Monday, September 25, 2017

Prescription Opioid Abuse Is Declining

And the government failing to disclose it. I wrote about this in my previous post, but I think this is important enough to give it its own post.  The two graphs below are from page 7 and 26 of the SAMHSA's Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health (here).

The top chart plainly shows that past month prescription opioid abuse is flat over the past decade or so, the era in which we supposedly saw an exploding opioid epidemic due to "over"-prescription of opioids (in some observers' estimations). The second chart shows that prescription opioid-related substance abuse disorders are also flat over the same period, even decreasing for some age demographics. 

In the 2016 version of this document, both of those charts go missing, even though the report shows similar graphics for all the other drug categories covered (cocaine, heroin, alcohol, marijuana, tobacco...). Why suddenly remove this information? I'd think the readers of this document would want to know that this trend is flat, particularly since they're hearing elsewhere that there's an "opioid epidemic" in this country. Like I say in my earlier piece, this is probably due to a methodology change in 2015 in which they started asking about "opioid misuse" and "any opioid use", which might make the numbers not directly comparable. But the question about "opioid misuse" is basically the same as the question from prior years, so I think they should have included it. It's not like adding the question about "any opioid use" dramatically changed the number of reported illicit opioid users. You can look at comparable sections of the text of both the 2014 and 2016 version. Here, once again, is my previous post:
[T]hat report says: "In 2016, an estimated 1.8 million people aged 12 or older had a pain reliever use disorder, which represents 0.7 percent of people aged 12 or older." That report, which I hadn't seen until just today, actually does not include the charts displaying the trend in prescription painkiller misuse and substance use disorders from 2002 to present (the charts shown above in this post). Why not? Why weren't those charts updated for the most recent report. Well, the 2014 version says, "The estimated 1.9 million people aged 12 or older in 2014 who had a pain reliever use disorder (Figure 31) represent 0.7 percent of the people aged 12 or older." The number of people with a substance abuse disorder regarding painkillers decreased by 100,000 people in the last two years. Is SAMHSA trying to disguise a decline in a widely publicized problem? Shame on them if they are.

I can find a similar duo of quotes about declining "past month use". The 2014 report says: "The estimated 4.3 million people aged 12 or older in 2014 who were current nonmedical users of pain relievers represent 1.6 percent of the population aged 12 or older." The 2016 report says: "An estimated 3.3 million people aged 12 or older in 2016 were current misusers of pain relievers, which represents 1.2 percent of the population aged 12 or older." Once again the chart is missing from the 2016 version of the report; if it were there it would show a sharp decline in past month painkiller misuse in 2016. Past month recreational use of prescription painkillers decreased by a million people, and the government is disguising this decline? My best non-cynical explanation for removing the charts is that 2015 was the first year that they started asking about "illicit painkiller use" and "any painkiller use" (previously they had just asked about illicit use). But then they should show the graph but have a footnote about the methodology change, like the Monitoring the Future report does.
And I include the following chart from the MTF report, showing what an appropriately-disclosed methodology change looks like:

I don't think there's some massive conspiracy to disguise a flat or declining trend here. In fact, I'd think the government would want to advertise its "success" in turning around a social problem. (Scare quotes around "success" because prescription opioid overdoses haven't declined, and any causal connection between the decline and some government policy would be suspect.) An editorial decision to remove that chart was made for some reason, though. This is pretty sloppy work, in my opinion.

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