“Substantially reducing the doses of pain medication prescribed for patients on long-term opioid therapy is associated with a threefold increase in suicide attempts and a 69 percent increase in overdoses, according to a study published this week in The Journal of the American Medical Association (JAMA). The study reinforces concerns that the “tapering” encouraged by federal guidelines as a response to the “opioid crisis” causes needless suffering among patients, leading to undertreatment of pain, withdrawal symptoms, and emotional distress.”
“Although the CDC’s advice was not legally binding, and although the guidance said doses should be tapered only when medically appropriate, doctors, lawmakers, insurers, and pharmacies interpreted the agency’s warnings about daily doses exceeding 90 MMEs as a hard limit. “These and other widely disseminated recommendations have led to increased opioid tapering among patients prescribed long-term opioid therapy,” Agnoli et al. note.”
“The CDC is mulling revisions to its advice. “A revised CDC Guideline that continues to focus only on opioid prescribing will perpetuate the fallacy that, by restricting access to opioid analgesics, the nation’s overdose and death epidemic will end,” Mukkamala warned in his letter to the CDC. “We saw the consequences of this mindset in the aftermath of the 2016 Guideline. Physicians have reduced opioid prescribing by more than 44 percent since 2012, but the drug overdose epidemic has gotten worse.””
“After years of steadily moving in tandem, two of America’s worst public health trends diverged during the coronavirus pandemic.
Drug overdose deaths jumped 30 percent last year to 92,500, according to newly released federal data, a sudden surge following years of incremental increases once the opioid epidemic took hold. But suicides actually dropped slightly, from 47,500 in 2019 to 44,800 in 2020.
Those two trends have tracked closely over the past decade, so much so that there is an umbrella term in academia that encompasses both of them (among other things): deaths of despair. Much of the recent stagnation in US life expectancy can be explained by these premature deaths, concentrated especially among young men, and scholars have theorized about the economic and social conditions driving those trends.
That was the situation before Covid-19. So what happened during the pandemic?”
“Obamacare’s Medicaid expansion, which gave millions of low-income adults access to health insurance, was linked to a 6 percent reduction in opioid overdose death rates — potentially preventing thousands of deaths — according to a new study in JAMA Network Open.
The study looked at what happened in counties in states that expanded Medicaid under the Affordable Care Act by 2017, compared to counties in states that didn’t expand Medicaid, accounting for variables like demographic and policy differences. The Medicaid expansion was made optional in a 2012 Supreme Court ruling, and only 32 states and Washington, DC, had opted to expand by the study period (with the total rising to 37 in the past few years).
The study helps put to rest claims by some Republican lawmakers, particularly Sen. Ron Johnson (WI), that the Medicaid expansion made the opioid crisis worse by expanding access to painkillers. The new study, echoing others before it, suggests the Medicaid expansion had the opposite effect, and that there wasn’t a link between the expansion and more deaths caused by painkillers, with the possible — and relatively uncommon — exception of methadone used in pain treatment.
The researchers found that Medicaid expansion counties had a 6 percent lower rate in opioid overdose deaths than non-expansion counties. That was mostly due to an 11 percent lower rate of deaths involving heroin and a 10 percent lower rate for deaths linked to synthetic opioids excluding methadone”