Both cigarettes and opioids are highly addictive – and can be fatal. Both of these substances are sold by profiteering companies using science that has been twisted by spinning or outright lies. Both have become the subject of multi-billion dollar lawsuits.
But opioids are not cigarettes. As the opioid settlement is finally nearing completion, it is important not to misuse the lessons learned from tobacco. Fundamentally, this means accepting that—unlike cigarettes—opioids have real uses in painkillers and addictive drugs.
However, so far, we are doing the opposite. We fail to realize that some people with intractable pain can benefit from opioids, and instead continue to reduce their access-usually without providing affordable and effective alternatives.
Rather than admit that the closure of “pharmaceutical factories” and the identification of “doctor shoppers” more often prompt people to take dangerous street drugs rather than recover, we often give up withdrawing patients. Rather than admit that the best treatment for opioid addiction—the only drug that has been shown to reduce mortality by 50% or more—is medical opioids (usually buprenorphine or methadone, but Some countries use heroin), we mainly provide treatment based on abstinence.
Understanding where the analogy between opioids and cigarettes is — and where it goes astray — can guide better policies.
First, unlike cigarettes, interrupting the supply of opioids may lead to death rather than cure.A recently published study of more than 100,000 patients American Medical Association Checked the dose reduction in the population People who have taken opioids for at least one yearResearchers expect these cuts to reduce the risk of overdose.
Conversely, no matter how fast or slow the gradual decrease of the drug is, the decrease in opioids almost doubles the chance of overdose in patients. Compared with those with stable doses, these patients are more than twice as likely to be hospitalized due to psychiatric problems than suicide attempts.
Early research supports these findings.A study found that the patients who rapidly reduced the dose were The likelihood of suicide increased nearly four times. Another study of veterans showed that suddenly quit smoking Suicide risk increased sevenfold For those who have been receiving opioids for a long time.
Because Five million to eight million Americans are currently taking opioids to treat chronic pain. These data indicate that many of today’s overdose and suicide cases may actually be the result of our attempts to alleviate the crisis.
In contrast, quitting smoking can increase life expectancy (although it can sometimes increase depression in disadvantaged groups). Even so, our strategy against large tobacco companies does not involve making cigarettes legally unavailable to current smokers. In fact, during the settlement negotiations, the complete ban on cigarettes — or the provision of cigarettes only when it is becoming increasingly difficult to obtain a prescription — was not even on the table, because regulators realized that this would cause a huge, dangerous The black market.
The same caution does not apply to opioids. Since 2011, the number of prescriptions has dropped by at least 60%, mainly due to the increase in the prescription monitoring database and the prosecution of “pharmaceutical” doctors. The repression frightened even legitimate doctors, as well as fear of giving up chronic pain patients — and anyone else who might be addicted.
Not surprisingly, this creates a fortune for distributors—their products are different from legal drugs, are not regulated, and vary greatly in dosage and purity. As a result, the number of overdose deaths has more than doubled with the decrease in prescriptions, reaching a record high of more than 93,000 in 2020.
However, the anti-opioid fighters have been in hot pursuit and continue to learn the wrong lessons from the history of tobacco. Big pharmaceutical companies lie about the benefits of opioids, just as big tobacco companies lie about cigarettes. Therefore, they believe that any positive claims about opioids must be suppressed and medical supplies must be further reduced.
This method obscures the fact of addiction that is vital to prevention and treatment. On the one hand, most opioid addiction does not start with medical treatment. 80% of people who start abusing prescription opioids get them from friends, family members, or other illegal sources rather than doctors—almost all addicted people have already used other drugs, such as cocaine or methamphetamine.
In addition, addiction usually begins in youth, 90% of which begin in adolescence or early adulthood experiments. On the contrary, chronic pain often appears in middle or old age.
Therefore, according to a review co-authored by the director of the National Institute of Drug Abuse, less than 8% of people who take opioids for pain for a long time will develop new addiction problems. In fact, this age group has the highest rate of opioid prescriptions — people over 65 — and the lowest rates of addiction and overdose. (No, this research was not funded by large pharmaceutical companies, even though they used some of them very dishonestly.)
It’s hard to stop teenagers from taking drugs for grandma’s misery. Policies aimed at minimizing surplus pills prescribed for acute pain make sense—as does the provision of safe storage for needed medications. But our current strategy to reduce prescriptions for chronic pain has failed.
Although caution is needed when applying tobacco history to opioid policy, the settlement does provide a clear warning lesson: use the money well.
Cigarette manufacturers have paid approximately $246 billion—but almost all of it has fallen into the general funds of the states. For example, in fiscal 2021, less than 3% of the US$27 billion allocated are directly used for smoking cessation and prevention.
To do better, we must strictly target opioid funds and use them wisely. This means shifting from cutting supply to helping.
First, the doctor must be allowed to continue to prescribe the medicine Patients already taking opioids-don’t worry about doing so responsibly will cause them to lose their license or freedom. Millions of “legacy patients”-and future patients who have exhausted other options-need a legal safe haven so they don’t die from the reduced dose designed to save them.
Second, addicts need better care: arrest or expulsion for suspected abuse is not treatment. When doctors diagnose opioid addiction, they should be able to legally prescribe methadone or buprenorphine on the spot without having to send the patient to a restricted clinic. In addition, rehabilitation centers that do not provide drugs or devalue drugs should not receive government or insurance funds.
In short, we need to use settlement funds for proven effective care and stop prioritizing
Prescription monitoring and enforcement. Despite the dangers, there are currently no substitutes for these drugs. Although a world without smoking is desirable, a world without opioids is a painful world.
This is an opinion and analysis article, and the opinions expressed by the author or author are not necessarily those of the author Scientific american.