Critic: Limiting opioid prescriptions would worsen overdose crisis

As Pennsylvania deals with an opioid overdose crisis that has caused more than 5,200 deaths in 2021, some proposed solutions may do more harm than good.

A plan to cut down on addiction may simply push more people to illicit, and less-safe, drugs.

House Bill 2781, sponsored by Rep. Ed Neilson, D-Philadelphia, would limit opioid prescriptions in a similar way as they are currently limited to minors.

“​​Research has shown that long-term opioid use often begins with treatment for acute pain,” Neilson wrote in a legislative memo. “This measure would limit opioid prescriptions to seven days for adults, with some exceptions, and require prescribers to discuss the risk of opioid addiction and the option of nonpharmacological alternatives with all of their patients, regardless of age.”

Neilson did not respond to requests for comment from The Center Square.

The problem, though, is that overprescribing isn’t driving the opioid crisis.

“From 2012-now, we actually have achieved the lowest level of prescribing in at least 20 years,” said Jacob Rich, a policy analyst with the Reason Foundation and a PhD student at Case Western Reserve University and the Cleveland Clinic.

Rich noted the consequences of other state laws that tried to rein in opioid prescriptions.

“What started to happen is that, when people who were flagged as potential recreational users or potentially dependent on opioids, they were cut off from their prescriptions – there would be a substitution to the black market,” Rich said.

“It is noble in its intention, but it’s going to have disastrous effects for pain patients, and it’s not going to do anything about limiting the number of deaths,” Rich said of the bill. “If anything, it would increase the number of deaths.”

The changing nature of opioid addiction in the commonwealth is a stark one. While the number of deaths has increased in recent years, the rate of that increase has slowed. However, the reason isn’t that fewer people are struggling with an opioid addiction.

“The number of people recreationally using opioids and the number of people who are addicted to opioids has been dropping for about … seven years,” Rich said. “The reason that is is because they’re dying at a higher rate than they’re replenishing. The opioid death rate is so high that we’re literally killing off the population of drug users. But we actually have one of the lowest opioid addiction rates in at least two decades.”

Addiction isn’t getting treated better in Pennsylvania, it’s that the response hasn’t improved.

“I think that’s actually the major cause: Drug users are just dying off at such a high rate that the population of drug users is in fact getting smaller,” Rich said. “That’s not because we’re solving addiction, it’s just because we’re killing them.”

Pennsylvania isn’t alone in its approach. Few states have figured out how to limit overdose deaths. Federal action has made the problem worse in some ways by giving money for programs that don’t pay off.

“Because they are all copying each other, they’re all failing together,” Rich said of state-level efforts. “The reason they’re failing together is because they’re copying programs that are incentivized by a federal grant, and we know that the prescription drug monitoring programs have only been followed by accelerated rates of death.”

The focus on monitoring prescriptions doesn’t address the problem that deadlier drugs, such as fentanyl, circulate in illegal drug markets. Politicians have an uphill battle in Pennsylvania and elsewhere to limit those deadly drugs.

“Until we realize that those are actually what’s caused the majority of the increase in death and stop doubling down on those (drug monitoring) programs, we’re going to keep fighting the same crisis,” Rich said.

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