Jeffrey A Singer,1–3 Jacob Z Sullum,4,5 Michael E Schatman6,7



1Valley Surgical Clinics, Ltd., Phoenix, AZ, USA; 2Department of Health Policy Studies and Center for the Study of Science, Cato Institute, Washington, DC, USA; 3Goldwater Institute, Phoenix, AZ, USA; 4Reason Magazine, Los Angeles, CA, USA; 5Creators Syndicate, Hermosa Beach, CA, USA; 6Research and Network Development, Boston PainCare, Waltham, MA, USA; 7Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA



According to the narrative underlying current policies aimed at reducing opioid-related deaths, the problem can be traced to a dramatic increase in opioid prescribing that began in the late 1990s. This trend supposedly was fueled by unscrupulous pharmaceutical company representatives who convinced practitioners that opioids posed a low risk of misuse and overdose (although a recent analysis1 suggests there were probably 30 or more root causes of the crisis). To illustrate this narrative, politicians and journalists have cited examples of patients who accidentally became “hooked” on opioids while taking them for pain, such as teenagers with orthopedic injuries who found the analgesics prescribed for them so alluring that they progressed to lives of drug abuse and addiction.2 This narrative drives policies targeting the prescription of opioids to patients in pain, with the goal of reducing the risk of addiction as well as the diversion of prescription opioids to the underground market. These policies include state prescription drug monitoring programs (PDMPs), abuse-deterrent formulations of prescription opioids, prescribing guidelines, and legal restrictions on prescribing for both acute and chronic pain.



