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Physicians who prescribe opioids for the treatment of pain are being held partly responsible for the sharply rising rates of opioid abuse and fatal overdose. The epidemic of opioid overdoses continues to worsen, despite restrictive measures by the Drug Enforcement Administration, such as the escalation of all opioids to Schedule II, including the least-potent, fixed-dose combination analgesics.
As a result, combinations such as hydrocodone/acetaminophen, which were formerly on the less-restrictive Schedule III, can no longer be routinely phoned in, nor prescribed in the less-expensive 90-day supplies offered by insurers.
While such restrictions on the availability of opioid pain medications may exert a beneficial effect on reducing the overdose rate, they also inevitably make it more difficult for patients to obtain opioids for the treatment of appropriate diagnosed pain syndromes.
"Illicit opioids" are illegal Schedule I drugs, like heroin, or nominally Schedule II drugs produced illegally. In recent years. The U.S. has been inundated with highly potent illegally manufactured fentanyl ("IMF" or "fake fentanyl"), which now accounts for the largest category of overdose deaths.
One study of overdose deaths in the U.S. reported that, among the 42,249 opioid-related overdose deaths in 2016, 40.4 percent involved prescription opioids. This finding may seem to imply that these overdose victims died as a result of taking opioids prescribed by physicians, perhaps even taking them as directed. However, the study’s authors actually were counting in this category all overdose victims who had any detectable prescription opioid in their blood, regardless of whether the opioid was actually prescribed by a physician or obtained illegally, and regardless of how many other drugs were present in the victim's blood.
Thus, a victim could take one stolen or diverted 5 mg hydrocodone tablet (a “prescription opioid") followed by a fatal intravenous overdose of street heroin, and the overdose would be included among those "involved with prescription opioids."
The data for this study were derived from death certificates of the overdose victims, a source which does not record how much of the opioid in their blood was from medication prescribed by a physician. And while we can infer that many patients had multiple opioids in their blood, there is no breakdown of which opioids were present at levels likely to have caused the fatal overdose.