U.S. Prescription Opioid Deaths the Headlines You Don’t See Published

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Very few journalist and for that matter, Congressman or Senators, will take the time to actually read the details on publications from government agencies, relying instead on headlines and summary conclusions to form an opinion. I believe this is the single largest cause for why the message around prescription opiate overdose deaths continues to be reported inaccurately.

And for those who actually read the details, I often wonder if they bother to pay attention to what is not said, asking appropriately hard questions for how and why the data from these agencies is reported the way it is.

When the NCHS or CDC report opiate overdose deaths at a national level, they report on the following causes and classifications of death:

  • Types of Opiates
    • T40.1 (Heroin)
    • T40.2 (other opioids) these are prescribed opiates
    • T40.3 (Methadone)
    • T40.4 (Other synthetic narcotics) Fentanyl and derivatives, Tramadol and non-natural occurring opioids.
  • Accidental poisoning by and exposure to noxious substances
    • X40 (non-opioid analgesics, antipyretics and antirheumatics)
    • X41 (antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified)
    • X42 (narcotics and psychodysleptics [hallucinogens], not elsewhere classified)
    • X43 (other drugs acting on the autonomic nervous system)
    • X44 (unspecified drugs, medicaments and biological substances)
  • Intentional self-poisoning
    • X60 (nonopioid analgesics, antipyretics and antirheumatics)
    • X61 (antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified)
    • X62 (narcotics and psychodysleptics [hallucinogens], not elsewhere classified)
    • X63 (other drugs acting on the autonomic nervous system)
    • X64 (unspecified drugs, medicaments and biological substances)
  • X85 (Assault by drugs, medicaments and biological substances)
    • i.e. Murder, Homicide…
  • Undetermined intent
    • Y10 (nonopioid analgesics, antipyretics and antirheumatics)
    • Y11 (antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified)
    • Y12 (narcotics and psychodysleptics [hallucinogens], not elsewhere classified)
    • Y13 (other drugs acting on the autonomic nervous system)
    • Y14 (other and unspecified drugs, medicaments and biological substances)

Reports on opiate overdose deaths from these classifications should in fact only report codes T40.1-4, X42, X62, X85 or Y12. But that is not how government works, they report it all and journalists and legislators accept this without question.

At typical report includes all codes in the ordered list above from 1999 – 2017 there were 768,044 deaths or 13.3% of the population over an 18 year period. See Table 1.

When non-opiate causes of death are removed, using only codes T40.1-4, X42, X62, X85 and Y12, there are 229,304 overdose deaths or 4.0% of the population over 18 years. See Table 2.

The other headline heard so often is how prescription opiates are the cause for all opiate related deaths. Here again we can use codes from the CDC and NCHS of T40.2, X42, X62, X85 and Y12, resulting in 86,646 overdose deaths or 1.5% of the population over an 18 year period. See Table 3.

But even this number doesn’t accurately reflect the chronic pain community. Removing causes of death which are accidental, intentional, homicide but still unexplained and there are 8,208 overdose deaths or 0.1% of the population over the last 18 years. See Table 4.

The problem with reported headlines, they make grand assumptions about chronic pain treated with opiates, never having looked at the specific causes and relationships. There’ll be those who argue that excluding these codes assumes chronic pain patients don’t accidentally overdose or intentionally commit suicide.

Until someone can prove such claims, I’m going to assume chronic pain patients are rational, well managed, employed or retired, who follow doctor’s orders, are not abusing nor are they depressed from being under medicated, nor being killed off by a family member or an acquaintance, .

After all, isn’t this how the anti-opiate zealots see themselves, as both rational and practical?

References:

How Prescription Opiate Overdose Data is Collected – Part 1

How Prescription Opiate Overdose Data is Collected – Part 2

How Prescription Opiate Overdose Data is Collected – Part 3.1

How Prescription Opiate Overdose Data is Collected – Part 3.2

 

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