On 2017 Dec 24, David Keller commented:

Treating pain versus preventing addiction - finding a balance

In their Viewpoint editorial, titled "Underlying Factors in Drug Overdose Deaths", Dowell and colleagues use the term "prescription opioids" to refer to all opioids that can be obtained by prescription, without distinguishing how they were, in fact, obtained. This nomenclature conflates two very distinct and different categories of opioid users: pain patients taking opioids prescribed by their physician, and persons who abuse opioids without medical indication or supervision. The latter should be designated "abusers of prescription opioids" to avoid creating a false impression of elevated risk from the proper use of prescribed opioids.

The Figure showing alarming increases in "prescription opioid overdose deaths" does not reveal what fraction of these deaths occur in persons who obtain prescription opioid medication by illegal means, such as buying or stealing pills from acquaintances or drug dealers, again inflating the risk of death from the proper use of prescribed opioids.

Overdose deaths should not be reported as "related to prescription opioids" when coexisting levels of alcohol, benzodiazepines, heroin or other illegal narcotics are found in the blood. Deaths from polysubstance abuse creates a falsely high impression of the risk of prescribed opioids when taken as directed.

Doctors know full well that "unnecessary exposure to prescription opioids" is to be avoided, but would the crisis of "prescription opioid overdose deaths" end, even if all "prescription opioids" were outlawed completely? Hint: heroin overdoses did not end when heroin was made illegal. Overdoses of "prescription opioids" by drug abusers will not end, regardless of how diligently doctors reduce the therapeutic use of opioids.

Pain patients are questioned as if they were criminals for needing strong pain medicine, by doctors wary of the legal and regulatory risk of "excessive prescribing" of opioids. Under-treatment of pain becomes inevitable, because clinicians lack time for the extensive documentation, discussions, warnings, contracts, testing, database queries and other precautions which are advised with each opioid prescription.

On 2017 Dec 24, David Keller commented:

Treating pain versus preventing addiction - finding a balance

In their Viewpoint editorial, titled "Underlying Factors in Drug Overdose Deaths", Dowell and colleagues use the term "prescription opioids" to refer to all opioids that can be obtained by prescription, without distinguishing how they were, in fact, obtained. This nomenclature conflates two very distinct and different categories of opioid users: pain patients taking opioids prescribed by their physician, and persons who abuse opioids without medical indication or supervision. The latter should be designated "abusers of prescription opioids" to avoid creating a false impression of elevated risk from the proper use of prescribed opioids.

The Figure showing alarming increases in "prescription opioid overdose deaths" does not reveal what fraction of these deaths occur in persons who obtain prescription opioid medication by illegal means, such as buying or stealing pills from acquaintances or drug dealers, again inflating the risk of death from the proper use of prescribed opioids.

Overdose deaths should not be reported as "related to prescription opioids" when coexisting levels of alcohol, benzodiazepines, heroin or other illegal narcotics are found in the blood. Deaths from polysubstance abuse creates a falsely high impression of the risk of prescribed opioids when taken as directed.

Doctors know full well that "unnecessary exposure to prescription opioids" is to be avoided, but would the crisis of "prescription opioid overdose deaths" end, even if all "prescription opioids" were outlawed completely? Hint: heroin overdoses did not end when heroin was made illegal. Overdoses of "prescription opioids" by drug abusers will not end, regardless of how diligently doctors reduce the therapeutic use of opioids.

Pain patients are questioned as if they were criminals for needing strong pain medicine, by doctors wary of the legal and regulatory risk of "excessive prescribing" of opioids. Under-treatment of pain becomes inevitable, because clinicians lack time for the extensive documentation, discussions, warnings, contracts, testing, database queries and other precautions which are advised with each opioid prescription.