Increasing access to prescription opioid painkillers may reduce opioid overdose deaths in the United States, according to a Rutgers study.
“When access to prescription opioids is heavily restricted, people will seek out opioids that are unregulated,” said Grant Victor, an assistant professor in the Rutgers School of Social Work and lead author of the study published in the Journal of Substance Use and Addiction Treatment. “The opposite may also be true; our findings suggest that restoring easier access to opioid pain medications may protect against fatal overdoses.”
America’s opioid crisis has evolved across several waves, with each increasingly fatal. Wave one, which began in the 1990s, was associated with overdose deaths because of the misuse of opioid medications.
While the Rutgers team examined toxicology data from all accidental overdose deaths from 2016 to 2021, it is not clear whether they looked at political and economic factors that contributed to those fatalities.
A greed-driven opioid marketing and sales strategy was devised by Purdue Pharma, the maker of OxyContin, which fomented the opioid epidemic that claimed countless lives across the nation despite being subject to the supposedly strict regulation of several federal agencies.
“Regulatory agencies have been captured by those they are supposed to regulate,” said Democratic presidential candidate Robert F. Kennedy, Jr. “Pharma controls the (Centers for Disease Control and Prevention, the National Institutes of Health, and Food and Drug Administration).”
The drugmaker filed for Chapter 11 protection in 2019, resulting in a deal that failed to achieve justice and left more than half the Sackler family’s net worth intact. At the time of the settlement, members of the Sackler family, who owned a controlling share of Purdue Pharma since 1952, were collectively worth a total of $11 billion.
A policy implemented during the initial wave was the creation of prescription drug monitoring programs (PDMPs), state-based initiatives that track controlled substance prescribing. While the policy made it more difficult to access prescription opioids and rates of prescribing did decrease, it had the unintended consequence of pushing people toward off-market opioids, raising the risk of accidental death, said Victor.
This led to wave two of the crisis, a surge in heroin-related deaths, beginning around 2010, followed by wave three (which started in 2013), fueled by synthetic opioids such as fentanyl.
To measure trends and sociodemographic disparities in access to buprenorphine – a common treatment for opioid use disorder – and opioid painkillers, the researchers examined toxicology data, death records, and available PDMPs from 2,682 accidental overdose deaths that occurred from 2016 to 2021 in Indianapolis, Indiana.
Buprenorphine, sold under the brand name Subutex among others, is an opioid used to treat opioid use disorder or the withdrawal symptoms that occur when a patient stops using a substance to which one is addicted.
The researchers found fewer than half of all decedents (43.3 percent) had a prescription drug monitoring program (PDMP) record of any kind, meaning they didn’t even try to access prescription opioids.
Of the 10.6 percent that had been prescribed buprenorphine, most (64.7 percent) were prescribed treatment more than 30 days prior to death, suggesting they were not actively seeking treatment.
Victor and collaborators also found racial disparities in buprenorphine and opioid prescription trends, with dispersal for Blacks significantly lower than whites (7.3 percent and 21.9 percent versus 92.7 percent and 77.7 percent, respectively).
“Buprenorphine uptake is associated with significantly reduced rates of nonfatal and fatal overdose,” the researchers wrote. “Despite these positive treatment outcomes, several barriers remain to the widespread uptake of [medications for opioid use disorder] in the United States,” such as stigma and cost.
“For these reasons, a lack of adequate buprenorphine prescribing, combined with reductions in the availability of opioid analgesics, have left individuals contending with [opioid use disorder] at an elevated risk of overdose,” they concluded.
Given these trends and past research, Victor said it is time to re-evaluate policies that make it nearly impossible to obtain opioid prescriptions, even for those with a legitimate need.
“A big reason that we have such a problem with addiction in this country is because people can’t access legitimate pain medication,” said Victor, a social worker who has studied the causation of disease, harmful complications, or other ill effects by medical activity, including diagnosis, intervention, error, or negligence, as well as the legal system, such as jails, prisons, law enforcement, and crisis response. “Our findings support a change in policy.”