The Lethal Success of Pain Pill Restrictions
Jacob Sullum
Reason
May 9th, 2018
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Jacob Sullum
Reason
May 9th, 2018
In a speech on Monday, Attorney General Jeff Sessions said the Justice Department is striving to "bring down" both "opioid prescriptions" and "overdose deaths." A study published the following day suggests those two goals may be at odds with each other, highlighting the potentially perverse consequences of trying to stop people from getting the drugs they want.
Columbia University epidemiologist David Fink and his colleagues systematically reviewed research on the impact of prescription drug monitoring programs (PDMPs), which all 50 states have established in an effort to prevent nonmedical use of opioid analgesics and other psychoactive pharmaceuticals. Reporting their results in the Annals of Internal Medicine, Fink et al. say the evidence that PDMPs reduce deaths involving prescription opioids is "largely insufficient," adding that "implementation of PDMPs may have unintended negative outcomes - namely, increased rates of heroin-related overdose."
The review covers 17 studies, 10 of which looked at the relationship between PDMPs and deaths involving narcotic pain relievers. Three studies "reported a decrease," six "reported no change," and one "reported an increase in overdose deaths."
The picture looks worse when you take into account deaths involving illegally produced drugs, which now account for a large majority of opioid-related fatalities. Fink et al. found six studies that included heroin overdoses, half of which reported a statistically significant association between adoption of PDMPs and increases in such incidents.
To the extent that PDMPs succeed in making pain pills harder to obtain, they encourage nonmedical users to seek black-market substitutes. "Changes to either the supply or cost of prescription opioids after a PDMP is instituted," Fink et al. observe, "might reasonably drive opioid-dependent persons to substitute their preferred prescription opioid with heroin or nonpharmaceutical fentanyl."
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