CHRIS CHRISTIE, THE outgoing governor of New Jersey, has repeatedly told the story of a law school classmate who died of an overdose after getting hooked on oxycodone prescribed for back pain. A recently released final report from the President's Commission on Combating Drug Addiction and the Opioid Crisis, which Christie chaired, wrongly implies that such cases are typical.
"A widely held and supportable view is that the modern opioid crisis originated within the healthcare system," the report says; the problem began with "a growing compulsion to detect and treat pain."
According to this narrative, doctors in the late 1990s began to underestimate the risk of addiction and overdose among patients prescribed narcotics for pain. Responding to advocacy on behalf of pain patients and deceptive marketing by drug companies, they supposedly began prescribing opioids left and right, leading to a surge in "iatrogenic addiction" (addiction caused by treatment) and overdose deaths.
To correct that disastrous mistake, the Christie commission says, doctors need to worry less about the suffering caused by untreated pain and more about the dangers posed by painkillers. But that conclusion is fundamentally misguided, because the commission's explanation is wrong in several crucial ways.
Opioid addiction and opioid-related deaths typically involve multi-drug users with histories of substance abuse and psychological problems, not drug-naive patients who accidentally get hooked while being treated for pain. Attempts to prevent overdoses by closing off access to legally produced narcotics make matters worse for both groups, depriving pain patients of the analgesics they need to make their lives bearable while driving nonmedical users into a black market where the drugs are more variable and therefore more dangerous.
As Nora Volkow, director of the National Institute on Drug Abuse, noted in a 2016 New England Journal of Medicine article, "addiction occurs in only a small percentage of persons who are exposed to opioids--even among those with preexisting vulnerabilities." A 2010 review found that less than 1 percent of patients taking opioids for chronic pain experienced addiction. A 2012 review likewise concluded that "opioid analgesics for chronic pain conditions are not associated with a major risk for developing dependence." Volkow found that "rates of carefully diagnosed addiction have averaged less than 8% in published studies."
The risk of fatal overdose is even lower....