Study puts standard narrative on opioid crisis in doubt

Pharmaceutical companies are taking the blame for the opioid epidemic in America. We’ve all heard the narrative: Americans become addicted to pills prescribed by irresponsible doctors and peddled by unscrupulous drug companies. Many die of an overdose.

There’s no denying that this occurs. However, a new study from Massachusetts strongly suggests that it is not the main reason for the opioid epidemic.

The study found:

Prescription opioids were detected in postmortem toxicology reports of fewer than half of the decedents; when opioids were prescribed at the time of death, they were commonly not detected in postmortem toxicology reports. . .The major proximal contributors to opioid-related overdose deaths in Massachusetts during the study period were illicitly made fentanyl and heroin.

As Alexander Walley, one of the professors who conducted the study, put it:

Commonly the medication that people are prescribed is not the one that’s present when they die. And vice versa: The people who died with a prescription opioid like oxycodone in their toxicology screen often don’t have a prescription for it.

Does this mean that people who receive pain medication (e.g., following surgery) get hooked, switch to illegal drugs when their prescription runs out, and then die from the illegally obtained drugs? Certainly, this occurs. However, John Sexton at Hot Air disputes that it is common. He cites an article by Reason’s Jacob Sullum:

A 2018 BMJ analysis of medical records found evidence of “opioid misuse” in 1 percent of patients who took pain pills after surgery. While studies find that misuse is more common among chronic pain patients, a 2016 New England Journal of Medicine article concluded that “rates of carefully diagnosed addiction” average less than 8 percent.

That study, which was co-authored by Nora Volkow, director of the National Institute on Drug Abuse, noted that “addiction occurs in only a small percentage of persons who are exposed to opioids—even among those with preexisting vulnerabilities.”

In short, the opioid epidemic seems to be less about greedy corporations hooking patients on pills and more about old-fashioned drug dealing by old-fashioned drug dealers — the class of people for whom lenient sentencing is sought by the “jail break” movement on the theory that these are non-violent criminals.

In a way, the assignment of blame to big bad corporations reminds me of the narrative that emerged after the financial crisis of 2008. The left and the media pinned the blame on banks who issued subprime loans. But banks weren’t the main villains.

The main villains were leftist “community organizers,” who demanded a lowering of lending standards so their constituents could buy homes they couldn’t afford, Democratic politicians who pushed this demand, and regulators didn’t step in to deal with the consequences. This is well documented by Gretchen Morgenson, then of the New York Times, in her book Reckless Endangerment (written with Joshua Rosner). When the Bush administration flagged the problem, powerful Democrats like Barney Frank made sure it didn’t rock the boat.

I’m no fan of corporate America. But the opioid epidemic, like the financial crisis, looks like another case of corporations taking a vastly disproportionate share of the blame for the misconduct, and in some cases the sins, of others.

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