediction studies. Yet, these data may be useful when explicitly examining prescription opioids as a treatment, particularly if nonprescription opioid use is rare in the target population.…”

Evaluation of histological and ultrastructural changes provoked by prenatal tramadol

“…As a moderate opioid prodrug, tramadol is administered postoperatively to manage acute pain (Wallin et al 2021). It also acts at µopioid receptor by the reuptake inhibition of noradrenaline and serotonin and is a synthetic analog to codeine (Aubry and Carr 2022). Tramadol abuse is on the rise among adolescents who have a prior history of substance addiction and anxiety.…”