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It is time for someone to say this out loud. “We should not use opioids for back pain.”

Back pain is a common and sometimes disabling condition that af...

No Opioids for Back Pain. Period.

August 16, 2016

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Why are more people dying of opioid overdoses?

December 20, 2016

The Center for Disease Control has released the 2015 data on overdose mortality. The figures are not good (Rudd, Seth, David, & Scholl, 2016).

Since 2014, overdoses from opioids have risen from 28,647 to 33,091—the largest increase ever. As you can see from the graph below, opioid deaths are escalating at a rate faster than any time since this epidemic began. Much of the increase comes from the explosion of heroin and illicit fentanyl overdoses; but make no mistake, these overdoses are a direct result of the overprescribing and abuse of prescription opioids (Muhuri, Gfroerer, & Davies, 2013).



Our country is expanding programs to reduce overdose at a rapid pace. States are increasing the capacity of prescription drug monitoring programs (PDMPs). States are easing access to naloxone, and harm reduction organizations are providing it free to thousands. Drug courts are expanding. Prescribing guidelines and education for using opioids for chronic pain are available everywhere. And yet, overdoses are increasing at record rates. Why?


The marked increase in the availability and acceptability of heroin and illicit fentanyl has changed the natural history of opioid use disorder.  Just a few years ago, we could cut off someone’s supply of opioid pain medications and they would develop withdrawal symptoms and get into treatment. Today, we know that people change to heroin because of availability and cost (Cicero, Ellis, Surratt, & Kurtz, 2014). We must change our tactics, or more people will die.


To make a difference, we need to stop people from starting on opioids. That means fewer prescriptions for acute pain. We also need to change the ubiquitous education on “safe prescribing” to “less prescribing.” There is abundant evidence that fewer opioids result in better outcomes, but Big Pharma does not want you to know about that. (I will talk about that more in my next blog.)


As we reflect on why we are thankful this holiday season, let us respond to that thankfulness by redoubling out efforts in the coming year to reduce the suffering from the scourge of opioids. Let’s continue to improve our PDMPs. Continue (and increase) naloxone distribution. Increase accessibility to treatment for opioid use disorder. But most of all, let’s reduce prescribing. A lot!




Cicero, T. J., Ellis, M. S., Surratt, H. L., & Kurtz, S. P. (2014). The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry, 71(7), 821–6. http://doi.org/10.1001/jamapsychiatry.2014.366


Muhuri, P. K., Gfroerer, J. C., & Davies, M. C. (2013). Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. CBHSQ Data Review, (August).


Rudd, R. A., Seth, P., David, F., & Scholl, L. (2016). Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR. Morbidity and Mortality Weekly Report, 65(Early release), 1–8. http://doi.org/10.15585/mmwr.mm655051e1

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