Substandard Research used in the War on Opioids

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By R Carter

The NIH has an annual budget of around $30 billion each year for research. In 2014 $5.3 billion was spent on cancer research,  $1.2 billion heart disease, $1 billion on diabetes and about $200 million on chronic pan. Yet the cost to society for chronic pain is more than twice of all these combined.

The CDC, HHS, AMA and FDA as well as practicing physicians have pointed out in multiple publications that there is insufficient research evidence to support the government’s current policy on restricting or limiting the medical use of opiates as a deterrent to opiate abuse. Despite this, policy makers, medical boards, hospitals and clinics continue to adopt policies, some of which advocate for a 90% reduction in the use of opiates for hospital inpatients having surgery or other painful procedures. 

When asked how can such actions be justified, you’ll hear the default answer of opiate related deaths. Yet data being collected on this has started painting a very clear picture that these opiate related deaths occur in individuals primarily using illicit drugs, multiple illegal drugs and for those that do involve a prescribed opiate, at least 90% of the overdose deaths include one or more other drugs obtained through illegal sources.

Despite this growing volume of data from all across the nation, the research which gets the headlines continues to be of the type which fosters the lie that the use of opiates results in high levels of abuse and addiction. In this study the number of patients still using opiates 90 days post-op was 6.2% and it’s characterized as being high. An unjustified label bearing in mind the confounders which were not taken into consideration.  And without so much of an effort to make a few clicks for fact checking, the lie continues to be propagated in the media.

For example this article from MedicineNet, headlines a cohort study done by a University of Pittsburgh team with the tagline, “People given opioids for the first time in the hospital are likely to continue getting them for months after, a new study reports“.  The cohort study was lead by Julie Donohue, a professor of health policy and management.

On closer examination of the research there are a number of confounders which when taken into consideration, exposes the absurdity of the tagline used by MedicineNet.

  1. It’s a cohort study, meaning there was no control group, no double blind controls to prevent research bias, only a review of patient data collected not by the researchers but by other third parties. Cohort studies are considered the least reliable form of research for these reasons.
  2. No consideration was given to patient histories, age, gender or other demographics, or types of medical procedures under which the opiates were given.
  3. No consideration was given for complications which may have occurred following surgery which changed the course of care patients needed.
  4. The patient populations were limited to a small geographical area, meaning that local trends, standards of care, medical board guidelines, variations in hospital policy and other factors which influence decision making were not taken into consideration.

The only credit that can be given to the researcher is the fact that they acknowledged the fact that there were multiple confounders which were not taken into consideration. Yet I doubt a media outlet picking up on the published report even knows what a confounder is.

My biggest gripe continues to be the fact that studies like these get press and are reported as fact, implying and reinforcing the worst fears the public has, while hard data currently collected and reported by states and now the CDC are showing that the entire premise on which the opiate crisis has been built is turning out to be an embarrassment of presumption. Yet these facts go unreported by news and media. I’m not sure what to make of it except to say that it underscores the gullibility of the public and the bias of researchers and the press.

When organizations portray themselves as rational representatives of research using unbiased science, yet they only report one side and use the worst types of science to do that, then clearly they are not reporting science at all, but are instead a publisher of opinion and ideology. The same goes for news and media outlets who don’t fact check sources for appropriate truth and context.

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