50M Americans have chronic pain, assume 10M (20%) are on opioids. 76B pills over 10 years is 7.6B per year, so 760 pills per [chronic pain + opioid] person per year. Take 4 pills per day or 120 per month or 1440 per year. So basically 6 months of therapy for every chronic pain patient in the US.
Unfortunately for a lot of patients, opioids are the only thing that works.
Some of the issues activists are still working on are quality of life aspects of health care: for instance, Most policies will pay for the amputation of a diabetic patient's foot but NOT for a $50 pair of properly fitting shoes.
This is my 2 cents: I was looking for access info on the DEA database referenced here and found your discussion interesting. Thanks for the tips on getting past WAPO's paywall!
> No study evaluated the effectiveness of risk mitigation strategies on outcomes related to overdose, addiction, abuse, or misuse. Evidence was insufficient to evaluate benefits and harms of long-term opioid therapy in high-risk patients or in other subgroups.
> CONCLUSIONS: Evidence on long-term opioid therapy for chronic pain is very limited but suggests an increased risk of serious harms that appears to be dose-dependent. More research is needed to understand long-term benefits, risk of abuse and related outcomes, and effectiveness of different opioid prescribing methods and risk mitigation strategies.
This doesn't show they aren't effective.
Sanity check: 19.6 million people * 4 pills per day * 6 years ~= 172bn pills. That's over _double_ the actual number, suggesting high-impact chronic pain sufferers are, on average, only taking 2 pills per day.
[1] https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm
Edit: I overlooked that this only covers oxycodone and hydrocodone, and not the other opioids, but as they account for 3/4 of the total opioid pill shipments[2], it doesn't change the picture much (76bn * 4/3 ~= 101bn, which is still well under the number I posited above).
That's not to say there isn't an issue with diversion, but in terms of raw numbers, it doesn't seem excessive.
[2] https://www.washingtonpost.com/graphics/2019/investigations/...
Nobody has an incentive to audit their supply chains or doctor RXs to verify that of course.
The answer is plausible deniability. Nobody in the chain has specific knowledge of wrongdoing and nobody seeks it out.
I personally think we should just be able to buy any drug we want at a convenience store, but what do I know?
An interesting problem that I still haven't resolved.