# Opioids not actually all that deadly? **URL:** \ **Category:** Great Debates\ **Created:** [June 6, 2016, 11:42pm UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688 "2016-06-06T23:42:26Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 6, 2016, 11:42pm UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/1 "2016-06-06T23:42:26Z")
> **['Opioid Epidemic' Myths](https://reason.com/2016/05/18/opioid-epidemic-myths/)** > > Prescription painkillers are not as deadly or as addictive as commonly claimed. It’s a Reason article, and so it has a political motivation, but it also brings cites with it. Notably this one: > [@](#): > > Despite the decline in use, opioid-related deaths reported by the U.S. Centers for Disease Control and Prevention (CDC) continued to rise through 2014, when there were 29,467, a record number. An overwhelming majority of such deaths—more than nine out of 10, according to data from New York City—involve mixtures of opioids with other drugs rather than straightforward overdoses. > > That pattern, illustrated by the untimely ends of celebrities ranging from Janis Joplin to Philip Seymour Hoffman, suggests that the most effective way to prevent opioid-related deaths is to discourage people from combining painkillers or heroin with other drugs, especially depressants such as alcohol and benzodiazepines. It also suggests that the inherent deadliness of opioids has been greatly exaggerated. > > The CDC says “health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills.” That year the CDC counted about 16,000 deaths involving opioid analgesics, or one for every 16,000 or so prescriptions. > > Opioid-related deaths are rare even for patients who take narcotics every day for years. The CDC cites “a recent study of patients aged 15–64 years receiving opioids for chronic noncancer pain” who were followed for up to 13 years. The researchers found that “one in 550 patients died from opioid-related overdose,” which is a risk of less than 0.2 percent. It seems to me that we have a very real recreational opioid abuse problem, but that attacking the problem at the medical end is pretty stupid. People aren’t dying because doctors prescribe too many painkillers, people die because painkillers are a recreational drug which only becomes really dangerous when combined with other drugs or alcohol. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [June 6, 2016, 11:48pm UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/2 "2016-06-06T23:48:04Z")
It isn’t just combining opioids with CNS depressants that is deadly, combining them with stimulants is deadly too. The reason is stimulants mask the impact the depressants are having, which cause you to take a higher dose of depressants. Since cocaine has a half life of 1 hour while morphine has a half life of 6, you may take a ton of heroin thinking you can handle it because the cocaine is keeping you awake, but once the coke wears off you OD and die. > **[Speedball (drug)](https://en.wikipedia.org/wiki/Speedball_(drug)#Notable_deaths_attributed_to_speedball_use)** > > Speedball, powerball, or over and under is the polydrug mixture of a stimulant with a depressant, usually an opioid. The most well-known mixture used for recreational drug use is that of cocaine and heroin; however, amphetamines can also be mixed with morphine and/or fentanyl. A speedball may be taken intravenously or by nasal insufflation. > Speedballs often give stronger effects than either drug when taken alone due to drug synergy, and are a particularly hazardous mixture that can easily caus... > [@](#): > > Because the stimulant effects of cocaine wear off far more quickly than the depressant effects of heroin or morphine, fatal respiratory depression often occurs when the full effects of a heroin or morphine overdosage are felt in isolation. Due to the countering effect of the cocaine, a fatally high opioid dose can be unwittingly administered without immediate incapacitation, thus providing a false sense of tolerance until it is too late. This form of delayed opioid overdose is believed to be the most common mechanism of death in speedball overdoses. I’m currently reading Duff McKagans biography, he talks about how when he discovered mixing alcohol with cocaine, he was able to drink 2-3 times as much alcohol as normal. The cocaine kept his body awake with all the extra alcohol. But if the coke wears off first, then you just have 2-3x more alcohol in your system than normal and nothing to balance it out. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 6, 2016, 11:50pm UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/3 "2016-06-06T23:50:06Z")
But doesn’t that mean that worrying about prescriptions is barking up the wrong tree? Isn’t this primarily a street drug issue, just like meth or crack? ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [June 6, 2016, 11:55pm UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/4 "2016-06-06T23:55:01Z")
I don’t know the details, but I’m cynical enough to not think politicians or the DEA have the well being of the public in mind when they propose policy regarding drugs. I do know some chronic pain patients who have been forced to resort to heroin because they can’t get their legal pain pills anymore. ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [June 7, 2016, 12:04am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/5 "2016-06-07T00:04:02Z")
> [@adaher](#): > > But doesn’t that mean that worrying about prescriptions is barking up the wrong tree? Isn’t this primarily a street drug issue, just like meth or crack? No. People often become addicted to legitimate prescriptions, and when they can no longer access the drug, or afford it, they turn to heroin (street drugs). ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 7, 2016, 12:05am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/6 "2016-06-07T00:05:51Z")
Are they addicted because they use it recreationally, or because they have this medical problem known as PAIN? ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 7, 2016, 12:07am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/7 "2016-06-07T00:07:28Z")
Also, while addiction is never a good thing, if it’s purely an addiction based on medical need, the cites show that the risk is still very low for people who use these drugs as directed. ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [June 7, 2016, 12:08am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/8 "2016-06-07T00:08:38Z")
It often starts with the pain, but then turns into an addiction after the pain is gone. I mean, it’s not like doctors are prescribing these things just to get people addicted to them. ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [June 7, 2016, 12:10am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/9 "2016-06-07T00:10:50Z")
> [@Wesley\_Clark](#): > > I do know some chronic pain patients who have been forced to resort to heroin because they can’t get their legal pain pills anymore. It’s hard to believe this is the whole story with these people. If someone has a _legitimate_, ongoing pain issue, while they may have to jump thru additional hoops, it shouldn’t be impossible to get the medicine they need. OTOH, patients who _began_ as legitimate pain patients, may become addicted and when their “legitimate” source dries up they turn to heroin. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 7, 2016, 12:15am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/10 "2016-06-07T00:15:25Z")
Isn’t it the responsibility of medical professionals to properly wean people off these drugs? I would think that any doctor that just cut someone off would be committing malpractice. One doesn’t just stop using opioids cold turkey. ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [June 7, 2016, 12:19am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/11 "2016-06-07T00:19:42Z")
> [@adaher](#): > > Isn’t it the responsibility of medical professionals to properly wean people off these drugs? I would think that any doctor that just cut someone off would be committing malpractice. One doesn’t just stop using opioids cold turkey. It’s the patient’s responsibility to properly carry out the doctor’s instructions re titration. No doctor can ensure a patient’s compliance. If an addiction has already taken root in the patient, weaning off is not an option (in their minds). ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 7, 2016, 12:27am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/12 "2016-06-07T00:27:09Z")
According to the article though, even that’s not a huge risk. Less than 1% turn into addicts. It never hurts to remind patients and doctors of the risks of that course of treatment, but what the government is doing to put roadblocks in the way of access to medicine does not seem to be likely to help and will only hurt legitimate patients. ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [June 7, 2016, 12:27am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/13 "2016-06-07T00:27:34Z")
> [@adaher](#): > > Are they addicted because they use it recreationally, or because they have this medical problem known as PAIN? Taking a narcotic painkiller for an extended time, _for any reason_, will result in physical dependence and in many cases, addiction as well. The myth that you don’t get high from painkillers if you are taking them for pain is just that, a myth. ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [June 7, 2016, 12:31am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/14 "2016-06-07T00:31:07Z")
> [@adaher](#): > > According to the article though, even that’s not a huge risk. Less than 1% turn into addicts. > > It never hurts to remind patients and doctors of the risks of that course of treatment, but what the government is doing to put roadblocks in the way of access to medicine does not seem to be likely to help and will only hurt legitimate patients. 1% of how many people? ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [June 7, 2016, 12:41am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/15 "2016-06-07T00:41:33Z")
> [@Ambivalid](#): > > 1% of how many people? 259 million prescriptions. So we’re still talking about millions of people. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 7, 2016, 1:07am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/16 "2016-06-07T01:07:46Z")
So we harm the 99% to help the 1%? ---
**Author:** ![monstro](https://avatars.discourse-cdn.com/v4/letter/m/ba9def/32.png) [@monstro](https://boards.straightdope.com/u/monstro)\ **Post date:** [June 7, 2016, 1:12am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/17 "2016-06-07T01:12:04Z")
A couple of years ago I was prescribed hydrocodone after I got oral surgery. I still have the bottle. It’s almost completely full. Why? Because each dose made me nauseous. I decided I would rather deal with the pain. I’m guessing the 259 million prescriptions includes a lot of people like me. Folks in pain but not serious pain. When it’s not that bad and the pain is going to resolve itself after a week anyway, of course you aren’t going to get people popping pills. I’m guessing the likelihood of addiction steeply increases when the pain is chronic and severe. If we were to use the number of patients with severe and chronic pain as the denominator, what percentage would be classified as “addicts” then? I’m guessing a whole lot more than 1%. Just for interesting reading: [Why the opiod epidemic has hit West Virginia so hard.](http://www.businessinsider.com/why-the-opioid-epidemic-is-so-bad-in-west-virginia-2016-4) ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [June 7, 2016, 1:14am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/18 "2016-06-07T01:14:32Z")
> [@adaher](#): > > So we harm the 99% to help the 1%? Again, those with legitimate pain issues may have to jump thru additional hoops to get their meds but it’s certainly not impossible. I’m a perfect example myself; I’ve been a chronic pain patient for almost a decade and I have not been harmed by any of the law changes. ---
**Author:** ![ZipperJJ](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/zipperjj/32/211_2.png) [@ZipperJJ](https://boards.straightdope.com/u/ZipperJJ)\ **Post date:** [June 7, 2016, 1:15am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/19 "2016-06-07T01:15:43Z")
My friend’s 25 year old brother (a nursing student) was on opioids for back pain and became addicted, went to rehab, learned about heroin and where to get it, and 3 days out of rehab died of a heroin overdose. The threat is real. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 7, 2016, 1:16am UTC](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688/20 "2016-06-07T01:16:55Z")
Jumping through hoops is fine. Taking the hoops away entirely is not. My wife is prescribed low dose fentanyl patches. Most drug stores don’t have them in stock. So I asked them at first, back when I was naive, “Okay, can you order them?” “Sure!” they sometimes said. “Come back Friday.” I did. And then they explained that the order was denied. For what reason? Did the pharmacy issue painkillers without a prescription? Nope, nothing that blatant. [Next page](https://boards.straightdope.com/t/opioids-not-actually-all-that-deadly/756688.md?page=2)