By R Carter
Since this web site first went up, I’ve been critical of State Pharmacy and Medical Boards regarding their failure to publish data which cross references opioid related poisonings and diagnoses of opioid use disorder (OUD) with data from state prescription drug monitoring programs (PDMP).
Most states have had their PDMP programs up and running for ten years at an average cost to tax payers of $1 billion per year per state. For this cost, the most valuable data published from these programs for public consumption are number of prescriptions written per year, with a claim that reductions in these numbers are a major contributor in reducing opioid overdoses and OUD.
But the fact remains that such claims are nothing more than empty lies as long as states fail to publish data cross referenced against patients diagnosed with OUD or opioid poisoning. There has been one exception, Massachusetts, which published data between 2013-2015 on OUD and overdose deaths, cross referenced against the states PDMP database. The numbers showing only 1.3% of those who died from an opioid overdose had prescription drugs in their system at the time. This is a significantly lower rate than what’s been claimed by other state and federal agencies, such as the CDC.
Sometimes though, with effort and paying attention to detail, it’s possible to get some insight into these numbers through other reports issued by a state. Such is the case for Ohio which published PDMP data cross referenced against ICD-10 codes which must be on every script written for a controlled substance, cross referenced with ICD-10 codes for patients entering a hospital with an opioid overdose or entering treatment for OUD. While not completely comprehensive, the numbers displayed suggest the contribution of prescribed opioids to poisonings and therefore overdose deaths, and the contributions to patients diagnosed with OUD, are significantly lower than what has been reported by the state in press releases. Raising the question, is the $1 billion per state cost to tax payers, really having an impact on the opioid crisis as they claim?
The data from the State Medical Board of Ohio (SMBO) can be found on their website using this link. The two images below were taken from this web-page for two data points, drug poisonings related to opioid prescription written and substance use disorder related to prescribed opioids. It’s not clear from the report if “drug poisonings” includes all types of drugs or just opioids and if “substance abuse disorder” relates only to opioids or all types of substances. Given the context of the report though, it’s assumed that both these terms related only to opioids, otherwise the report would be an apple to oranges comparison.
Image 1 below shows PDMP data or prescriptions written, where the prescription was tied to a subsequent diagnosis code for drug poisonings. It’s not clear which year this data represents, but based on the totals, it likely to be 2018 or 2019 data. If in fact these numbers represent ten years of PDMP data, then they represent such low levels of contribution from prescription, as to be statistically insignificant. And since the ICD-10 classification used represents drug poisonings in general, we must assume from the right side of report, that it represents opioids only, given the quantification of Morphine Equivalent Dosage or MED.
A Grand Total of 110 poisonings out of an estimated 450,000 opioid scripts, means about 0.00024% of all scripts written where associated with an overdose or poisoning. That’s not even statically relevant much less a contributing factor to the opioid crisis.
The 25 percentile MED represents a 20 MED dosage given to these 110 patients. The 75 percentile represents a 40 MED dosage given to these 110 patients. The 25 and 75 percentile of Days’ Supply, represents the number of days’ supply written for the 110 recorded poisonings which was between 3 and 9 days.
What becomes clear from these numbers is that they represent prescription written for short time periods and low amounts, well below the recommended dosage level of 50 MED advocated for by the CDC and in all likeliness, represents acute pain management scenarios of short duration.
That means they don’t represent treatment of chronic non-cancer pain, which happens to be the target group singled out by public health officials, state and federal agencies as the group most likely to be at risk for overdose and abuse of prescription opioids. That’s a substantial disconnect from the rhetoric we hear from our governing leaders.
On the subject of OUD, Image 2 shows the same divisions as Image 1 only these individuals are those who were issued a prescription for an opioid and were subsequently diagnosed as having OUD. This includes a wide range of substance types such as combined formulations used in cough syrups and decongestants, not just opioids for pain management.
Of the 449,745 scripts written, total dosage in the 25 percentile group was 75 MED, for the 75 percentile group the dosage was 130 MED. The Days’ Supply for the 25 percentile group was 7 days, for the 75 percentile group was 24 days.
Based on the Days’ Supply, these groups are also likely representative of short term acute pain of less than 90 days duration, which means they are not chronic non-cancer pain patients. An example would be those who have had a surgical procedure and or a complication following surgery, that results in the use of an opioid beyond the 7 day limit set by the State of Ohio. But the Days’ Supply is also an indication that these individuals do not represent chronic non-cancer pain of greater than 90 days, which is the defining criteria for chronic pain conditions. Yet chronic non-cancer pain is specifically targeted by state and federal regulations, as the group most at risk for OUD or overdose.
Again the rhetoric from government doesn’t sync with the data which is collected and government continues to be silent on accounting for these differences.
Of the fifty US States plus the District of Columbia, none with the exception of Massachusetts, publishes any direct proof to support the claims that prescription opioids are the major contributing substance to opioid overdoses and OUD. Requests from individuals within the chronic pain community for states to publish such direct evidence, continues to be ignored and the $1 billion annual cost per state to taxpayers also continues.
Such silence from states has raised questions as to the validity of the claims they make. Some have floated the possibility that states continue to deceive tax payers, so that states can continue to make a claim in court against pharmaceutical companies and chain pharmacies. It appears that with data no better than what is seen here, the claims of states are in fact a lie, perpetrated by government at tax payer expense, to fatten state coffers with ill-gotten gains from dubious sources.
In fact this is what appears to be happening now in Oklahoma. The state has been awarded a nearly half billion settlement against Johnson and Johnson and shortly afterwards, a squabble began over who will control those funds and what they will be used for. The decision made, one which is not consistent with the claims made by the state before and during the court case. If it continues, it has all the hallmarks of slash and grab effort by the state by those who can profit most from the ruling.
Main stream media continues to ignore the kind of information included in this post, failing to use the resource available to them to uncover truths behind why PDMP data is not used to verify claims made by states on the actual contribution of prescription opioids to the opioid crisis. This allows states to continue perpetrating a false claim and profiting from it at the expense of corporate American. Some corporations may in fact be guilty of something, but a public nuisance worth nearly a half billion, is a stretch when the state has data which would show the actual contribution made by prescription opioids in the opioid crisis.
And as this lie is continually propagated, efforts to thwart abuse and overdose are targeted at chronic non-cancer pain patients who, as evident from this data, either never represented the sources of abuse or poisonings, or no longer do. Yet the narrative remains unchanged as States plan how they will pick the pockets of corporate America and blame chronic non-cancer pain management, as the cause.