Does Restricting Prescription Opioids Save Lives In The Long Term?

By Beth Leipholtz 03/05/19
A new study found that over a five- to 10-year period, policies limiting the prescription of opioids would initially increase deaths as many individuals turn to heroin or fentanyl.
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doctor denying prescription opioid to patient

Combating the opioid epidemic is complicated for a number of reasons—one of which, according to new research, is that cutting back on prescriptions may cause more deaths in the short-term, despite saving them in the long-term.

This information comes from a simulation study recently published in the American Journal of Public Health. The study determined that over a five- to 10-year period, policies limiting the prescription of opioids would initially increase deaths as individuals may turn to heroin or fentanyl.

The simulation study was led by Stanford University researchers Allison Pitt, Keith Humphreys and Margaret Brandeau.

“This doesn’t mean these policies should not be considered,” said Humphreys, who was a former senior policy adviser at the White House Office of National Drug Control Policy (ONDCP) during the Obama administration. “Over longer periods, they will reduce deaths by reducing the number of people who initiate prescription opioids.”

Austin Frakt, director of the Partnered Evidence-Based Policy Resource Center at the VA Boston Healthcare System, wrote in a New York Times opinion piece that restrictions on prescribing opioids seem to be a logical response to curbing the crisis. As many as 80% of heroin users in the U.S. are estimated to have previously used prescription opioids.

However, the idea of limiting prescriptions becomes more complicated when individuals who are truly in need of the medications for pain management are taken into account. 

It’s a situation in which there has to be a trade-off of some sort, according to Frakt.

“This is the fundamental trade-off opioids present, with which we have been battling for decades,” Frakt writes. “As the pendulum swung further toward treating pain, opioid-related deaths ballooned. Now to stem the deaths, it is swinging back, challenging us to treat pain in other ways.”

According to the researchers of the simulation study, there is no one policy that would solve the crisis or even make a significant difference. The policy that could be most effective, according to the researchers, is increasing access to naloxone, an opioid overdose antidote. Even so, this would likely only bring the deaths down about 4% over the next decade. 

“Expanding access to naloxone is inexpensive and saves lives,” Pitt said. “That’s an attractive combination, but we should be realistic that it will only save a small percentage of opioid deaths.” 

As such, researchers note that combining policies such as increasing naloxone access, expanding treatment and more needle exchanges could help to save twice that number of lives. 

“Policy interventions can prevent many deaths, as well as the other destruction that opioids bring to individuals, families and communities,” Frakt concludes. “But prescription opioids are neither all bad nor all good. Policies that sound sensible—potentially helping many people—could also cause a lot of damage, particularly in the short run.”

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Beth is a Minnesota girl who got sober at age 20. By day she is a website designer, and in her spare time she enjoys writing about recovery at www.lifetobecontinued.com, doing graphic design and spending time with her boyfriend and three dogs. Find Beth on LinkedInInstagram and Twitter.

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